Hallux valgus is so common that in medical practice there are more than four hundred surgical solution options for this problem.Of course, not all interventions are equally successful and completely solve the patient's problem, therefore, in modern practice, the most progressive intervention options remain, in which the patient has a high chance of recovery.Today, hallux valgus surgery focuses on being as invasive as possible combined with good treatment effects from the intervention.
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Hallux valgus is not just an adult problem;it can also appear in children.The formation of a lump in the big toe in the early stages does not bother the patient until sharp pain when walking, problems with shoe selection and periodic osteomyelitis appear.At this stage, most patients try to relieve pain with traditional methods.Various methods of compresses and baths only prolong the course of the disease and lead to the only correct solution for deformity of the thumb - surgical intervention.
Indications for the operation are:
- increased pain in the big toe;
- chronic inflammation that cannot be stopped, constant swelling;
- skin lesions in the valgus area (cracks, pus, ulcers);
- plana valgus foot with severe curvature of the big toe joint;
- inability to help the patient using conservative methods;
- the appearance of a limp;
- Limited movement in the feet.
Doctors insist on treating thumb valgus with surgery alone, since most patients are treated at a stage of the disease when the pathology cannot be treated conservatively.At the same time, if left untreated, bunions will eventually lead to a redistribution of the load to the other toes, causing the second to fifth toes to become painful and crooked.Only with timely surgical intervention can such complications be avoided.
Prepare for intervention
During the surgical treatment of hallux valgus, serious orthopedic preparations are performed.The patient undergoes all necessary tests.The most important thing is a blood test, the results of this test are important to exclude signs of inflammatory processes in the body.
In some cases, the list of standard tests can be supplemented by determining hormone levels and signs of cancer if the doctor suspects the development of a malignant process in the foot.
A mandatory stage of orthopedic surgery is X-ray diagnosis - during the study, images are taken in two projections to determine the nature of the deformation and the severity of the pathological disorder.
In difficult cases, doctors may use magnetic resonance imaging or computed tomography.Such a study gives more accurate results.Based on the test results, the doctor decides which method is best to perform the surgery.
Classification of surgical intervention
All operations performed for valgus can be divided into two large groups - minimally invasive operations and reconstructive interventions.The first type of surgical intervention in the foot is characterized by low trauma.
Surgery is used to a limited extent - only in the initial stages of development of the disease, if the deformation is insignificant and there is a benign growth of cartilage tissue, which can be easily removed surgically.In all other cases, minimally invasive surgery did not solve the patient's problem.
Most minimally invasive interventions are performed quickly and without complications.Scarring after this surgery is minimal.The doctor makes two to three punctures for intervention, the length of the puncture does not exceed 0.5 cm.After these surgeries, the skin recovers very quickly and the disability period is up to two weeks.
When performing regenerative interventions, the degree of soft tissue damage will be more significant.However, a huge advantage of surgeries is that they help to eliminate even significant deformities of the legs and help treat severe curvatures.The incision during the reconstructive intervention is up to 4 cm long and is located on the inside of the foot.With this type of surgery, doctors will completely restore the anatomical position of the big toe.
You can also consider activities depending on where they are performed.There are three groups of interventions - on soft tissue, on bone tissue and combined surgery.When performing soft tissue interventions, valgus deformity can only be eliminated if the metatarsal head is not deformed.During such intervention, the doctor works only with soft tissues - tendons, muscles, bursae.
With surgical intervention on bone tissue, correction of second and third degree deformities is possible.Intervention includes grinding down a portion of the bone or performing an osteotomy.In a combined surgery, the intervention occurs in both soft tissue and bone.But the possibilities of such surgery are even wider - doctors can simultaneously remove bone growths and perform ligamentoplasty.
Operational engineering
Bunions can be removed using several surgical techniques, each of which has its own advantages and is chosen for certain indications.
MCBRIDE OPERATION
During the surgical intervention, according to McBride, an incision is made in the space between the first metatarsals at the level of the head.Using forceps, the doctor pushes the soft tissues apart and makes an incision into the intermetatarsal ligament, which lies on the surface.Then the surgeon reaches the tendon of the muscle responsible for abducting the first finger - it is mobilized and sutured with a special suture material - vicryl.
Next, the doctor manipulates the sesamoid bone;he passes through the deep ligament, which is attached to the sesamoid bone, thereby eliminating its subluxation.After that, the joint capsule of the ankle joint is dissected along the outer surface, then an incision is made on the inner surface of the foot, about 5-6 cm long, through which the nerve is separated and retracted to the side.
The capsule dissection is performed in an English V shape, with the apex pointing toward the thumb.Homan hooks are placed above and below the bone and remove cartilage growths on the metatarsal heads.If this is not done, the patient will experience joint pain in the future.
In the future, development of the operation may proceed in two ways, depending on the need for osteotomy.When cutting bones, it is necessary to use a pin to attach the tendon to the bone fragments.At the final stage, excess cystic tissue is removed, plastic surgery is performed with a certain tissue tension, after which the surgeon sutures the edges of the wound and processes its surface.
This technique was proposed more than eight decades ago, but to this day this operation has not lost its relevance.To prevent recurrence after intervention, patients should wear special orthopedic shoes after surgery.
SERIOUS METHOD
The surgical technique using the minimally invasive SERI technique was proposed in 1998 by surgeon Cesare Faldini.Currently it is also actively used in the surgical practice of doctors in many countries.This is a minimally traumatic procedure and is effective in the early stages of the development of the disease and with moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed 40 degrees.
AUTHORITY TO SETTLE!Operations are not performed due to severe arthritis.Patients may also be denied this type of intervention if the first metatarsophalangeal joint is unstable.
Foot surgery is performed under local anesthesia.The doctor makes an incision on the projection of the head of the big toe metatarsal, opens the joint capsule and performs an osteotomy with a special file or chisel.During this process, further load redistribution onto the distal part of the metatarsal can be achieved.
During surgery, doctors use Kirschner wires to create the correct position of the thumb - they are inserted into the inner surface of the surface in an oblique direction, then the doctor himself moves the finger and places it in the desired position.Operation during rehabilitation requires a plaster cast - it is applied for at least two weeks.The needle is removed after about 1-1.5 months.
CHEVRON METHOD
The Chevron technique is used for small deformations if the angle is less than 17 degrees.The main condition for such intervention is the absence of arthritis and other severe changes caused by valgus foot.
Surgical treatment is carried out as follows: at the initial stage, the doctor cuts the skin just above the metatarsal joint of the foot.The shortened connections and joint capsule are highlighted.Often, degenerative changes in the tissues and ligaments cause thumb deformity.Calluses on the joints are removed with a chisel or saw.
An incision is made on the metatarsal bone at the level of the head, it is translated laterally and placed under the sesamoid bone.The phalanx is then fixed with screws or wires and the capsule is closed.The titanium screw does not need to be removed after surgery, but the wire will be removed three months after surgery, unless it is necessary to do so sooner.
TOWEL METHOD
In most patients, the bunion can be removed with a Scarf osteotomy.This operation is performed for moderate valgus deformity of the big toe.Today, surgery is the most common treatment for valgus;It has many advantages over other methods.
The positive aspects of the operation are as follows:
- During the procedure, not only the metatarsal head can be shifted, but also rotated, which allows achieving a more progressive result compared to other surgical interventions;
- If the size is insufficient, the doctor may perform a bone lengthening procedure;
- With varus deformity, the bone may be displaced medially;
- To reduce the load on the inside of the foot and the big toe area, you can move the bones slightly downward and to the side;
- If necessary, you can shorten the length of the bone;
- When the joint pronates, the bony elements can rotate.
Surgery is performed under spinal anesthesia.The surgeon will make an incision on the inside of the foot from the tip of the toe to the tip of the metatarsal bone.Then a zigzag cut is made on the side of the first toe bone, after which the bone head is moved to the desired position, its angle changes.At the same time, the doctor also changed the position of the tendons attached to the thumb.
The deformed joint capsule is then separated from the outside and the bone is fixed to the required position with titanium screws.Normally the laces are not removed;If it does not cause discomfort, the patient continues to wear the screw.Rehabilitation after surgery takes three to six weeks.Immediately after the intervention, the patient should wear a special orthotic or brace, in which it is necessary to load the foot as soon as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
Hallux valgus can also be removed with a laser, but patients should not place high hopes on this surgical method.Although it is minimally invasive and gentle, it is used only in the early stages of the pathological process.
The undoubted advantage of surgical intervention is that a small incision is made by the doctor near the largest point of the protruding bone.After healing, such a wound is practically invisible, which allows maximum restoration of the aesthetics of the foot.Using lasers, doctors can perform limited interventions:
- carry out an exophyterectomy - using a laser, part of the cartilage growth formed at the early stages of valgus is removed;
- perform an osteotomy with a large incision - during surgery, the proximal part of the big toe will be removed;
- perform arthrectomy - the articular surfaces of the metatarsal bones and part of the phalanx of the big toe are removed.
Laser removal is usually performed in clinics with special equipment.Recovery after surgery is minimal - patients can walk normally after just a few weeks.
The only limitation of laser intervention is that it cannot correct the misalignment of the bone, only based on the necessary parameters.In this case, the patient is at risk of relapse.
joint disease
Surgical removal of bunions by arthroplasty is quite rarely used today, but sometimes it is the only way for patients to get rid of bunions.Surgery is one of the most radical intervention methods.
With the help of such surgery, it is possible to remove the base of the first toe and fix the toes together with special screws.
IMPORTANT! During surgery, the main goal is achieved - to eliminate deformation and return the joint to the correct position, however, not every patient feels comfortable after such an operation.
There are serious contraindications to intervention:
- vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- polyneuropathy.
With arthritis and osteoarthritis, patients may also be denied surgery if the joint is severely deformed, destroyed, or persistently inflamed.In this case, the patient will be advised to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: severe pain, discomfort due to the titanium fastening structures inserted into the bones, and limping.Rehabilitation after intervention lasts eight weeks.A cast is required only in the first days after surgery - this is necessary to immobilize the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that help reduce stress on the operated leg.
Evaluate
If a patient is undergoing surgery to remove valgus, he can read reviews and find out what types of interventions were performed and their effectiveness.Here are some similar comments:
"Last year I had to stop my career as a ballerina due to the hallux valgus deformity. We did it using the towel wrapping method, everything seemed fine but my legs still hurt when I exert myself."
"I had hallux valgus for a long time but didn't dare to have surgery. I had complicated arthritis. Recovery took more than two and a half months, but after surgery, everything became much easier. Now I can walk without a cane and no longer have pain."
"The bones in my feet are hereditary - my mother and grandmother also suffered from gout. I decided to have surgery as soon as the first signs appeared. The surgery was done with a laser, all the excess tumors were removed from me, now my feet look normal but the doctors told me to monitor for possible recurrence."
Surgeries for hallux valgus in most cases allow a person to solve the problem of bunions on the fingers.When the first signs of valgus appear, you should not delay treatment - the best results appear at the early stages of the disease's development.