Hallux valgus is so common that in medical practice there are more than four hundred options for surgical solutions to this problem.Of course, not all interventions have been equally successful and have not completely resolved the patient's problem.Therefore, in modern practice, the most progressive options for intervention remain, in which patients have great chances of recovery.Today, hallux valgus surgery aims to be as invasive as possible, combined with a good therapeutic effect of the intervention.
Indications
Hallux valgus is not just a problem for adults;it can also appear in children.The formation of a bump on the big toe at the initial stage does not bother patients until sharp pain appears when walking, problems with choosing shoes and periodic inflammation of the bone.At this stage, most patients attempt to relieve pain using traditional methods.Various compresses and baths only prolong the course of the disease and lead to the only correct solution to hallux valgus deformation: surgical intervention.
The indications for the operation are:
- increased pain in the big toe;
- chronic inflammation that cannot be stopped, constant swelling;
- skin lesions at the valgus curvature (cracks, suppuration, ulcers);
- valgus plane foot with severe curvature of the big toe joint;
- inability to help patients with conservative methods;
- the appearance of a lame gait;
- limitation of motor activity of the foot.
Doctors insist on treating thumb valgus exclusively surgically, since most patients are treated at a stage of the disease when it is not possible to correct the pathology conservatively.At the same time, if left untreated, bunions eventually lead to a redistribution of the load on the other toes, causing pain and curvature of the second to fifth toes.Only with timely surgical intervention can such complications be avoided.
Preparation for intervention
During surgery for hallux valgus, serious preparation is carried out in orthopedics.The patient undergoes all the necessary tests.The most important is a blood test, the results of which are important to exclude signs of an inflammatory process in the body.
In some cases, the standard list of tests can be supplemented by determining the level of hormones and cancer markers if doctors suspect the development of a malignant process in the foot.
An obligatory stage of orthopedic operations is X-ray diagnostics - during the study, images are taken in two projections to determine the nature of the deformation and the severity of pathological disorders.
In difficult cases, doctors may use magnetic resonance imaging or computed tomography.Such a study gives more precise results.Based on the test results, doctors decide which method is best to perform the operation.
Classification of surgical interventions
All operations performed for valgus can be divided into two large groups: minimally invasive operations and reconstructive interventions.The first type of surgical intervention on the foot is characterized by low trauma.
Surgical interventions are used to a limited extent - only at the initial stage of the development of the disease, if the deformation is insignificant and in the presence of benign growth of cartilage tissue, which can be easily removed by surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most minimally invasive procedures are performed quickly and do not cause complications.Scarring after this operation is minimal.The doctor makes two to three punctures for the procedure, the length of which does not exceed 0.5 cm.After these operations, the skin recovers very quickly and the period of disability can be up to two weeks.
During reconstructive procedures, the volume of soft tissue lesions is greater.However, the huge advantage of operations is that they help eliminate even significant leg deformities and correct severe curvatures.The incision during a reconstructive procedure reaches up to four centimeters and is located on the medial aspect of the foot.With this type of surgery, doctors completely restore the anatomical position of the big toe.
You can also consider operations based on the location in which they are carried out.There are three groups of interventions: on soft tissue, on bone tissue and combined surgery.When performing soft tissue procedures, valgus deformity can only be eliminated if there is no deformity of the metatarsal head.During such an intervention, the doctor works exclusively with soft tissues - tendons, muscles, bursae.
Through surgical intervention on the bone tissue, it is possible to correct second and third degree deformities.The procedure consists of filing down part of the bone or performing an osteotomy.In a combined operation, the procedure occurs on both soft tissue and bone.But the possibilities of such surgical intervention are wider: doctors can simultaneously remove a bone growth and perform ligament plastic surgery.
Operational techniques
Bunions can be removed using several surgical techniques, each of which has its own advantages and is selected for certain indications.
OPERATION MCBRIDE
In a McBride surgical procedure, an incision is made in the first intermetatarsal space just at the level of the heads.Using forceps, the doctor spreads the soft tissues and makes an incision in the intermetatarsal ligament, located on the surface.After that, the surgeon gains access to the tendon of the muscle responsible for the abduction of the first finger - it is mobilized and sewn with a special suture material - vicryl.
Next, the doctor works with the sesamoid bones;it passes through the deep ligament, which is attached to the sesamoid bone, thereby eliminating its subluxation.Next, the capsule of the metatarsophalangeal joint is dissected along the outer surface, after which an incision is made on the inner surface of the foot, approximately 5-6 cm long, through which the nerve is isolated and retracted to the side.
Dissection of the capsule is carried out in the shape of the English letter V, with its apex directed towards the thumb.Homan's hooks are placed above and below the bone, and the cartilaginous growths on the head of the metatarsal bone are removed.If this is not done, patients will experience joint pain in the future.
In the future, the development of the operation can take place in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a pin that will attach the tendon to the bone fragments.At the final stage, excess capsule 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 date the operation has not lost its relevance.To avoid relapses after the procedure, patients are recommended to wear special orthopedic shoes after the operation.
SERIAL METHOD
The surgical technique using the minimally invasive SERI technique was proposed in 1998 by surgeon Cesare Faldini.Today it is also actively used in the surgical practice of doctors in many countries.This is a minimally traumatic and effective procedure at the initial stage of development of the disease and in cases of moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed more than forty degrees.
REFERENCE!The operation was not performed due to severe osteoarthritis.Patients may also be refused this type of procedure if the first metatarsophalangeal joint is unstable.
Foot surgery is performed under local anesthesia.The doctor makes an incision in the projection of the head of the metatarsal bone of the big toe, opens the joint capsule and performs an osteotomy with a special file or chisel.During this procedure, it is possible to further distribute the load on the distal part of the metatarsal bone.
During the surgical procedure, doctors use Kirschner wires to create the correct position of the thumb - they are inserted into the medial side of the surface in an oblique direction, after which the doctor manually moves the finger and places it in the desired position.The operation during the rehabilitation process requires wearing a cast - it is applied for at least two weeks.The needle is removed after approximately 1-1.5 months.
CHEVRON METHOD
The Chevron technique is used for minor deformations if the angle is less than 17 degrees.The main condition for such an intervention is the absence of osteoarthritis and other serious changes caused by valgus of the foot.
Surgical treatment is carried out as follows: at the initial stage, the doctor makes an incision in the skin just above the metatarsophalangeal joint of the foot.The shortened connections and the joint capsule itself are highlighted.Typically, degenerative changes in tissues and ligaments cause thumb deformity.Calluses on the joint are removed using a chisel or saw.
An incision is made on the metatarsal bone at the level of the head, it is shifted outwards and placed under the sesamoid bone.The phalanx is then fixed using screws or wires and the capsule is closed.Titanium screws do not require removal after surgery, but wires are removed three months after surgery unless needed sooner.
SCARF METHOD
In most patients, the bunion can be removed using a Scar osteotomy.This operation is carried out in cases of moderate valgus of the first toe.Today, surgery is the most universal method of treating valgus;it has many advantages over other methods.
The positive aspects of the operation are as follows:
- during the procedure, it is possible not only to move, but also to rotate the head of the metatarsal bone, which allows you to achieve a more gradual result than with other surgical interventions;
- If the size is insufficient, the doctor can perform bone lengthening;
- in case of varus deformity, the bone can be displaced to the medial side;
- to reduce the load on the inside of the foot and in the area of the first toe, you can slightly move the bone down and to the side;
- if necessary, you can shorten the length of the bone;
- When the joint is pronated, the bony elements can rotate.
The surgical procedure is performed under spinal anesthesia.The surgeon makes an incision on the inside of the foot, from the beginning of the toe to the beginning of the metatarsal bone.After that, a zigzag cut is made on the side of the bone of the first toe, after which the head of the bone is moved to the desired position, its angle changes.At the same time, the doctor also changes the location of the tendons attached to the thumb.
Then the deformed joint capsule is separated from the outside and the bones are fixed in the desired position using titanium screws.Usually, the bindings are not removed;if they cause no discomfort, patients continue to wear screws.Rehabilitation after surgery takes three to six weeks.Immediately after the procedure, patients are recommended to wear a special orthosis or splint in which it is necessary to load the foot as soon as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
Laser removal of hallux valgus is also possible, but patients should not place high hopes on this surgical method.Although it is minimally invasive and the most gentle, it is used exclusively at the early stage of the development of the pathological process.
The undoubted advantage of the surgical intervention is the small incision that doctors make near the most important point of the bone protrusion.After healing, such an injury is practically invisible, which allows maximum restoration of the aesthetics of the foot.Using a laser, doctors are able to perform limited procedures:
- perform exostectomy - with the help of a laser, part of the cartilaginous growth that forms in the early stage of valgus is removed;
- make an osteotomy with a large incision - during surgery, the proximal phalanx of the first toe is removed;
- perform resection arthroplasty - the articular surfaces of the metatarsal bone and part of the phalanx of the big toe are removed.
Laser removal is usually carried out in clinics with special equipment.Recovery after surgery is minimal: patients can walk normally after just a few weeks.
The only disadvantage of laser intervention is that the incorrect position of the bone cannot be corrected, but it is only rectified according to the required parameters.In this case, patients are at risk of relapse.
ARTHRODESIS
Surgery to remove valgus by arthrodesis is used quite rarely today, but sometimes it is the only way for patients to get rid of valgus of the big toe.Surgery is one of the most radical methods of intervention.
With the help of such a surgical intervention, it is possible to remove the base of the phalanx of the first toe and fix the toes with special screws.
IMPORTANT! During the operation, the main goal is achieved - to eliminate deformation and give the joint the correct position.However, not all patients feel comfortable after such an operation.
There are serious contraindications to the procedure:
- vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- polyneuropathy.
In cases of arthritis and osteoarthritis, patients may also be refused surgery if the joints are severely deformed, destroyed, or constantly inflamed.In this case, patients will be advised to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: intense pain, discomfort due to the titanium fixation structures installed in the bone and lameness.Rehabilitation after the operation lasts eight weeks.It is necessary to walk in a cast only in the first days after surgery - this is necessary to fix the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that will relieve stress on the operated leg.
Notice
If a patient undergoes surgery to eliminate valgus, he can read reviews and find out what types of interventions are performed and how effective they are.Here are some similar reviews:
"Last year I had to end my career as a ballerina due to a hallux valgus deformity. We did it with the scarf method, everything seemed to be going well, but the leg still hurts with exercise."
"I have suffered from hallux valgus for a long time, but I did not dare to have an operation. I had a complex arthrodesis, the healing took more than two and a half months, but after the operation it became much easier. Now I can walk without a cane and I no longer have pain."
"My foot bone is hereditary. My mother and grandmother also suffered from gout. I decided to have an operation as soon as the first signs appeared. The operation was carried out using a laser, all excess growths were removed from me, now my leg looks normal, but the doctors told me to watch for possible relapses."
Surgical interventions for hallux valgus in most cases allow a person to solve the problem of a bunion on the finger.When the first signs of valgus appear, you should not delay treatment - the best results appear at an early stage of the development of the disease.