Valgus deformation of the thumb of the foot is so common that in medical practice you can count more than four hundred options for the operational solution to this problem.Of course, not all interventions were the same success and completely solved the problem with patients, so in modern practice the most progressive intervention options remained, with the chances of patients recovering.Today, the surgery of Khalus Valgus focuses on as much as possible invasiveness in combination with a good therapeutic effect of the intervention.
Testification
Khalus valgus is not only a problem for adults, it can also occur in children.The formation of a cone on the leg of the thumb at the initial stage does not disturb patients, while when walking acute pain, problems with the selection of shoes, periodic inflammation of the bone occurs.At this stage, most patients try to relieve the pain of folk methods.Various compresses and baths only tighten the course of the disease and lead to the only true solution to Valgus deformity - surgery.
The operations for the operation are:
- increased pain in the thumb of the foot;
- chronic inflammation that cannot be stopped, constant swelling;
- damage to the skin in the curvature of valgus (cracks, supplies, ulcers);
- Valgus Plan with a pronounced curvature of the thumb joint;
- the inability to help patients with conservative methods;
- The appearance of a lame gait;
- Restricting motor activity in the foot.
Doctors insist on the treatment of valgus thumbs extremely surgically, as most patients turn to the stage of the disease when it is not possible to correct the pathology conservatively.At the same time, if you do not start treating the bone of the legs, it will eventually lead to a redistribution of the load of other toes, which is why the fingers will suffer and bend from the second to the fifth.Only with timely surgery can such complications be avoided.
Preparing for intervention
During the Valgus deformation operation of the thumb joint, serious preparation is performed in the orthopedics.The patient performs all the necessary tests.The key to them is a blood test, according to the results that are important to exclude the signs of the inflammatory process in the body.
In some cases, the standard list of analyzes can be supplemented by determining the level of hormones and markers for oncology if doctors suspect the development of a malignant process in the foot.
A mandatory stage in orthopedic surgery is the diagnosis of X -ray - during the study the photos are made in two projections to determine the nature of the deformity and the severity of pathological disorders.
In difficult cases, doctors may resort to magnetic resonance imaging or computed tomography.Such a study gives more accurate results.According to the analyzes, doctors decide how it will be best to perform the operation.
Classification of Surgical Interventions
All operations performed by Valgus can be divided into two large groups - invasive surgery and reconstructive interventions.The first type of foot surgery is characterized by low trauma.
Operations are used limited - only in the initial stage of the development of the disease, if the deformity is insignificant and in the presence of benign cartilage growth, which is easily eliminated by surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most of the minimally invasive interventions are done quickly and do not cause complications.The scars after such an operation are minimal.The doctor makes two to three punctures, the length of which does not exceed 0.5 cm.After these operations, the skin recovers very quickly and the period of incapacity for work is up to two weeks.
During the reconstructive interventions, the volume of soft tissue damage is more significant.A huge plus surgery, however, is that they help to eliminate even significant deformation of the feet and help with severe curvature.The incision in the reconstructive intervention reaches four centimeters, it is located on the medial side of the foot.With such surgery, doctors completely restore the anatomical position of the thumb of the foot.
You can also look at the operations depending on the location that has been performed.Three groups of interventions are distinguished - on soft tissues, on bone tissue and combination surgery.When conducting interventions on soft tissues, it is possible to eliminate the deformation of valgus only if there is no deformation of the head of the plus bone.In the course of such intervention, the doctor works exclusively with soft tissues - tendons, muscles, channels.
With surgery on bone tissue, it is possible to adjust the deformation of the second and third degrees.The intervention is to pass some of the bone or to have an osteotomy.With a combined operation, the intervention is performed in both soft tissues and bone.But the capabilities of such surgery are wider - doctors can simultaneously eliminate bone growth and make connections.
Operational techniques
Several operational techniques can be eliminated on the legs, each of which has its own advantages and is selected with certain indications.
Operation McBride
With surgery, McBraid is performed in the first interval of interface exactly at the level of the heads.Using brackets, the doctor spreads soft tissues and cuts the interfluena ligament, which is located on the surface.The surgeon then gains access to the tendon of the muscle, which is responsible for the distribution of the first finger - it is mobilized and sewn from special seam material - vicril.
In addition, the doctor works with bones formed by Sesame, it crosses a deep package that is attached to the bone formed by Sesame, which is eliminated by its subluxation.The plusnephalanx capsule is then dissected on the outer surface, after which the incision is carried out on the inner surface of the foot about 5-6 cm long, the nerve is separated through it and deviated sideways.
The dissection of the capsule is made in the form of the English letter V, and its peak is directed to the thumb.Above the bone and below it, the hooks of the domestic person are removed underneath, removing the growth of cartilage on the head of the metatarsal bone.If this is not done, patients will experience joint pain in the future.
In the future, the development of the operation can be done in two ways, depending on the need for osteotomy.In osteotomy, there is a need to use a speaker to attach the tendon to the bone fragments.In the last stage, the excess tissue of the capsules is removed, plastic is performed with a certain tension of the tissues, after which the surgeon sews the edges of the wound and treats its surface.
Such a technique was offered more than eight decades ago, but to this day the operation has not lost its relevance.So after the intervention there is no relapse, after surgery, patients are advised to wear special orthopedic shoes.
Seri technique
The operational technique for the minimum invasive technique of SERI was proposed in 1998 by surgeon Cezare Faldini.It is now actively used in the surgical practice of doctors in many countries.It refers to low -traumatic procedures and is effective in the initial stage of the development of the disease and with a moderate curvature of the valgus of the foot when the angle of deviation of the thumb of the foot does not exceed more than forty degrees.
Reference!The surgery is not performed due to severe arthrosis.Also, patients may refuse this type of intervention with the instability of the first metatarsophalangeal joint.
The surgery of the foot is performed under local anesthesia.The doctor cuts in the projection of the head of the plus the bone of the thumb, opens the joint capsule, conducts an osteotomy with a special file or chisel.In the process of such a procedure, you can achieve a more redistribution of the load on the distal part of the plus bone.
In the process of surgery, doctors use the knitting needle to create the correct position of the thumb - they begin in the medial side of the surface in the direction of spitting, after which the doctor carries a finger in manual mode and puts it in the right position.The operation in the rehabilitation process requires wearing a plaster bandage - it is applied for at least two weeks.The spoke is removed after about 1-1.5 months.
Chevron technique
Shevron technique is used for minor deformation if the angle is smaller than 17 degrees.The main condition for the application of such intervention is the lack of arthrosis and other serious changes that provoke the valgus of the foot.
Surgical treatment is performed as follows - at the initial stage the doctor cuts the skin just above the release - change of the foot of the foot.The short connections and the joint capsule itself differ.Usually, degenerative changes in tissues and connections cause deformation of the thumb.The bone corn on the joint is removed with the help of a chisel or file.
The bone of the metatarsal part is cut at the level of the head, it is shifted from the outside and is installed under the sesamoid bone.Then, with the help of screws or wire, the phalanx is attached and the capsule closes.After surgery, the titanium screws do not require removal, but they eliminate the wire three months after surgery, if it is not necessary to do this earlier.
Scarf
In most patients, you can remove the leg bone using a scarf osteotomy.Such surgery is performed with moderate deformation of valgus on the first toe of the foot.To date, surgery is the most universal method of treating Valgus, there are many advantages over other methods.
The positive aspects of the operation are as follows:
- In the process, it is possible not only to displace, but also to turn the head of the plus bone, which allows you to achieve a more progressive result than with other surgical interventions;
- The doctor may with insufficient value to perform the extension procedure;
- With variant deformity, you can displace the bone in the medial side;
- To reduce the load in the inside of the foot and area of the first finger, you can move the bone slightly down and from the side;
- If necessary, you can shorten the length of the bone;
- When the joint is pronounced, the bone elements can rotate.
Surgical intervention is performed in spinal anesthesia.The surgeon on the inside of the foot makes a cut from the beginning of the finger to the beginning of the bone of the metatarsal bone.Then a zigzag cut is made on the bones of the first finger, after which the bone head is moved to the desired position, its angle changes.At the same time, the doctor changes the location of the tendons that are attached to the thumb.
The deformed capsule is then separated from the outside and the bones are fixed in the required position using titanium screws.Usually the fasteners are not removed if they do not bring discomfort, then patients and then go with screws.Rehabilitation after surgery takes three to six weeks.Immediately after the intervention, patients are advised to wear a special orthosis or rubber in which it is necessary to load the foot as early as possible.The tire rushes all the time until the recovery period passes.
Laser intervention
Removal of Valgus deformation with laser is also possible, but patients should not hope greatly for such a method of surgery.Although it is minimal and tender, it is used exclusively in the early stage of the development of the pathological process.
An undeniable advantage of surgery is a small incision that doctors make close to the largest point in the bone sill.After healing, such an injury is not practically noticed, allowing you to restore the aesthetics of the foot as much as possible.By using a laser, doctors have the ability to conduct limited intervention:
- It is performed existing - with the help of a laser, some of the cartilage growth is removed, which is formed in the early stage of Valgus;
- Make an osteotomy with a large incision - in the process of surgery, the proximal phalanx of the first finger is removed;
- Perform arthroplasty for resection - the joint surfaces of the plus bone and part of the phalanx of the thumb are removed.
Laser removal is usually done in clinics where there is special equipment.Recovery after surgery is minimal - after a few weeks, patients can walk normally.
The only downside to laser intervention is that the incorrect bone position is not subject to correction and it grows only under the desired parameters.In this case, patients are at risk of recurrence.
Arthrodesis
Valgus removal surgery through arthrodesis is used quite rarely, but sometimes it is the only way for patients to get rid of the big toe.The operation belongs to the most radical methods of intervention.
With the help of such surgery, it is possible to remove the base of the phalanx of the first toe of the foot and to fix the toes with special screws.
Important! During the operation, the main goal is achieved - eliminating deformation and giving the joint the correct position, but not all patients become comfortable after such surgery.
There are serious contraindications to intervention:
- vascular atherosclerosis and other bloodshed;
- Diabetic leg;
- Polyneuropathy.
With arthritis and arthrosis, patients can also refuse surgery if the joints are very deformed, destroyed, constantly inflamed.In this case, patients will advise minimally invasive surgery.
Among the complications of surgery, the following pathologies, discomfort due to structures for attachment of titanium installed in the bone may occur.Rehabilitation after the intervention lasts eight weeks.Walking in gypsum is only necessary in the first days after surgery - this is necessary to fix the elements.You can use the baroque trunk.This is specially designed orthopedic shoes that will remove the load from the working foot.
Examinations
If the patient has surgery to eliminate Valgus, he or she can read reviews and understand what types of intervention are performed and how effective they are.Here are some similar opinions:
"Last year, I had to finish the ballerina's career due to the deformation of Valgus on the finger. They made a scarf according to the method, it seemed that everything was going well, but the leg is still hurting the load."
"I have been suffering for a long time, but I didn't dare to go to the surgery. I did a complex arthrodesis, the restoration took more than two and a half months, but after the surgery it was much easier. Now I can walk without a stick and not torture pain."
"My leg is hereditary - even my mother and grandmother suffered from gout. I decided to do the surgery as soon as the first signs appear. The operation used a laser, all the additional outgrowths were removed, now the leg has a normal appearance, but the doctors said they were following possible relapses."
Valgus deformation operations in most cases allow a person to solve the problem of the bone of their finger.When the first signs of Valgus appear, do not delay treatment - the best results appear in the early stage of the disease.