Valgus deformation of the foot thumb is so common that, in medical practice, you can count more than four hundred options for the operational solution of this problem.Obviously, not all interventions were the same success and completely solved the patient's problem;Therefore, in modern practice, the most progressive options for intervention were left, in which the chances of patient recovery are high.Today, Operation Khalus Valgus is focused on the lowest possible invasion in combination with a good therapeutic effect of intervention.
Nominations
Khalus Valgus is a problem not only for adults, but it can also appear in children.The formation of a cone in the thumb leg in the early stage does not disturb patients until sharp pain appears when walking, problems with shoe selection, periodic bone inflammation.At this stage, most patients are trying to relieve pain with folkloric methods.Several compresses and baths just tighten the course of the disease and lead to the only true solution of deformation by Valgus - surgical intervention.
The indications for the operation are:
- Increased pain in the thumb of the foot;
- chronic inflammation, which cannot be interrupted, constant swelling;
- Skin damage to Valgus curvature (cracks, suppression, ulcers);
- Flat Papo Valgus with a pronounced curvature of the thumb joint;
- the inability to help patients with conservative methods;
- the appearance of a thigh gear;
- Limiting motor activity in the foot.
Doctors insist on the treatment of valgus, the thumbs exclusively surgically, as most patients turn into the disease stage when the pathology cannot be correct in a conservative way.At the same time, if you do not start treatment of bone in the legs, it will lead to the redistribution of the load on other fingers, which is why the fingers will suffer and bend from the second to fifth.Only with timely surgical intervention can it be avoided.
Preparation for intervention
During the operation for the deformation of Valgus from the foot thumb joint, serious preparation is performed in orthopedics.The patient performs all the necessary tests.Their key is a blood test, according to the results from which it is important to exclude signals from the inflammatory process in the body.
In some cases, the standard analysis list can be complemented by determining the level of hormones and markers for oncology if doctors suspect the development of an evil process in the foot.
A mandatory stage in orthopedic operations is a diagnosis of radius -x - during the study, the images are taken into two projections to determine the nature of deformation and the severity of pathological disorders.
In difficult cases, doctors can resort to magnetic resonance imaging or computed tomography.This study provides more accurate results.According to the analysis, doctors decide how it will be better to perform the operation.
Classification of surgical interventions
All operations performed by Valgus can be divided into two large groups - an invasive operation and reconstructive interventions.The first type of surgical intervention in the foot is characterized underneath trauma.
Operations are used limited - only at the early stage of disease development, if deformation is insignificant and in the presence of benign cartilage growth, which is easily removed through surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most minimally invasive interventions are performed rapidly and do not cause complications.Scars after such operation are minimal.The doctor does two to three punctures, whose duration does not exceed 0.5 cm.After these operations, the skin is restored very quickly and the period of disability for work is up to two weeks.
During reconstructive interventions, the volume of damage to soft tissues is more significant.However, a huge advantage of operations is that they help remove up to significant leg deformation and help with severe curvature.The incision in the reconstructive intervention reaches up to four centimeters, is located on the medial side of the foot.With this surgery, doctors completely restore the anatomical position of the thumb of the foot.
You may also consider operations, depending on where they are performed.Three groups of interventions are distinguished - in soft tissues, bone tissue and combined surgery.When performing soft tissue interventions, it is possible to eliminate valgus deformation only if there is no deformation of the positive bone head.During such an intervention, the doctor works exclusively with soft tissues - tendons, muscles, edge.
With surgical intervention in bone tissue, it is possible to correct the deformation of the second and third degree.The intervention is to record a part of the bone or perform the osteotomy.With a combined operation, the intervention occurs in both soft tissues and bone.But the possibilities of this surgery are broader - doctors can simultaneously remove bone growth and make ligaments.
Operational techniques
Several operational techniques can be eliminated on the legs, each with its own advantages and is selected with certain indications.
Operation McBride
With surgical intervention, McBraid is performed in the first interval between flood, only at the head level.Using staples, the doctor spreads soft fabrics and cuts the ligament between flood, located on the surface.After that, the surgeon gains access to the muscle tendon, responsible for allocating the first finger - is mobilized and sewn by special suture material - Vikril.
In addition, the doctor works with Sesam -shaped bones, it crosses a deep package that is attached to the Sesam -shaped bone, which is eliminated by its subluxation.Then the Plusnephalanx joint capsule is dissected on the outer surface, after which the incision is made on the inner surface of the foot of about 5-6 cm long, the nerve is released through it and is diverted to the side.
The dissection of the capsule is made in the form of the letter in English V, and its peak is directed to the thumb.From above the bone and below it, The Homeman's hooks are removed under it, the growth of the cartilage in the head of the metatarsal bone are removed.If this is not done, patients in the future will feel pain in the joint.
In the future, the development of the operation can occur in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a radius that attaches the tendon to bone fragments.In the final phase, excess capsule tissue is removed, plastic with a certain tension of the tissues is performed, after which the surgeon sews the edges of the wound and processes its surface.
This technique was proposed over eight decades, but to this day the operation has not lost its relevance.So that, after the intervention, there is no relapse, after surgery, patients are recommended to wear special orthopedic shoes.
Seri Technique
The operational technique for the minimally invasive technique of Seri was proposed in 1998 by surgeon Cesare Faldini.It is now actively used in the surgical practice of doctors in many countries.It refers to low -traumatic procedures and is effective at the early stage of disease development and with a moderate curvature of Valgus of the foot, when the footage of the thumb of the foot does not exceed more than forty degrees.
REFERENCE!The operation is not performed due to severe arthrosis.In addition, patients can refuse this type of intervention with the instability of the first metatarsophangic joint.
The foot operation is performed under local anesthesia.The doctor makes an incision in the projection of the positive bone head of the thumb, opens the joint capsule, conducts osteotomy with a special file or chisel.In the process of such a procedure you can obtain additional load redistribution at the distal part of the positive bone.
In the surgery process, doctors use Kirshner's knitting needle to create the correct position of the thumb - they start on the medial side of the surface towards the skewer, after which the doctor brings a finger in manual mode and defines it in the correct position.The operation in the rehabilitation process requires the use of a plaster bandage - is applied for at least two weeks.Radius removal is performed after about 1-1.5 months.
Chevron technique
The Chevron technique is used for small deformations if the angle is less than 17 degrees.The main condition for the implementation of such an intervention is the lack of arthrosis and other serious changes that Valgo de Foot causes.
Operational treatment is performed as follows - in the early stages, the doctor cuts the skin just above the drag joint of the foot.The reduced connections and the joint capsule itself are distinguished.Generally, degenerative changes in tissues and ligaments cause thumb deformation.Bone corn at the joint is removed using a chisel or file.
In the metatarsal bone, an incision is performed at the head level, it changes outside and is installed under the sesamoid bone.So, with the help of screws or wires, the phalanx is attached and the capsule closes.After the operation, titanium screws do not require removal but eliminate the wire three months after surgery if there is no need to do it earlier.
Scarf technique
In most patients, you can remove the bone in the leg using handkerchief.This operation is performed with moderate deformation of Valgus from the first toe.To date, operation is the most universal method of treatment in Valgus, has many advantages compared to other methods.
The positive aspects of the operation are as follows:
- In the process, it is possible not only to change, but also turn the head of the positive bone, which allows you to obtain a more progressive result than with other surgical interventions;
- The doctor can with insufficient value perform the stretching procedure;
- With the deformation variation, you can change the bone on the medial side;
- To reduce the load on the inside of the foot and the first area of the finger, you can move the bone a little downward and to the side;
- If necessary, you can reduce bone length;
- In pronouncing the board, the bone elements can be rotated.
Surgical intervention is performed under spine anesthesia.The surgeon inside the foot makes a cut from the beginning of the finger to the beginning of the metatarsal bone.After that, a zig -shaped incision is made on the side of the first finger bones, 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, which are stuck in the thumb.
Then a deformed joint capsule is separated from the outside and the bones are fixed to the necessary position using titanium screws.Normally, fasteners are not removed if they do not cause any discomfort, the patients and then follow the screws.Rehabilitation after the operation takes three to six weeks.Immediately after intervention, patients are recommended to use a special orthosis or tire, in which it is necessary to carry the foot as soon as possible.The tire runs all the time while the recovery period passes.
Laser intervention
Valgo deformation removal with a laser is also possible, however, patients should not be highly hope for this method of surgery.Although it is minimal and smoother, it is used exclusively at the early stage of the development of the pathological process.
An undisputed advantage of surgical intervention is a small incision of size, which doctors make near the largest point on the edge of the bone.After healing, this injury is hardly noticeable, which allows to restore foot aesthetics as much as possible.With the use of a laser, doctors have the opportunity to perform limited intervention:
- The exists is performed - with the help of a laser, part of cartilaginous growth is removed, formed at the early stage of Valgus;
- Do the osteotomy with a large cut - in the surgery process, the proximal phalanx of the first finger is removed;
- Perform resection arthroplasty - the joint surfaces of the bone and part of the thumb phalanx are removed.
Laser removal is usually performed in clinics where there are special equipment.Recovery after surgery is minimal - within a few weeks, patients can walk normally.
The only disadvantage of laser intervention is that the incorrect position of the bone is not subject to correction and only grows in the desired parameters.In this case, patients are threatened with relapses.
Arthrodesis
The operation to remove the valgus by arthrodesis is rarely used, but sometimes this is the only way for patients to get rid of the big toe.The operation belongs to the most radical intervention methods.
With the help of this surgery, it is possible to remove the base of the phalanx from the first finger and fix the fingers with special screws.
IMPORTANT! During the operation, the main objective is achieved - eliminating deformation and giving the joint the correct position, but not all patients become comfortable after this surgery.
There are serious against intervention -indications:
- vascular atherosclerosis and other circulatory disorders;
- Diabetic foot;
- Polyneuropathy.
With arthritis and arthrosis, patients can also refuse surgery if joints are very deformed, destroyed and constantly inflamed.In this case, patients will advise minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur with pain, discomfort due to titanium fixation structures installed in the bone.Rehabilitation after intervention lasts eight weeks.Walking in the plaster is necessary only in the early days after surgery - it is necessary to fix the elements.You can use a baroka boot.This is a specially designed orthopedic shoe that will remove the load from the operated leg.
Revisions
If the patient has an operation to eliminate Valgus, he can read criticism and find out what types of intervention are performed and how effective they are.Here are some similar opinions:
"Last year I had to finish the dancer's career due to the deformation of Valgus from the finger. They made a handkerchief according to the method, it seems that everything went well, but the leg still hurts with the load."
"I've been suffering for a long time, but I didn't dare go to the operation. I was a complex arthrodesis, the restoration took more than two and a half months, but after the operation it was much easier. Now I can walk without a stick and not torment the pain."
"The bone on my leg is hereditary - even my mother and grandmother suffered from drop. I decided to do the operation as soon as the first signs appear. The operation was using a laser, all extra growths were removed for me, now the leg has a normal look, but doctors said they follow possible relapses."
In most cases, Valgus deformation operations allow a person to solve the bone problem on the finger.When the first signs of valgus appear, do not postpone treatment - the best results appear in the early stage of disease development.