The 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 of this problem.Of course, not all interventions were the same success and completely solved the problem of patients, so in modern practice the most progressive options for the intervention remained, in which the possibilities of recovery of patients are high.Today, the Khalus Valgus operation focuses on an invasiveness as low as possible in combination with a good therapeutic effect of the intervention.
Indication
Khalus Valgus is a problem not only for adults, but can also appear in children.The formation of a cone in the thumb leg in the initial stage does not disturb patients until acute pain appears when walking, problems with the selection of shoes, the periodic inflammation of the bone.At this stage, most patients are trying to relieve pain with popular methods.Several compresses and bathrooms only press the course of the disease and lead to the only true valgo deformation solution: surgical intervention.
The indications for the operation are:
- greater pain in the thumb of the foot;
- Chronic inflammation, which cannot be stopped, constant swelling;
- damage to the skin in the curvature of the valgo (cracks, suppuration, ulcers);
- Flat valge with a pronounced curvature of the thumb joint;
- the inability to help patients with conservative methods;
- the appearance of a lag march;
- Limit motor activity in the foot.
Doctors insist on the treatment of the valge in the exclusively surgical thumbs, since most patients revolve in the disease stage when it is not possible to correct the pathology conservatively.At the same time, if the bone treatment does not begin in the legs, it will finally lead to the redistribution of the load in other fingers, so the fingers will suffer and be folded from the second to the fifth.Only with timely surgical intervention can such complications be avoided.
Preparation for intervention
During the operation for the deformation of the lodge of the thumb of the foot, a serious preparation in the orthopedics is carried out.The patient performs all the necessary tests.Their key is a blood analysis, according to the results of which it is important to exclude the signs of the inflammatory process in the body.
In some cases, the standard analysis list can be complemented by determining the level of hormones and oncology markers if doctors suspect the development of an evil process in the foot.
A mandatory stage in orthopedic operations is a diagnosis of X -ray: During the study, images are taken in two projections to determine the nature of the deformation and severity of pathological disorders.
In difficult cases, doctors can resort to magnetic resonance or computerized tomography.Such study offers more precise results.According to the analysis, doctors decide how it will be better to perform the operation.
Classification of surgical interventions
All operations carried out by Valgus can be divided into two large groups: an invasive operation and reconstructive interventions.The first type of surgical interventions in the foot is characterized by low trauma.
The operations are used, only in the initial stage of the development of the disease, if the deformation is insignificant and in the presence of a benign growth of the cartilage, which is easily eliminated through surgery.In all other cases, minimally invasive operations do not solve patient problems.
Most minimally invasive interventions are performed quickly and do not cause complications.The scars after this operation are minimal.The doctor makes two to three punctures, whose length does not exceed 0.5 cm.After these operations, the skin is restored very quickly, and the period of inability to work is up to two weeks.
During reconstructive interventions, the volume of damage to soft tissues is more significant.However, a great advantage of operations is that they help eliminate even a significant deformation of the legs and help with a severe curvature.The incision in the reconstructive intervention reaches up to four centimeters, is located on the medial side of the foot.With such surgery, doctors completely restore the anatomical position of the thumb of the foot.
It can also consider operations depending on the location that are made.Three interventions groups are distinguished: in soft tissues, in bone tissue and combined surgery.When performing interventions in soft fabrics, it is possible to eliminate the deformation of the valgo only if there is no deformation of the bone heads more.In the course of this intervention, the doctor works exclusively with soft tissues: tendons, muscles, warehouses.
With the surgical intervention in the bone tissue, it is possible to correct the deformation of the second and third degree.The intervention is to present a part of the bone or drive osteotomy.With a combined operation, the intervention occurs both in soft and bone fabrics.But the possibilities of such surgery are broader: doctors can simultaneously eliminate bone growth and make ligaments.
Operational techniques
Various leg techniques can be eliminated, each of which has its own advantages and selected with certain indications.
McBride operation
With the surgical intervention, McBraid is carried out in the first interval between itself at the level of the heads.Using clamps, the doctor extends soft fabrics and makes a ligament cut between itself, which is on the surface.After that, the surgeon obtains access to the muscle tendon, which is responsible for the allocation of the first finger: it is mobilized and sewn by a special suture material: Vikril.
In addition, the doctor works with Sesam -shaped bones, crosses a deep package that is attached to the Sesam -shaped bone, which is eliminated by its subluxation.Then, the mostnephalanx joint capsule is dissected on the external surface, after which the incision is made on the internal surface of the foot of approximately 5-6 cm long, the nerve is released through it and deviates to the side.
The dissection of the capsule is performed in the form of the English letter, and its peak is directed towards the thumb.From above on the bone and under it, the homemanán hooks are removed below, cartilage growths are removed in the head of the metatarsal bone.If this is not done, patients in the future will experience articulation pain.
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 radius that will link the tendon to the bone fragments.In the final stage, excess tissue of the capsules is eliminated, plastic is carried out with a certain tension of the tissues, after which the surgeon sews the edges of the wound and processes its surface.
Such a technique was proposed more than eight decades ago, but until today the operation has not lost its relevance.So after the intervention there is no relapse, after surgery, patients who wear special orthopedic shoes are recommended.
Seri technique
The operational technique for the minimally invasive technique of Seri was proposed in 1998 by the surgeon Cesare Faldini.Now it is also actively used in the surgical practice of doctors from 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 Valgo del Pie, when the angle of deviation from the thumb of the foot does not exceed more than forty degrees.
REFERENCE!The operation is not carried out due to severe osteoarthritis.In addition, patients can reject this type of intervention with the instability of the first metatarsophalangeal joint.
The operation on the foot is carried out under local anesthesia.The doctor makes an incision in the projection of the bone head of the thumb, opens the joint capsule, performs osteotomy with a special file or chisel.In the process of this procedure, you can achieve a greater redistribution of the load in the distal part of the bone more.
In the surgery process, doctors use Kirshner's fabric needle to create the correct position of the thumb: they begin on the medial side of the surface in the ASA direction, after which the doctor brings a finger in manual mode and places it in the right position.The operation in the rehabilitation process requires the use of a dressing for the plaster: it is applied for at least two weeks.The removal of the radius is carried out after approximately 1-1.5 months.
Chevron technique
The Chevron technique is used for minor deformations if the angle is less than 17 degrees.The main condition for the implementation of this intervention is the lack of osteoarthritis and other serious changes that the feet of the foot causes.
The operational treatment is carried out as follows: in the initial stage, the doctor cuts the skin just above the foot plating joint.The shortened connections and the Board capsule are distinguished.In general, degenerative changes in tissues and ligaments cause thumb deformation.Bone corn on the joint is removed using a chisel or file.
In the metatarsal bone, an incision is carried out at the head level, changes abroad and installed under the Sesamoid bone.Then, with the help of screws or wire, the phalanx is linked and the capsule closes.After the operation, titanium screws do not require extraction, but eliminate the cable three months after surgery, if there is no need to do this before.
Scarf technique
In most patients, you can eliminate leg bone with an Oosteotomy scarf.This operation is carried out with moderate deformation of the first finger of the foot.To date, the operation is the most universal method to treat Valgo, it 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 bone more, which allows it to achieve a more progressive result than with other surgical interventions;
- The doctor can with insufficient value carry out the lengthening procedure;
- With the deformation of the Varior, you can change the bone on the medial side;
- To reduce the load on the inside of the foot and the first finger area, you can move the bone a little down and to the side;
- If necessary, you can shorten the bone length;
- When pronouncing the joint, the bone elements can be rotated.
The surgical intervention is carried out under spinal 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 zigzag -shaped incision is made on the side of the first finger bones, after which the head of the bone moves to the desired position, its angle changes.At the same time, the doctor changes the location of the tendons, which are united to the thumb.
Then, a capsule of the deformed joint is separated from the outside and the bones are fixed in the required position wearing titanium screws.Usually, the fasteners are not eliminated, if they do not bring any discomfort, then the patients and then go with screws.Rehabilitation after the operation takes three to six weeks.Immediately after the intervention, patients who use special orthosis or tire are recommended, in which it is necessary to load the foot as soon as possible.The tire hastened all the time while the recovery period passes.
Laser intervention
The elimination of the deformation of the valgo with a laser is also possible, however, patients should not be highly anticipated for such surgery method.Although it is minimum and softer, it is used exclusively at the early stage of the development of the pathological process.
An undoubted advantage of surgical intervention is a small incision in size, which doctors do close to the largest point in the bone shelf.After healing, such injury is practically not noticeable, which allows you to restore foot aesthetics as much as possible.With the use of a laser, doctors have the opportunity to carry out a limited intervention:
- The existence is carried out: with the help of a laser, part of the cartilaginous growth is eliminated, which is formed at the early stage of Valgo;
- Make osteotomy with a large cut: in the surgery process, the proximal phalanx of the first finger is eliminated;
- Perform the resection arthroplasty: the articular surfaces of the bone are eliminated and part of the thumb phalanx.
Laser elimination is usually carried out in clinics where there are special equipment.Recovery after surgery is minimal: in a few weeks, patients can normally walk.
The only inconvenience of the laser intervention is that the incorrect position of the bone is not subject to correction, and only grows under the desired parameters.In this case, patients are threatened with relapses.
Arthrodesis
The operation to eliminate the valge by arthrodesis is rarely used, but sometimes this is the only way for patients to get rid of the big finger of the foot.The operation belongs to the most radical intervention methods.
With the help of such surgery, it is possible to eliminate the base of the first finger of the foot and fix the fingers with special screws.
IMPORTANT! During the operation, the main objective is achieved, eliminating the deformation and giving the joint the correct position, but not all patients feel comfortable after such surgery.
There are serious contraindications for intervention:
- vascular atherosclerosis and other circulatory disorders;
- Diabetic foot;
- Polyneuropathy
With arthritis and osteoarthritis, patients can also reject surgery if the joints are very deformed, constantly inflamed.In this case, patients will advise minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies can occur pain, discomfort due to titanium fixing structures installed in the bone.The rehabilitation after the intervention lasts eight weeks.Walking in plaster is necessary only in the first days after surgery;This is necessary to solve the elements.You can wear a Baroka boot.This is a specially designed orthopedic shoe that will eliminate the load from the operated leg.
Reviews
If the patient has an operation to eliminate the valge, you can read reviews and find out what types of intervention are carried out 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 of the finger. They made a scarf according to the method, it seems that everything went well, but the leg still hurts the load."
"I have been suffering for a long time for a long time, but I did not dare to go to the operation. They made me a complex arthrodesis, the restoration took more than two and a half months, but after the operation it became much easier. Now I can walk without a stick and not torment the pain."
"The bone of my leg is hereditary, even my mother and my grandmother suffered from gout. I decided to do the operation as soon as the first signs appear. The operation was using a laser, all the additional growths were taken away, now my leg has a normal appearance, but the doctors said they were still possible relay."
Valgus deformation operations in most cases allow a person to solve the bone problem on their finger.When the first signs of Valgo appear, it does not postpone the treatment, the best results appear at the early stage of the development of the disease.