Deformation of the big toe valgus is so common that in medical practice you can calculate more than four hundred options for the operational solution of this problem.Of course, not all interventions were the same success and completely resolved the problem of patients, so in modern practice the most progressive options for intervention remained in which patients' chances of recovery are high.Today, Khalus Valgus surgery is concentrated on the lowest invasiveness as possible in combination with a good therapeutic effect of intervention.
Indications
Khalus Valgus is a problem not only for adults, it can also appear in children.Forming a cone on the leg of the thumb at the initial stage does not disturb patients until a sharp pain appears when walking, problems with shoe choices, periodic bone inflammation.At this stage, most patients are trying to relieve pain with popular methods.Different compresses and baths only tighten the course of the disease and lead to the only true solution of valgus deformity - surgical intervention.
Indications for operation are:
- grown pain in the big toe;
- chronic inflammation, which cannot be stopped, persistent swelling;
- damage to the skin in valgus bending (cracks, suppression, ulcers);
- Planet valgus foot with a pronounced curvature of the finger joint;
- inability to help patients with conservative methods;
- the emergence of a lame walk;
- Limiting motor activity in the foot.
Doctors insist on the treatment of the finger valgus fingers exclusively surgically, as most patients return 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 treatment of bone on the foot, it will eventually lead to redistribution of load on the other fingers, which is why the fingers will suffer and bend from the second to the fifth.Only with time surgical interventions can such complications be avoided.
Preparation for interference
During surgery for deforming the finger joint valgus, serious preparation is performed in orthopedics.The patient performs all necessary tests.Their theller is a blood test, according to the results of which it is important to exclude signs of the inflammatory process in the body.
In some cases, the standard list of tests can be completed by determining the level of hormones and markers for oncology if doctors suspect the development of a malignant foot process.
A mandatory stage in orthopedic operations is an X -Ray diagnosis - during the study, pictures are taken in two projections to determine the nature of deformation and the severity of pathological disorders.
In difficult cases, doctors can use magnetic resonance or calculated tomography.Such a study yields more accurate results.According to the analysis, doctors decide which way it will be better to perform the surgery.
Classification of surgical interventions
All operations performed by valgus can be divided into two major groups - an invasive operation and reconstructive intervention.The first type of surgical interventions in the legs is characterized by low trauma.
Operations are used limited - only at the initial stage of the development of the disease, if the deformation is irrelevant and in the presence of a benign cartilage growth, which is easily removed through surgery.In all other cases, minimum invasive surgeries do not solve patient problems.
Most minimum invasive interventions are performed quickly and do not provoke complications.Scars after such surgery are minimal.The doctor does two to three paintings, the length of which does not exceed 0.5 cm.After these operations, the skin is back very quickly, and the disability period is up to two weeks.
During reconstructive interventions, the volume of soft tissue damage is more important.However, a big plus of operations is that they help to remove even a significant deformity of the legs and help with severe bending.Cutting 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 big toe.
You can also consider the operations depending on the location they are performed.Three groups of interventions are distinguished - in soft tissue, bone tissue and combined surgery.When performing soft fabrics, it is possible to eliminate valgus deformity only if there is no deformation of the plus bone head.During such an intervention, the doctor works exclusively with soft tissue - tendons, muscles, a bors.
With surgical intervention in bone tissue, it is possible to correct second and third degree deformity.The intervention is to present part of the bone or bring osteotomy.With a combined operation, the intervention occurs in both soft tissue and bone.But the possibilities of such surgery are wider - doctors can simultaneously remove bone growth and make ligaments.
Operational techniques
Some operating techniques can be eliminated on foot, each of which has its advantages and is selected with certain indications.
McBride operation
With surgical intervention, McBbraid is carried out in the first interval among the head only at the level of the head.Using clips, the doctor spreads soft fabrics and makes a ligament cut between the surface, which is on the surface.After that, the surgeon acquires access to the muscle tendon, which is responsible for distributing the first finger - is mobilized and sewn from a special sewing material - Vikril.
Further, the doctor works with bones in the form of a sesam, it traverses a deep package that is attached to the bone formed by the Sesami, which is eliminated by its subluxation.Then, the coupling capsule plusnephalanx is distributed 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 deviated to the side.
The capsule dissection is done in the form of the English letter V, and its roof is directed towards the thumb.From the top above the bone and under it, the hooks of the house are removed underneath, the growth of the cartilage in the metatarsal bone head are removed.If this is not done, patients in the future will suffer pain in the joint.
In the Future, the Development of the Operation Can Place in Two Ways, Depending on the Need for Osteotomy.With osteotomy, there is a need to use a spoke that will will attach the tendon to bone fragments.In the last stage, excessive capsules are removed, plastic with a certain tissue voltage is performed, after which the surgeon sews the ends of the wound and processes its surface.
Such a Technique was proposed more than eight decades ago, but unil to the operation has not lost it relevance.So that after the intervention there is no relapse, after surgery, the patients are recommended to wear special orthopedic shoes.
Technique series
The Operational Technique for the minimally invasive technique of series was proposed in 1998 by Surgeon Cesare Faldini.Now it is also active in the surgical pract of the doctors of Many Countries.Refers to low -traumatic procedures and is effective at the initial stage of development of the disease and with a moderate curvature of the foot valgus, when the angle of deviation of the toe does not exceed forty degrees.
Reference!The operation is not carried out duue to severe arthrosis.Also, Patients May Refuse 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 a cut on the projection of the plus bone head of the thumb, opens the joint capsule, develops osteotomy with a separate file or chisel.In the process of such procedure, you can Achieve sturgery redistribution of the distance on the distal part of the plus bone.
In the process of surgery, doctors use the Kirshner knit needle to create the exact position of the thumb - they begin on the medial side of the surface in the direction of saliva, after which the doctor brings a finger to the manual mode and places it in the right position.Operation in the rehabilitation process requires wearing a gypsum sauce - it is applied for at least two weeks.The verb removal is performed after about 1-1.5 months.
Chevron technique
The Chevron technique is used for small deformities if the angle is less than 17 degrees.The main situation for the implementation of such an intervention is the lack of arthrosis and other serious changes that the foot valg provokes.
Operational treatment is performed as follows - in the initial phase, the doctor trims the skin just over the interconnected foot joint.Shortened connections and the joint capsules themselves are distinguished.Usually degenerative changes in tissues and ligaments provoke deformity of the thumb.The bone corn in the joint is removed using a chisel or file.
In the metatarsal bone, a cut is performed at the head level, moved to the outside and is installed under the sessamoid bone.Then, with the help of screws or wire, Phalanx is attached, and the capsule closes.After surgery, titanium screws do not require removal, but they eliminate the wire three months after surgery if you do not need to do so earlier.
Scarf
In most patients, you can remove the bone in the foot using Shall-Oosteotomy.Such an operation is performed with moderate deformity of the first toe valgus.So far, surgery is the most universal method of valgus treatment, it has many advantages over other methods.
The positive aspects of the operation are as follows:
- In this process, it is possible not only to move but also turn the bone plus head, which allows you to achieve a more progressive result than with other surgical interventions;
- The doctor can with an insufficient value carry out the legence procedure;
- With varor deformation, you can shift the bone in the medial side;
- To reduce the load on the inner part of the foot and the first finger, you can move the bone a little down and to the side;
- If necessary, you can lotten the length of the bone;
- When Proning the Joint, Bone Elements Can Be Rotated.
Surgical Intervention is Carriad Out Under Spinal Anesthesia.The surgeon on the inside of the foots of the creature of the beginning of the metatarsal bone.After that, a zigzag -shaped cut is made on the side of 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, which are attached to the thumb.
THEN, A deformated jaint capsule is separated from the outsides and the bones are fixed in the required position using titanium screen.Typically, fasteners are not removed, if they do not bring any discomfort, then patients and then go screws.Rehabilitation after the operation taxes from Three to Six Weeks.Immediately after the intervention, patients are recommended to wear a special orthosis or tire, in which it is necessary to charge the foot as soon as possible.The tire rushes all the time while the recovery period.
Laser intervention
The removal of valgus deformation with a laser is also posseible, Howver, Patients Should not Be Highly Hopes for Such A Method of Surgery.Although it is minimal and mast gentle, it is used exclusively at the Early Stage of the Development of the Pathological Process.
An undivked advantage of surgical intervention is a small incision in size, which doctors make near the rest point in the ledge of the bone.After healing, Such an injury is practically not noticeable, whic allows you to restore the aesthetics of the foot as much as postible.With the use of a laser, doctors have the opportunity to conduct Limited Intervention:
- There is an existenceComy - with the help of a laser, a portion of the cartilaginous growth is removed, which is formed in the early stage of the valgus;
- Make osteotomy with a large incision - in the process of surgery, removed the proximal phalanx of the first finger;
- Performing the arthroplasty of the resection - the articular surfaces of the plus bone and part of the thumb are removed.
Laser removal is usually performed in clinics where there are special equipment.After surgery recovery is minimal - within a few weeks, patients can walk normally.
The only drawback of laser intervention is that the incorrect bone position is not subject to correction, and it only grows under the desired parameters.In this case, patients are threatened with relapses.
Arthritis
The surgery to remove the valgus from 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 methods of intervention.
With the help of such surgery, it is possible to remove the phalanx base of the first toe and adjust your fingers with separate screws.
Important! During surgery, the main goal was achieved - eliminating deformation and shared the proper position, but not all patients become comfortable after such surgery.
There are serious contraindications for intervention:
- vascular atherosclerosis and other circulatory disorders;
- Diabetic foot;
- Polneuropathy.
With arthritis and arthritis, patients can also refuse surgery if the joints are highly deformed, destroyed, constantly inflamed.In this case, patients will advise minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies can occur severe pain, discomfort due to titanium fixing structures installed on the bone.Rehabilitation after intervention lasts eight weeks.Walking on gypsum is only necessary in the first days after surgery - this is necessary to adjust the elements.You can use a baroque boot.This is a specially designed orthopedic shoe that will remove the load from the operated foot.
Review
If the patient has an operation to eliminate the valgus, he can read reviews and find out what types of intervention are performed and how effective they are.Here are some similar thoughts:
"Last year, I had to finish my dancer career due to the deformity of the finger valgus. They made a scarf by method, it seems that everything went well, but the foot still hurts in the load."
"I've suffered for a long time for a long time, but I didn't dare go to surgery. I became a complex arthrodes, the restoration lasted more than two and a half months, but after surgery it became much easier. Now I could walk without a stick and I could not torture pain."
"The bone on my leg is hereditary - even my mother and grandmother suffered from the ground. I decided to have the operation as the first signs were displayed. The surgery was using a laser, all extra growths were removed for me, now the foot has a normal appearance, but doctors said to follow possible relapses."
Valgus deformation operations in most cases allow a person to solve the bone problem on his finger.When the first signs of valgus appear, do not delay treatment - the best results appear in the early stage of the disease development.