The 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 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 intervention remained, in which the patients' chances of recovery are high.Today, the Khalus Valgus operation is focused on as lower invasiveness as possible in combination with a good therapeutic effect of the intervention.
Indications
Khalus Valgus is a problem not only for adults, it can also appear in children.The formation of 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 the selection of shoes, periodic inflammation of the bone.At this stage, most patients are trying to relieve pain with folk methods.Various compresses and baths only tighten the course of the disease and lead to the only true solution of valgus deformation - surgical intervention.
Indications for the operation are:
- increased pain in the thumb of the foot;
- chronic inflammation, which cannot be stopped, constant swelling;
- damage to the skin in valgus curvature (cracks, suppuration, ulcers);
- Plana Valgus foot with a pronounced curvature of the joint of the thumb;
- the inability to help patients with conservative methods;
- the appearance of a lame gait;
- Limiting motor activity in the foot.
Doctors insist on the treatment of Valgus the thumbs exclusively surgically, since most patients turn at the stage of the disease when it is not possible to correct the pathology conservatively.At the same time, if you do not start the treatment of the bone on the legs, it will ultimately lead to the redistribution of the load on other fingers, which is why the fingers will suffer and bend from the second to the fifth.Only with timely surgical intervention can such complications be avoided.
Preparation for intervention
During the operation for valgus deformation of the joint of the thumb of the foot, serious preparation is carried out in the orthopedics.The patient conducts all the necessary tests.The key of them 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 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.
An obligatory stage in orthopedic operations is an X -ray diagnosis - during the study, pictures are taken in two projection in order to determine the nature of deformation and the severity of pathological disorders.
In difficult cases, doctors can resort to magnetic resonance or computed tomography.Such a study gives more accurate results.According to analyzes, doctors decide in which way it will be best to perform the operation.
Classification of surgical interventions
All operations that are done by Valgus can be divided into two large groups - an invasive operation and reconstructive interventions.The first type of surgical interventions on the foot is characterized by low trauma.
Operations are used limited - 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 cartilage, which is easily removed through surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most of minimally invasive interventions are performed quickly and does not provoke complications.Scars after such an operation are minimal.The doctor makes from two to three punctures, the length of which does not exceed 0.5 cm. After these operations, the skin is restored very quickly, and the period of incapacity for work is up to two weeks.
During reconstructive interventions, the volume of damage to the soft tissues is more significant.However, a huge plus of operations is that they help to remove even a significant deformation of the legs and help with severe curvature.The incision in reconstructive intervention reaches up to 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 consider operations depending on the location they are carried out.Three groups of interventions are distinguished - on soft tissues, on bone tissue and combined surgery.When conducting interventions on soft fabrics, it is possible to eliminate Valgus deformation only if there is no deformation of the head of the plus bone.In the course of such an intervention, the doctor works exclusively with soft tissues - tendons, muscles, a borses.
With surgical intervention on bone tissue, it is possible to correct deformation of the second and third degree.The intervention is to file a part of the bone or conduct osteotomy.With a combined operation, intervention occurs both in soft tissues and in bone.But the possibilities of such surgery are broader - doctors can simultaneously remove the bone growth and make ligaments.
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 surgical intervention, McBraid is carried out in the first inter -flood interval just at the level of the heads.Using clamps, the doctor spreads soft fabrics and makes a cut of the inter -flood ligament, which is located on the surface.After that, the surgeon gains access to the tendon of the muscle, which is responsible for the allocation of the first finger - it is mobilized and stitched by a special suture material - Vikril.
Further, the doctor works with sesam -shaped bones, he crosses a deep bundle that is attached to the sesam -shaped bone, which is eliminated by its subluxation.Then, the capsule of the plusnephalanx joint 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 it is diverted to the side.
The dissection of the capsule is made in the form of the English letter V, and its peak is directed towards the thumb.From above above the bone and below it, the hooks of the homeman are removed under it, cartilage growths on the head of the metatarsal bone are removed.If this is not done, patients in the future will experience pain in the joint.
In the future, the development of the operation can take place in two ways, depending on the need for osteotomy.With osteotomy, there is a need to use a spoke that will attach the tendon to bone fragments.At the final stage, excess tissue of the capsules are removed, plastic with a certain tension of the tissues is carried out, 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 that after the intervention there is no relapse, after surgery, the 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.Now it is also actively used in the surgical practice of doctors of many countries.It refers to low -traumatic procedures and is effective at the initial stage of the development of the disease and with a moderate valgus curvature of the foot, when the angle of deviation of the thumb of the foot does not exceed more than forty degrees.
REFERENCE!The operation is not carried out due 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 an incision in the projection of the head of the plus bone of the thumb, opens the joint capsule, conducts osteotomy with a special file or chisel.In the process of such a procedure, you can achieve further redistribution of the load on the distal part of the plus bone.
In the process of surgery, doctors use Kirshner's knitting needle to create the correct position of the thumb - they start in the medial side of the surface in the spit direction, after which the doctor brings a finger in manual mode and sets it in the right position.The operation in the process of rehabilitation requires the wearing of a gypsum dressing - it is applied for at least two weeks.The removal of the spoke is carried out after about 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 such an intervention is the lack of arthrosis and other serious changes that Valgus of the foot provokes.
Operational treatment is carried out as follows - at the initial stage, the doctor cuts the skin just above the plused -wrapping joint of the foot.Shortened connections and the joint capsule itself are distinguished.Usually degenerative changes in the tissues and ligaments provoke deformation of the thumb.Bone corn on the joint is removed using a chisel or file.
On the metatarsal bone, an incision is carried out at the head level, it shifts in 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 the operation, titanium screws do not require removal, but they eliminate the wire three months after surgery, if there is no need to do this earlier.
Scarf technique
In most patients, you can remove the bone on the leg using SCARF-oosteotomy.Such an operation is performed with moderate valgus deformation of the first finger of the foot.To date, the operation is the most universal method of treating Valgus, 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 shift, 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 can with an insufficient value carry out the lengthening procedure;
- With varior 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 area, you can move the bone a little down and to the side;
- If necessary, you can shorten the length of the bone;
- When pronating the joint, bone elements can be rotated.
Surgical intervention is carried out under spinal anesthesia.The surgeon on the inside of 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 bones of the first finger, after which the bone head is shifted 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 deformed joint capsule is separated from the outside and the bones are fixed in the required position using titanium screws.Typically, fasteners are not removed, if they do not bring any discomfort, then patients and then go with screws.Rehabilitation after the operation takes 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 load the foot as early as possible.The tire rushes all the time while the recovery period passes.
Laser intervention
The removal of valgus deformation with a laser is also possible, however, patients should not be highly hopes for such a method of surgery.Although it is minimal and most gentle, 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 make near the largest point in the ledge of the bone.After healing, such an injury is practically not noticeable, which allows you to restore the aesthetics of the foot as much as possible.With the use of a laser, doctors have the opportunity to conduct limited intervention:
- Existectomy is carried out - with the help of a laser, part of the cartilaginous growth is removed, which is formed at the early stage of Valgus;
- make osteotomy with a large cut - in the process of surgery, the proximal phalanx of the first finger is removed;
- Carry out resection arthroplasty - the articular surfaces of the plus bone and part of the thumb phalanx are removed.
Laser removal is usually carried out in clinics where there is special equipment.Recovery after surgery is minimal - in a few weeks, patients can walk normally.
The only drawback of laser intervention is that the incorrect position of the bone is not subject to the correction, and it only grows under the desired parameters.In this case, patients are threatened with relapses.
Arthrodesis
The operation to remove Valgus by arthrodesis is used quite rarely, but sometimes this is the only way for patients to get rid of the large finger of the foot.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 finger of the foot and fix the fingers with special screws.
IMPORTANT! During the operation, the main goal is achieved - eliminating the deformation and giving the joint the correct position, but not all patients become comfortable after such surgery.
There are serious contraindications for intervention:
- vascular atherosclerosis and other circulatory disorders;
- Diabetic foot;
- Polyneuropathy.
With arthritis and arthrosis, patients can also refuse surgery if the joints are very deformed, destroyed, constantly inflamed.In this case, the patients will advise minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur-severe pain, discomfort due to titanium fastening structures installed in the bone.Rehabilitation after the intervention lasts eight weeks.Walking in gypsum is necessary only in the first days after surgery - this is necessary to fix the elements.You can use a baroka boot.This is a specially designed orthopedic shoes that will remove the load from the operated leg.
Reviews
If the patient has an operation to eliminate Valgus, he can read reviews and find out what types of intervention are carried out and how effective they are.Here are a few similar opinions:
“Last year, I had to finish the career of the ballerina due to the valgus deformation of the finger.They made a scarf according to the method, it seems that everything went well, but the leg still aches at the load. ”
“I have been suffering for a long time for a long time, but I did not dare to go to the operation.I was made 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 do not torment pain. "
“The bone on my leg is hereditary - even my mother and 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 extra growths were removed to me, now the leg has a normal look, but the doctors said to follow possible relapses. ”
Valgus deformation operations in most cases allow a person to solve the problem of the bone on his finger.When the first signs of Valgus appear, do not postpone treatment - the best results appear at the early stage of development of the disease.