Hallux valgus is so common that in medical practice there are more than four hundred options for surgically solving this problem.Of course, not all interventions had the same success and completely solved the patient's problem.Therefore, in modern practice, the most advanced intervention options remain, where patients have a high chance of recovery.Nowadays, hallux valgus surgery focuses on the greatest possible invasiveness, combined with a good therapeutic effect of the procedure.
Notes
Hallux valgus is not just a problem for adults;it can also occur in children.The formation of a lump on the big toe in the initial stages does not bother the patient until severe pain occurs when walking, problems with choosing shoes and periodic inflammation of the bone.At this stage, most patients try to relieve the pain using traditional methods.Various compresses and baths only prolong the course of the disease and lead to the only correct solution to hallux valgus deformity - surgical intervention.
Indications for surgery are:
- increased pain in the big toe;
- chronic inflammation that cannot be stopped, constant swelling;
- Damage to the skin in the area of valgus curvature (cracks, suppuration, ulcers);
- Plana valgus foot with severe curvature of the metatarsophalangeal joint of the big toe;
- Inability to help patients with conservative methods;
- the appearance of a limping gait;
- Restriction of motor activity in the foot.
Doctors insist on treating thumb valgus exclusively surgically, since most patients are treated at a stage of the disease where conservative correction of the pathology is not possible.At the same time, if bunions are left untreated, over time the load will be redistributed to other toes, causing the second to fifth toes to suffer and become crooked.Such complications can only be avoided through timely surgical intervention.
Preparation for the procedure
Hallux valgus surgery involves serious orthopedic preparation.The patient undergoes all necessary examinations.The key to this is a blood test, the results of which are important to exclude signs of an inflammatory process in the body.
In some cases, the standard list of tests can be supplemented by determining the level of hormones and cancer markers if doctors suspect the development of a malignant process in the foot.
A mandatory step of orthopedic operations is X-ray diagnostics - during the examination, images are taken in two projections to determine the type of deformity and the severity of pathological disorders.
In difficult cases, doctors may resort to magnetic resonance imaging or computed tomography.Such a study provides more accurate results.Based on the test results, doctors decide which method is most suitable for performing the operation.
Classification of surgical procedures
All operations performed at Valgus can be divided into two large groups - minimally invasive operations and reconstructive procedures.The first type of surgical intervention on the foot is characterized by low trauma.
Surgical intervention is used only to a limited extent - only at the initial stage of the development of the disease, when the deformation is insignificant and there is a benign outgrowth of cartilage tissue that can be easily removed by surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most minimally invasive procedures are performed quickly and do not cause complications.The scars after this operation are minimal.For the procedure, 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 duration of disability is up to two weeks.
In reconstructive procedures, the extent of soft tissue damage is more important.However, a great advantage of operations is that they help eliminate even significant deformities of the legs and help with severe curvatures.The incision for reconstructive procedures extends up to four centimeters and is located on the medial side of the foot.During this type of surgery, doctors completely restore the anatomical position of the big toe.
You can also consider operations depending on where they occur.There are three groups of procedures: on soft tissue, on bone tissue and combined procedures.When operating on soft tissues, a valgus deformity can only be eliminated if there is no deformation of the metatarsal head.During such an operation, the doctor works exclusively with soft tissues - tendons, muscles, bursa.
Through surgical interventions on bone tissue, it is possible to correct second and third degree deformities.The procedure involves filing down part of the bone or performing an osteotomy.In a combined operation, the intervention takes place in both the soft tissue and the bone.However, the possibilities of such an operation are more comprehensive: doctors can simultaneously remove a bone growth and perform ligament plastic surgery.
Operating techniques
Bunions can be removed using various surgical techniques, each of which has its own advantages and is selected for specific indications.
OPERATION MCBRIDE
In the McBride surgical procedure, an incision is made in the first intermetatarsal space just at the level of the head.Using staples, the doctor pushes the soft tissues apart and makes an incision in the surface intermetatarsal ligament.After that, the surgeon gains access to the tendon of the muscle responsible for the abduction of the index finger - it is mobilized and sutured with a special suture material - Vicryl.
Next, the doctor works with the sesamoid bones;It crosses the deep ligament attached to the sesamoid bone, thereby eliminating its subluxation.The capsule of the metatarsophalangeal joint of the big toe is then dissected along the outer surface, after which an approximately 5-6 cm long incision is made on the inner surface of the foot, through which the nerve is isolated and retracted to the side.
The capsule is prepared in the shape of an English letter V, the tip of which is directed towards the thumb.Homan hooks are placed above and below the bone and cartilage growths on the head of the metatarsal bone are removed.If this does not happen, patients will experience joint pain in the future.
In the future, the operation can be carried out in two ways, depending on the need for an osteotomy.During osteotomy it is necessary to use a pin that attaches the tendon to the bone fragments.At the final stage, excess capsular tissue is removed, plastic surgery is performed with a certain tissue tension, after which the surgeon sutures the edges of the wound and treats its surface.
This technique was proposed more than eight decades ago, but to date the operation has not lost its relevance.To prevent relapses after the procedure, patients are recommended to wear special orthopedic shoes after surgery.
SERI METHOD
The surgical technique using the minimally invasive SERI technique was proposed in 1998 by the surgeon Cesare Faldini.It is now actively used in surgical practice by doctors in many countries.It is a low-traumatic procedure that is effective at the initial stage of disease development and with moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed forty degrees.
REFERENCE!Due to severe osteoarthritis, the operation is not carried out.Patients can also refuse this procedure if the first metatarsophalangeal joint of the big toe is unstable.
Foot surgeries are performed under local anesthesia.The doctor makes an incision in the protrusion of the metatarsal bone of the big toe, opens the joint capsule and performs an osteotomy using a special file or chisel.With this procedure it is possible to achieve a further redistribution of the load on the distal part of the metatarsal bone.
During the surgical procedure, doctors use Kirschner wires to establish the correct position of the thumb.They are inserted obliquely into the medial side of the surface.The doctor then moves the finger manually and puts it in the desired position.The operation during the rehabilitation process requires wearing a plaster cast - this is applied for at least two weeks.The needle is removed after approximately 1-1.5 months.
CHEVRON METHOD
For smaller deformations, the chevron technique is used if the angle is less than 17 degrees.The main requirement for such an intervention is the absence of arthrosis and other serious changes caused by foot valgus.
Surgical treatment is carried out as follows: In the initial stage, the doctor cuts the skin just above the metatarsophalangeal joint of the foot.The shortened connections and the joint capsule itself are highlighted.Typically, degenerative changes in tissue and ligaments lead to deformation of the thumb.Callus on the joint is removed with a chisel or saw.
An incision is made on the metatarsal bone at the level of the head, this is moved outwards and placed under the sesamoid bone.The phalanx is then secured with screws or wires and the capsule is closed.Titanium screws do not need to be removed after surgery, but wires will be removed three months after surgery unless needed sooner.
SCARF METHOD
In most patients, the bunion can be removed using a scarf osteotomy.This operation is performed for moderate valgus deformity of the first toe.Today, surgery is the most universal method for treating valgus;It has many advantages over other methods.
The positive aspects of the operation are as follows:
- During the procedure, it is possible not only to move the head of the metatarsal bone, but also to rotate it, which allows achieving a more progressive result than other surgical procedures.
- If the size is not enough, the doctor may perform bone lengthening;
- With a varus deformity, the bone can be displaced medially;
- To reduce stress on the inside of the foot and the first toe area, you can move the bone slightly down and to the side;
- If necessary, you can shorten the length of the bone;
- When the joint pronates, the bone elements can be rotated.
The operation is performed under spinal anesthesia.The surgeon makes an incision on the inside of the foot from the start of the toe to the start of the metatarsal bone.After that, a zigzag cut is made on the side of the bone of the first toe, after which the head of the bone is moved to the desired position and its angle changes.At the same time, the doctor also changes the position of the tendons that are attached to the thumb.
The deformed joint capsule is then separated from the outside and the bones are fixed in the desired position with titanium screws.Normally the fasteners are not removed;If they do not cause discomfort, patients continue to wear screws.Rehabilitation after surgery takes three to six weeks.Immediately after the procedure, patients are recommended to wear a special orthosis or splint, which requires the foot to be loaded as early as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
Removing the hallux valgus with a laser is also possible, but patients should not have high hopes for this surgical method.Although it is minimally invasive and the most gentle, it is used exclusively in the early stages of the pathological process.
The undoubted advantage of surgical intervention is the small incision that doctors make near the largest part of the bony prominence.After healing, such an injury is practically invisible, which allows maximum restoration of foot aesthetics.Using a laser, doctors can perform limited procedures:
- perform an exostectomy - using a laser to remove part of the cartilage growth that forms in the early stages of valgus;
- Perform an osteotomy with a large incision.During the operation, the basal phalanx of the first toe is removed.
- Perform resection arthroplasty - the articular surfaces of the metatarsal bone and part of the phalanx of the big toe are removed.
Laser removal is usually performed in clinics that have special equipment.Recovery after surgery is minimal – patients can walk normally again after just a few weeks.
The only disadvantage of laser surgery is that the incorrect position of the bone cannot be corrected, it is only ground to the required parameters.In this case, patients are at risk of relapse.
ARTHRODESIS
Surgery to remove valgus using arthrodesis is rarely performed these days, but is sometimes the only way for patients to get rid of big toe valgus.Surgery is one of the most radical intervention methods.
With the help of such an operation, it is possible to remove the base of the phalanx of the first toe and attach the toes to each other using special screws.
IMPORTANT! During the operation, the main goal is to eliminate the deformity and give the joint the correct position.However, not all patients feel well after such an operation.
There are serious contraindications to the procedure:
- vascular arteriosclerosis and other circulatory disorders;
- diabetic foot;
- Polyneuropathy.
In the case of arthritis and osteoarthritis, patients may also be refused surgery if the joints are severely deformed, destroyed or permanently inflamed.In this case, patients are recommended minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: severe pain, discomfort caused by titanium fastening structures built into the bone and limping.Rehabilitation after the procedure lasts eight weeks.Walking in a plaster cast is necessary only in the first days after the operation - this is necessary to fix the elements.You can use Baruk's boots.These are specially developed orthopedic shoes that relieve the strain on the operated leg.
Reviews
If a patient undergoes surgery to eliminate valgus, he can read reviews and find out what types of procedures are performed and how effective they are.Here are some similar opinions:
"Last year I had to end my career as a ballerina due to a hallux valgus deformity. We did it with the scarf method, everything seemed to go well, but the leg still hurts with exertion."
"I have been suffering from hallux valgus for a long time, but I did not dare to undergo surgery. I had a complex arthrodesis, recovery took more than two and a half months, but after the operation it became much easier. Now I can walk without a cane and have no pain."
"The bone in my foot is hereditary - my mother and grandmother also suffered from gout. I decided to have an operation as soon as the first signs appeared. The operation was performed with a laser, all excess growths were removed from me, now my leg looks normal, but the doctors told me to be careful of possible relapses."
Operations for hallux valgus in most cases allow a person to solve the problem of a bunion on the finger.When the first signs of valgus appear, you should not delay treatment - the best results appear at an early stage of disease development.