Hallux valgus is so common that in medical practice there are more than four hundred surgical solution options for this problem.Of course, not all interventions were equally successful and completely resolved the patient's problem, therefore, in modern practice, the most progressive intervention options remain, in which patients have a high chance of recovery.Today, hallux valgus surgery aims to be as invasive as possible combined with a good therapeutic effect of the intervention.
Indications
Hallux valgus is not just a problem for adults;It can also appear in children.The formation of a lump on the big toe at the initial stage does not bother patients until sharp pains appear when walking, problems with choosing shoes and periodic inflammation of the bone.At this stage, most patients try to relieve pain using traditional methods.Various compresses and baths only prolong the course of the disease and lead to the only correct solution for hallux valgus deformity - surgical intervention.
Indications for the operation 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);
- flat valgus foot with severe curvature of the big toe joint;
- inability to help patients with conservative methods;
- the appearance of a limp;
- limitation of motor activity in the foot.
Doctors insist on treating thumb valgus exclusively surgically, as most patients are treated at a stage of the disease when it is not possible to correct the pathology conservatively.At the same time, if left untreated, bunions will eventually lead to a redistribution of the load to the other toes, causing the second to fifth toes to suffer and become crooked.Only with timely surgical intervention can such complications be avoided.
Preparing for the intervention
During hallux valgus surgery, serious preparation is carried out in orthopedics.The patient undergoes all necessary examinations.The main one 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 examinations can be supplemented by determining the level of hormones and cancer markers, if doctors suspect the development of a malignant process in the foot.
An obligatory stage of orthopedic operations is radiographic diagnosis - during the study, images are taken in two projections to determine the nature of the deformity and the severity of pathological disorders.
In difficult cases, doctors may resort to MRI or CT scans.This study provides more accurate results.Based on the test results, doctors decide which method is best to perform the operation.
Classification of surgical interventions
All operations performed for valgus can be divided into two large groups - minimally invasive operations and reconstructive interventions.The first type of surgical intervention on the foot is characterized by low trauma.
Surgeries are used to a limited extent - only at the initial stage of the development of the disease, if the deformity is insignificant and in the presence of a benign growth of cartilaginous tissue, which can be easily removed by surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most minimally invasive interventions are performed quickly and do not cause complications.Scars after this operation are minimal.The doctor makes two to three punctures for the intervention, the length of which does not exceed 0.5 cm.After these operations, the skin recovers very quickly and the period of disability is up to two weeks.
When carrying out reconstructive interventions, the volume of damage to soft tissues is more significant.However, a big advantage of operations is that they help to remove even significant deformities of the legs and help with severe curvatures.The incision during reconstructive intervention reaches up to four centimeters and is located on the medial surface of the foot.With this type of surgery, doctors completely restore the anatomical position of the big toe.
You can also consider operations depending on the location in which they are carried out.There are three groups of interventions - in soft tissue, in bone tissue and combined surgery.When performing soft tissue interventions, valgus deformity can only be eliminated if there is no deformation of the metatarsal head.During such an intervention, the doctor works exclusively with soft tissues - tendons, muscles, bursae.
With surgical intervention in bone tissue, it is possible to correct second and third degree deformities.The intervention involves filing part of the bone or performing an osteotomy.In a combined operation, the intervention takes place in both soft tissues and bones.But the possibilities of this surgery are wider - doctors can simultaneously remove a bone growth and perform ligament plastic surgery.
Operational Techniques
Bunions can be eliminated using several surgical techniques, each with its own advantages and selected for certain indications.
OPERATION MCBRIDE
During the surgical intervention according to McBride, an incision is made in the first intermetatarsal space just at the height of the heads.Using forceps, the doctor separates the soft tissues and makes an incision in the intermetatarsal ligament, which is on the surface.After that, the surgeon has access to the tendon of the muscle responsible for the abduction of the first 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, which is attached to the sesamoid bone, thus eliminating its subluxation.Next, the capsule of the metatarsophalangeal joint is dissected along the outer surface, after which an incision is made on the inner surface of the foot, approximately 5-6 cm long, through which the nerve is isolated and retracted to the side.
The dissection of the capsule is made in the shape of the English letter V, with its apex directed towards the thumb.Homan hooks are placed above and below the bone, and the cartilaginous growths on the head of the metatarsal bone are removed.If this is not done, patients will experience joint pain in the future.
In the future, the operation may be carried out in two ways, depending on the need for osteotomy.In osteotomy, it is necessary to use a pin that will fix 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 this day the operation has not lost relevance.To avoid relapses after the intervention, patients are recommended to wear special orthopedic shoes after the operation.
SERI METHOD
The surgical technique using the minimally invasive SERI technique was proposed in 1998 by surgeon Cesare Faldini.Now it is also actively used in the surgical practice of doctors in many countries.It is a low-traumatic and effective procedure in the initial phase of the development of the disease and with moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed more than forty degrees.
REFERENCE!The operation is not performed due to severe arthrosis.This type of intervention may also be denied to patients if the first metatarsophalangeal joint is unstable.
Foot surgery is performed under local anesthesia.The doctor makes an incision in the projection of the head of the metatarsal bone of the big toe, opens the joint capsule and performs an osteotomy with a file or special chisel.During this procedure, it is possible to achieve greater redistribution of the load on the distal part of the metatarsal bone.
During the surgical procedure, doctors use Kirschner wires to create the correct position of the thumb - they are inserted into the medial side of the surface in an oblique direction, after which the doctor manually moves the finger and places it in the desired position.The operation during the rehabilitation process requires the use of a plaster cast - it is applied for at least two weeks.The needle is removed after about 1-1.5 months.
CHEVRON METHOD
The Chevron technique is used for small deformations if the angle is less than 17 degrees.The main condition for such an intervention is the absence of arthrosis and other serious changes caused by valgus foot.
Surgical treatment is carried out as follows: at 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 tissues and ligaments cause deformation of the thumb.The callus on the joint is removed with a chisel or saw.
An incision is made in the metatarsal bone at the level of the head, it is moved outward and placed under the sesamoid bone.The phalanx is then secured with screws or wires and the capsule is closed.Titanium screws do not require removal after surgery, but wires are removed three months after surgery unless necessary sooner.
SCARF METHOD
In most patients, the bunion can be removed with a Scarf osteotomy.This operation is performed for moderate valgus deformity of the first toe.Today, surgery is the most universal method of treating valgus;It has many advantages over other methods.
The positive aspects of the operation are the following:
- during the procedure it is possible not only to displace, but also to rotate the head of the metatarsal bone, which makes it possible to obtain a more progressive result than with other surgical interventions;
- If the size is insufficient, the doctor may perform a bone lengthening procedure;
- in varus deformity, the bone may be displaced to the medial side;
- to reduce the load on the inside of the foot and in the region of the first toe, you can move the bone slightly downwards and to the side;
- if necessary, you can shorten the length of the bone;
- When the joint is pronated, the bony elements can be rotated.
The surgery is performed under spinal anesthesia.The surgeon makes an incision on the inside of the foot, from the beginning of the toe to the beginning of the metatarsal bone.Next, 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, its angle changes.At the same time, the doctor also changes the location of the tendons that are attached to the thumb.
Then the deformed joint capsule is separated from the outside and the bones are fixed in the desired position with titanium screws.Usually fasteners are not removed;if they do not cause discomfort, patients continue to use screws.Rehabilitation after surgery takes three to six weeks.Immediately after the intervention, the patient is recommended to wear an orthosis or special splint, in which it is necessary to load the foot as soon as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
Removing hallux valgus with a laser is also possible, but patients should not place high hopes on this method of surgery.Although it is minimally invasive and the most gentle, it is used exclusively at the initial stage of the development of the pathological process.
The undoubted advantage of surgical intervention is the small incision that doctors make near the largest point of the bone protrusion.After healing, this injury becomes practically invisible, which allows for maximum restoration of the aesthetics of the foot.Using a laser, doctors are able to perform limited interventions:
- perform exostectomy - with a laser, part of the cartilaginous growth that forms in the initial phase of valgus is removed;
- make an osteotomy with a large incision - during surgery, the proximal 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 where there is special equipment.Recovery after surgery is minimal - patients can walk normally after a few weeks.
The only disadvantage of laser intervention is that the incorrect position of the bone cannot be corrected, but only rectified within the required parameters.In this case, patients are at risk of relapse.
ARTHRODESIS
Surgery to remove valgus through arthrodesis is rarely used today, but sometimes it is 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 this surgery, it is possible to remove the base of the phalanx of the first toe and fix the toes together with special screws.
IMPORTANT! During the operation, the main goal is achieved - to eliminate the deformity and give the joint the correct position, however, not all patients are comfortable after such surgery.
There are serious contraindications to the intervention:
- vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- polyneuropathy.
With arthritis and osteoarthritis, patients may also be denied surgery if the joints are severely deformed, destroyed or constantly inflamed.In this case, patients will be advised to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: intense pain, discomfort due to the titanium fixation structures installed in the bone and lameness.Rehabilitation after the intervention lasts eight weeks.It is necessary to walk in a cast only in the first few days after surgery - this is necessary to fix the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that relieve stress from the operated leg.
Reviews
If a patient undergoes surgery to eliminate valgus, they can read reviews and find out what types of interventions are performed and how effective they are.Here are some similar opinions:
"Last year I had to end my dancing career due to a hallux valgus deformity. We did it using the scarf method, everything seemed to go well, but my leg still hurts when I exert myself."
"I've been suffering from hallux valgus for a long time, but I didn't dare to have surgery. I had a complex arthrodesis, the 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 I don't feel any pain."
"The bone in my foot is hereditary - my mother and grandmother also suffered from gout. I decided to have surgery as soon as the first signs appeared. The operation was done with a laser, all the excess growths were removed from me, now my leg looks normal, but the doctors told me to monitor possible relapses."
Hallux valgus surgeries, in most cases, allow a person to resolve the problem of a bunion on the toe.When the first signs of valgus appear, treatment should not be delayed - the best results appear at an early stage in the development of the disease.