Hallux valgus is so common that in medical practice there are more than four hundred options for surgical solutions to this problem.Of course, not all interventions were equally successful and completely solved the patient's problem, which is why in modern practice more progressive intervention options persist, in which patients have a high chance of recovery.Today, hallux valgus surgery focuses on being as invasive as possible combined with a good therapeutic effect of the intervention.
Indications
Hallux valgus is not just an adult problem;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 pain appears 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.
The 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 foot valgus with severe curvature of the big toe joint;
- inability to help patients with conservative methods;
- the appearance of walking with a limp;
- limitation 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 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 load to other toes, causing the second to fifth toe to suffer and sprain.Only with timely surgical intervention can such complications be avoided.
Preparing for the intervention
During hallux valgus surgery, serious orthopedic preparation is carried out.The patient undergoes all the necessary tests.The key 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 stage of orthopedic operations is X-ray 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 scan.A study of this type gives more precise results.Based on the test results, doctors decide which method is best to perform the operation.
Classification of surgical interventions.
All operations performed in 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 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.The scars after this operation are minimal.For the intervention, 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 period of disability is up to two weeks.
When performing reconstructive interventions, the volume of damage to soft tissues is more significant.However, a big advantage of operations is that they help eliminate even significant deformities of the legs and help with pronounced curvatures.The incision during the reconstructive intervention reaches up to four centimeters and is located on the medial side of the foot.With this type of surgery, doctors completely restore the anatomical position of the big toe.
Operations can also be considered depending on the place in which they are carried out.There are three groups of interventions: soft tissue, bone tissue and combined surgery.When performing soft tissue interventions, valgus deformity can be eliminated only 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 on bone tissue it is possible to correct second and third degree deformities.The intervention consists of filing part of the bone or performing an osteotomy.In a combined operation, the intervention occurs in both soft tissues and bones.But the possibilities of this type of surgery are broader: doctors can remove a bone growth and simultaneously perform ligament plastic surgery.
Operational techniques
Bunions can be removed using various surgical techniques, each of which has its own advantages and is selected for certain indications.
OPERATION MCBRIDE
According to McBride, during the surgical intervention an incision is made in the first intermetatarsal space just at the height of the head.With the help of forceps, the doctor separates the soft tissues and makes an incision in the intermetatarsal ligament, which is located on the surface.After this, the surgeon accesses the tendon of the muscle responsible for abduction of the big toe;It is mobilized and sutured with a special suture material: vicryl.
Next, the doctor works with the sesamoid bones;crosses the deep ligament, which is attached to the sesamoid bone, thereby eliminating its subluxation.The capsule of the metatarsophalangeal joint is then 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.
Dissection of the capsule is performed 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 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 development of the operation can be carried out in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a pin that will attach the tendon to the bone fragments.At the final stage, excess tissue from the capsule is removed, plastic surgery is performed with some 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 its relevance.To avoid relapses after the operation, 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 stage of development of the disease and with a moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed forty degrees.
REFERENCE!The operation is not performed due to severe osteoarthritis.Patients may also be denied this type of intervention 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 special file or chisel.During this procedure, it is possible to achieve greater load redistribution 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 cast, which is applied for at least two weeks.The needle is removed after about 1 to 1.5 months.
CHEVRON METHOD
The Chevron technique is used for minor deformations if the angle is less than 17 degrees.The main condition for such intervention is the absence of osteoarthritis and other serious changes caused by foot valgus.
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.Normally, degenerative changes in tissues and ligaments cause deformation of the thumb.Joint calluses are removed with a chisel or saw.
An incision is made in the metatarsal bone at the level of the head, moved outward and placed under the sesamoid bone.The phalanx is then fixed with screws or wires and the capsule is closed.The titanium screws do not require removal after surgery, but the wires are removed three months after surgery unless it is necessary to do so 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 big 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 achieve a more progressive result than with other surgical interventions;
- If the size is insufficient, the doctor may perform a bone lengthening procedure;
- with varus deformity, the bone can be displaced to the medial side;
- to reduce the load on the inside of the foot and the big 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 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.After that, a zigzag cut is made on the side of the bone of the first finger, 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 location 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 required position using titanium screws.The bindings are usually not removed;If they do not cause any discomfort, patients continue using screws.Rehabilitation after surgery lasts three to six weeks.Immediately after the intervention, patients are recommended to wear a special orthosis or splint, in which it is necessary to load the foot as soon as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
It is also possible to remove hallux valgus with a laser, but patients should not place high hopes on this method of surgery.Although it is minimally invasive and the gentlest, it is used exclusively in the early stages 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 bone protrusion.After healing, this injury is practically invisible, which allows the aesthetics of the foot to be restored to the maximum.With the help of a laser, doctors can perform limited interventions:
- perform an exostectomy: with the help of a laser, part of the cartilaginous growth that forms in the initial stage of valgus is removed;
- perform an osteotomy with a large incision;during surgery, the proximal phalanx of the first finger 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 drawback of laser intervention is that the incorrect position of the bone cannot be corrected, but is only rectified according to the required parameters.In this case, patients are at risk of relapse.
ARTHRODESIS
Surgery to remove valgus through arthrodesis is very 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 such surgery, it is possible to remove the base of the phalanx of the first finger and fix the fingers 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 feel comfortable after such surgery.
There are serious contraindications for the intervention:
- vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- polyneuropathy.
In the case of 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 recommended to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: severe pain, discomfort due to the titanium fastening 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 days after surgery;This is necessary to fix the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that will relieve stress on the operated leg.
Reviews
If a patient undergoes surgery to remove valgus, they can read reviews and find out what types of interventions are performed and how effective they are.Below 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 be going well, but my leg still hurts when I exert myself.”
"I have suffered from hallux valgus for a long time, but I did not dare to undergo surgery. I had a complex arthrodesis, the recovery took more than two and a half months, but after the operation it was much easier. Now I can walk without a cane and I have no pain."
"The bone in my foot is hereditary; my mother and grandmother also suffered from gout. I decided to undergo surgery as soon as the first signs appeared. The operation was performed with a laser, all the excess growths were removed, now my leg looks normal, but the doctors told me to watch for possible relapses."
Surgeries for hallux valgus in most cases allow a person to solve the problem of a bunion on the toe.When the first signs of valgus appear, you should not delay treatment;The best results appear at an early stage of disease development.