Operation hallux valgus

A great risk to the curvature of the foot is seen in people who have a tendency to articulate pathologies and wearing shoes uncomfortable. A disease in which the bone that protrudes from the first joint of the big toe called hallux valgus. Due to the deformation of the foot that often affects women. To correct the distortion, it is necessary to eliminate hallux valgus, operation is performed using 3-4 stages of the disease. The frequency of occurrence of pathology depends on the age of the person. The foot begins to deform with prolonged use of shoes with high heels. The process has a duration of several years. To change the width of the foot is most often observed in middle and old age.

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The doctors say that surgery to correct the foot is a procedure without which it is impossible to do if the bone has acquired a large size, and prevents walking. A blow to the leg prevents the movement. The main sign of the progression of hallux valgus is pain. The deformity seen in people with flat feet and a long metatarsal bone. Treatment of hallux valgus pathology deals with the podiatrist. Helps to restore the normal position of the foot and to avoid the bone.

Stage of the pathological process

The decision to undergo the surgery of the hallux valgus, the doctor accepts. He drew attention to the degree of curvature of the foot. In the first 2 stages of the disease, the conservative treatment is performed. If the correction is impossible, that requires surgical intervention. There are 4 degrees of severity of hallux valgus:

  1. In the first stage. The angle of deviation of the metatarsophalangeal joint does not exceed 15 degrees;
  2. In the second stage. It is characterized by the appearance of small but perceptible shock. The deviation angle of 15-20 degrees;
  3. In the third stage. The bone in the foot becomes severe, inflamed at the time of walking, and wear tight shoes. The diversion of the union is 20 to 30 degrees;
  4. The fourth stage. It is characterized by pain and complications. The angle of deviation of the metatarsophalangeal joint exceeds 30 degrees.

In the initial stages of the disease, surgery hallux valgus of the first toe is not necessary. In these cases, the issue can be resolved without surgical intervention. If the load on the legs will not decline, will occur hallux valgus curvature of the foot. As the progression of the disease, thumb increasingly veers towards the interior, while the set – out. As a result, the foot expands. In the later stages of hallux valgus is a constant swelling bumps of the foot. The pain appear not only during walking but also at rest.

Indications for surgery

After the realization of diagnostic procedures, surgeon orthopedic to decide if the surgery on the foot in hallux valgus. Surgical treatment of curvature of the feet is performed while the joint deviation of more than 20 degrees. Strongly protruding hallux valgus in the foot in an adult will not work independently. Therefore, the operation with the deformation of grade 3 and 4 – a question of time.The pronounced curvature of the base of the foot in the absence of pain and inflammation, is related to the indications for surgical intervention. If hallux valgus brings discomfort, the operation hallux valgus the big toe is necessary. Before carrying out the surgical treatment, conduct some research.

There are the following indications for surgical intervention:

  • Frequent and severe pain in the region of the base of the thumb;
  • The development of the inflammation when wearing shoes;
  • Swelling of the thumb;
  • Flat foot;
  • The absence of effect of conservative treatment methods;
  • The appearance of complications.
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Before you start the treatment, the doctor and the patient discuss the "pros" and "cons" operation for hallux valgus. The patient must understand that surgical intervention will help to prevent the dangerous effects of strain. Complications hallux valgus curvature of the foot are: the formation of ulcers on the surface of the deformation joint, bone infection, gait disturbance.

Contraindications to operative treatment

There are cases in which restore the shape of the foot with the surgery is impossible. These include the serious illness of vital organs. Surgery of the hallux valgus of the first toe is contraindicated if the patient has significant changes in the analysis. To remove the bone is not recommended, if the angle of deviation of the joint is less than 20 degrees. Absolute contraindications to operation for hallux valgus include the following States:

  • Violation of the coagulation of the blood;
  • Decompensation of diabetes;
  • Acute failure of the cardiovascular and respiratory systems;
  • Uncontrolled hypertension;
  • Thrombophlebitis of the veins of the lower extremities;
  • Chronic diseases of the system osteoarticular.

To detect the presence of contraindications after performing the biochemical tests and General blood tests, coagulation, chest x-ray of the foot. The surgery can not be prohibited, but before you run it that it should receive treatment. Among the contraindications related: acute infectious diseases, and worsening of inflammatory diseases chronic.

Methods of surgical treatment

There are various types of surgeries for hallux valgus. The choice of a particular method of treatment depends on the degree of deformation and condition of the patient. Assign minimally-invasive and open surgery. Depending on the stage of hallux valgus deviation of the big toe distinguishes the following methods of surgical treatment:

  • The manipulation of the soft tissues of the feet;
  • The proximal and distal osteotomy;
  • Lapidus Operation;
  • Keller Arthroplasty.

There are some 200 varieties of surgical interventions on elimination of valgus deformation. All treatments aimed at the correction of the curvature of the metatarsal bones. The purpose of each one of the operations is the removal of the bone in the foot and release of the patient from the pain. How to restore the normal form of the foot, not the podiatrist.

In minimally invasive procedures include the surgery. They include the excision of bone tissue. Recovery after hallux valgus surgery of this type is very quick. Percutaneous removal of bumps on the leg is shown in the cases in which the curvature is not very pronounced.

The manipulation of the soft tissues is located in the section of the muscles and ligaments of the foot. Is conducted at small deformations, and in cases in which the intervention in the organs of the bone is contraindicated. One of the varieties of the manipulation of the soft tissues is the surgery McBride.

Osteotomy is a surgical intervention that consists of an artificial fracture of the metatarsal bone and fixing in the desired position. Depending on the severity of hallux valgus is provided with a certain curvature, this surgical technique.

Arthrodesis is the validation of the joint in the correct position. Applied during the deformation of 3-4 degrees. To get rid of the bones performed arthrodesis according to Lapidus – this means that the joint is fixed in its position by means of special devices. To remove the hallux valgus using the Keller operation. It consists of the resection of the tissue affected of articulating surfaces and fixation of the metatarsal bones. Is done in rare cases, such as the mobility of the big toe after this procedure is violated.

Each operation is different and special surgical technique. The surgeon should discuss in advance the operating tactics of the patient. Warn the patient that the day is scheduled for the intervention and how long is the recovery period.

Preparation for surgery

Before the surgery, the doctor prepares for the procedure. It is for diagnostic studies. A few days before the operation you must perform:

  • The KLA;
  • OAM;
  • Biochemical analysis of blood;
  • Coagulogram;
  • X-rays of the foot in the projection side;
  • Electrocardiography;
  • Tests for HIV, syphilis and hepatitis.
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At the discretion of the physician and the patient addressed the issue of the conduct of the anesthesia. If you want to remove the bone a minimally invasive technique, performed under local anesthesia. In the absence of contraindications and the patient's wishes to cut the knot under General anesthesia. Anesthesia intravenous is done in cases in which it is expected to open surgery. Reviews of surgery of hallux valgus in most cases positive. Almost all patients reported they felt no discomfort during the procedure in spite of local anesthesia.

Operations on the soft tissues

Excision of soft tissue of the foot is used as a treatment of hallux valgus. The indication for this method of operation is the deviation of the gold is less than 25 degrees. This method of treatment is often combined with other surgical procedures. The varieties of interventions in the soft tissues of the foot, corresponds to the operation of McBride.

This surgical technique of the procedures is the section of the muscle, resulting in thumb. With this procedure, the bone accepts the correct position. After excluding muscle carried out the removal of the capsule of the articulation of the lateral side. The tendon is sutured to the head of the metatarsal bone. This procedure leads to a secure fixation of the thumb. Rehabilitation after hallux valgus surgery takes several months.

Technique of interbody fusion

A possible method of treatment of hallux valgus surgery is a Lapidus. This is arthrodesis of the metatarsophalangeal joint. To correct for the curvature to make the replacement of cartilage. The joint to give a position of physiological and fix it with a special plate.

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Shoes orthopedic after surgery for hallux valgus to wear for 8 weeks. You need special shoes that help to reduce the load on the forefoot. Arthroplasty according to Keller almost never used.

The proximal and distal osteotomy

Osteotomy performed with an important deviation of the big toe. The essence of the operation is to perform a bone fracture with the subsequent fixing in the desired direction. Distal Chevron osteotomy to be used more often. Is made V-shaped fracture of the metatarsal bone. Then, it is the lateral movement and locking compression screws. The suture surgical be removed after 2 weeks. All of the patients are shown in the physical therapy and massage after the surgery for hallux valgus.

The proximal osteotomy is made through the dissection of the tissues of the foot from the base of the big toe to the metatarsal bone. This method of operating, if the deviation is greater than 40 degrees. After the dissection of the tissue to produce Z in the form of cutting of the bone, and after participating in a bow with the screws of titanium.

Complications after a surgical treatment

In exceptional cases, there are complications of the surgery. That can occur during the execution of the surgical procedure or recovery period. Possible complications include:

  • Damage to the nerves of the foot;
  • Thrombosis of arteries and veins of the legs;
  • The infection of the tissues of the feet;
  • Necrosis aseptic of the metatarsal head;
  • Numbness of the thumb.

The postoperative period has passed successfully, it is important to follow all the recommendations of the doctor. The activity of the union is restored, little by little, so that the burden should be minimal. After the merger of the bone sample of physiotherapy.

The recovery period

The result of the operation was a success, in the early days of the foot is fixed in one position. In the early days of the movement of the legs limit. After stihaniya pain syndrome prescribe a foot massage.

In the joint motion, it is necessary to develop for several months. For this purpose, all patients are recommended a set of special exercises. Gymnastics is allowed only after 3 months after the surgery. Until that time, the joint develop with continuous passive motion and massage. Exercises for the fingers of the foot after hallux valgus surgery performed in a few months. They should not have a heavy load to the joint. Gymnastics is the flexion and the extension of the gold, the muscle tension of the foot. The rehabilitation period is about six months. After 6 months, the patients return to normal physical activity.

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To restore the functions of the foot patients wearing shoes orthopedic with special templates. It is necessary that the main load is distributed on the rear foot. Orthopedic ear after the surgery in the foot is recommended to wear a few months before full recovery.

24.08.2018