Types of surgical interventions on Halus valgus

hallux valgus

Hallux valgus (Halus valgus) – a pathological transformation of the first metatarsophalangeal joint. With the development of the disease after the thumb to deform the rest of the toes. In the first phases of the therapy are widely used various orthopaedic devices. In cases where conservative medicine is ineffective, surgical intervention. Halus valgus operation fixed a severe deformity of the foot. The type of surgery will depend on the severity of the disease and the presence of comorbidities.

The causes of the disease

Halus valgus discomfort while walking and spoils the appearance of the foot. In addition, the disease is able to disturb the circulation, because of the emergence of the bursitis and arthritis. Appearance Halus valgus can cause:

  • Disorders in the endocrine system;
  • The weakening of ligaments;
  • The omission of longitudinal and transverse arches of the foot;
  • The age of the lesions of the bones;
  • A genetic predisposition.

The medical practice is a lot of evidence that Halus valgus is more common in women who prefer shoes and boots with high heels. Often stop transformirovalsya of the representatives of certain professions, for example, a dancer. Observe and "nepotism" Halus valgus – often the mothers and grandmothers of patients who suffer from this type of deformation. In men the ligaments more elastic and more strong, so that Halus valgus is diagnosed mostly after the injury.

The symptoms of Hallux valgus

symptoms

The first stage Halus valgus inherent stiffness and discomfort when walking. The progression of the Hallux valgus is often accompanied by bursitis, an inflammation of the lining of the bag in the region of the joint, aggravantes the course of the disease. In addition, there is pain in the joints when walking and sometimes at night. They are different in severity, from barely noticeable to unbearable, cut or prolonged pain.

Stop wasting the depreciation of the function. The further course of the disease is capable of causing changes in the intervertebral disks and cause the manifestation of osteochondrosis, arthrosis. Pain whining character in this phase Halus valgus appear in the spine. Without movement, the patient feels numbness in the extremities, and heaviness, and after the engine load is a pain.

At the same time, the joint swells. Growing that causes the synovial folds. As a result, the cartilage thins, the bones are forced to touch each other. The abrasion of the articulating surfaces of the causes of the appearance of osteophytes abnormal growth of bone tissue.

The development of the disease

The gradual development Halus valgus often do not diagnose the disease in an early stage, when pathological disorders, it can still be adjusted with the help of therapy traditional and the use of special devices. Small stamp at the base of the big toe is often think corn and trying to get rid by the methods usual. But with the time, "corn" increasingly solidifies and expands, causing pain during the movement.

Excessive load experienced by the joint, causing the inflammation of bone tissue. When the big toe shifts angle of more than 30°, all deformed toes. Orthopedists divide by Halus valgus in three stages:

  • And – the finger moves to the outer edge of the angle of less than 25°, the metatarsal bone towards the interior at the angle less than 12°;
  • II – the finger moves to the outer edge at a 25° angle of the metatarsal bone inward angle of less than 18°;
  • III – the finger moves towards the outer edge, at an angle of more than 35°, the metatarsal bone towards the inner angle larger than 18°.

Important! The degree of changes in the structure of the foot is the main factor in the determination of the method of surgical treatment Halus valgus.

Indications for surgery

The main indications for surgical therapy Halus valgus – pain, inflammation and lesions of the tissues of the bones. Hallux valgus can be cured by conventional methods to complete the formation of the skeleton, only in children and adolescents. In an adult patient so that the disease can only slow down to stop the pain, to resume the load on certain parts of feet and prevent the appearance of complications.

methods of treatment

To solve the problem with the Halus valgus allows for a surgical treatment. The plan of operation Halus valgus the foot is developed for a particular patient, the disease is inherent in a variety of manifestations and complications.

Types of surgical interventions

The choice of method of surgical intervention is influenced by the nature of the disease, the degree of adverse tissue changes, the presence of contraindications severe. There are more than three hundred type of surgery for Halus valgus. Are divided into main groups:

  • That affect the soft tissues.
  • That act on the bone;
  • The combination of the manipulation of the soft tissues and bones.

Before the surgery Hallux valgus excised condyles. Such traumatic effects later impairment of the function of the foot. Now the orthopedists prefer to do less traumatica of the operation.

Soft technique

Minimally invasive operations are shown in the first stages of pathological processes. Involve the handling, slightly affecting the soft tissue and also tendon. The aim of saving techniques – the reconstruction of the aesthetics and the elimination of the inconvenience when moving. These operations allow patients to recover quickly. But the risks remain to the development of hallux valgus disorders in the future.

During the operation, making two punctures (3-4 mm) on both sides of the first finger of the foot. Using microtools, open to the whole of the capsule, which, when the disease is often compressed. Its extension through a small incision gives space to the configuration of the axis of the finger in a position that is physiological. For the complete elimination of the curvature of the finger some of the bone rasp micro caedentes. In the implementation of the manipulations that use x-ray control. Special clamps are not used.

Reconstructive surgery

removal

In this type of surgical interventions produce a longitudinal incision with a length of 2-4 cm in the area of the lateral plane of the foot. The big toe is installed in a position that is physiological. The bone growth is liquidated in the area of the joint of the finger and the cane to restore the ligament.

In the metatarsal bone is affected in several ways:

  • Austin, also known as herringbone (cut in V - or L-shaped) – for small displacements of the thumb (less than 17°);
  • Scarf (cut in the shape of a Z) – in the case of medium and severe forms of the deviation of a finger (from 17° to 40°);
  • Akin (dissection of the sphenoid) is often combined with minimally invasive methods.

After osteotomy the bone fragments are fixed with a compression screw titanium. They do not usually require extraction. If you have problems with titanium retainers removed as an outpatient three months after the surgery.

Interbody fusion

This method is more radical the surgery the Halus valgus in the bottom of the osteoarthritis. It creates a fixed joint. Removed and the pain, and morbidity laborans articulari symptoms and the deformity. The lack of joints does not affect the motion of the patient and his activity.

Arthrodesis is used if other therapies Halus valgus did not bring the expected result. When the surgical procedure fragments of the joint to rigidly connect the special screws. Before installing the screws, remove the joint surfaces of the first metatarsal head and to the phalanx proximal to the first finger of the foot. The physiological structure of the foot is restored, the symptoms of osteoarthritis disappear.

Contraindications and complications

Any manipulation, surgery is absolutely contraindicated in:

  • Serious diseases of the vessels of the extremities (atherosclerosis);
  • Diabetic effects on the peripheral nervous system (foot, diabetic);
  • Purulent infections;
  • The diseases of the organs hematopoietic.

When osteoarthritis and arthritis surgical treatment feasible. But, choose the method of operation Halus valgus, take into account the appearance of possible complications during the surgery itself and the recovery period.

After the surgery Halus valgus reconstructive form can appear complications inherent to open-cavernous interventions:

  • The infection of the tissues;
  • Blood clots in the deep veins;
  • Aseptic necrosis of the head of the metatarsal (very rare);
  • The restriction of the functional activity of the first finger;
  • The violation of the nervous cords;
  • Swelling of allergic nature;
  • Numbness of the extremities.

Complications occur infrequently. Typically, patients after the surgery feel well both in youth and in adulthood.

recovery

Recovery

After the surgery, patients are assigned to sleep. The first day allowed gradually to work – at first to move the fingers of the feet. On the third day can be a bit such as. The doctor will tell you what to wear after the surgery Halus valgus. In the first place, only orthopaedic devices (orthoses) which removes the load from the affected part of the foot. Under the supervision of a doctor at the hospital, the patient is 10 days to 14 days.

The taking of water treatment for the removal of seams, it is necessary to wrap the leg in plastic. Bandage does not slip and wet, otherwise, it can cause a relapse. Walking without orthopaedic devices are allowed, not earlier than six weeks. In the area of the foot and lower ankle joint of up to three months after the surgery Halus valgus can persist inflammation. They are removed with cool compresses.

At the beginning of the recovery of the function of the foot and the healing of wounds, postoperative apply:

  • Massage;
  • Electrophoresis;
  • The procedures extracorporeal shock wave therapy;
  • Exercises of physiotherapy.

Two months after the surgery, Halus valgus, the patient may recommend preventive of swimming and an exercise bike. The complete recovery after the surgery Halus valgus has four to six months. However, occasionally the foot should be set at the level above the head. To load its not worth it. At night you can use a corrective splint. After the surgery, Halus valgus, it is recommended that you massage the arch of the foot on the tennis ball.

Postoperative rehabilitation will accelerate special shoes designed for the fixation of the joints of the feet and not having them oppressive effect. To wear shoes the need of not less than three months. On the closing of the uncomfortable shoes and high heels are the best way to forget.

Important! If necessary, the surgery on both feet, it is advisable to apply them with a break of three to six months.

After operating Halus valgus advanced methods patients almost immediately able to walk. But it is important to trust the operation to a qualified technician and follow all the recommendations in the postoperative period.

11.09.2018