Operation with the deformation of the big toe (Hallux Valgus)

Valgus deformity of the foot and orthopedic disorder, manifested in pathological changes in the form of fingers which occupy a position at an angle to each other. The most common form of the disease is valgus deformity of the big toe, which can be easily identified by its external symptom is a bulging in the side of the hill in the field of finger the base.

Pathology not only brings discomfort while walking and spoils the aesthetic appearance, but also leads to the development of arthritis, bursitis, circulatory problems, injuries in the area of the ankle of the Letter. Causes of hallux valgus of the first toe (Hallux valgus) are:

Operation with the deformation of the big toe (Hallux Valgus)
  • Endocrine diseases;
  • Walk plan (transverse and longitudinal);
  • Weakness joint ligaments;
  • Age-related degenerative changes in the bone tissue (13% in patients over the age of 60 years);
  • The genetic predisposition.

There is ample evidence of the fact that the disease is highly susceptible to dancers, and women who prefer to wear shoes with high heels. An imbalance of ligament-tendon complex that develops when excessively high elasticity of the joints, leads to cross-plan, and as a result Hallux valgus.

The development of the disease

The slow progression of the disease is not always possible to diagnose at an early stage when the deformity is correctable by the application of the therapy is conservative and orthopaedic devices (orthotics). Appeared soft formation to the base of the first finger of the foot is often confused with the corn, and the use of traditional methods to get rid of the defect. Of course, this treatment does not result, over time, the bump hardens, grows in size, causes pain when walking.

In a next step, the first finger is noticeably more twisted, deviating to the outer edge of the foot and move the other fingers. Plus-phalangeal joint is subjected to excessive loads, which leads to inflammatory and degenerative processes in the bone tissue (Hallux rigidus). When the deviation of the thumb at an angle of over 30 degrees deformation takes place all of the toes (hammer in the form of a curvature, corns, ingrowth of the nail).

Stages of deformation,

In Orthopaedics there are three degrees of Hallux valgus:

  • Phase I. The angle of deviation of the first toe towards the outside to less than 25 degrees, the deviation of the metatarsal bone in the internal face of at least 12 degrees.
  • Stage II. The angle of deviation of the first toe towards the outside more than 25 degrees, the deviation of the metatarsal bone in the internal face of at least 18 degrees.
  • Phase III. The angle of deviation of the first toe towards the outside more than 35 degrees, the deviation of the metatarsal bone in the inner side of more than 18 degrees.
Indications of surgical treatment

The degree of deformation of bone and joint complex is the main factor in the choice of the surgery of the hallux valgus.

Indications of surgical treatment

The main indication for surgery is pain and discomfort when walking, the development of inflammatory and destructive changes in the bone tissue. Valgus deformity of foot (Halyus Valgus) can be treated as conservative only in childhood and early adolescence, the formation of the skeleton.

An adult can only stop the progression of the disease, relieve pain, restore physiological loading in different parts of the feet and prevent serious complications. For this purpose, orthotic devices (insoles, inserts, clips, headbands). To completely solve the problem with Hallux Valgus is possible only by surgical methods.

The plan of operation is developed individually for each patient, since this pathology has a great diversity of manifestations and the factors, the most common of which are: bursitis of the little finger, osteoarthritis of the metatarsophalangeal joint, osteomyelitis, arthritis, infections of soft tissues.

Types of consultations at the foot while HalluxValgus

The choice of method operation is determined by the nature of the pathology, the severity of the injury, the presence (absence of contraindications regarding. The first stage applies gentle technique (mini-invasive), which minimally affected the soft tissues and tendons.

The goal of surgery is the restoration of the aesthetics of the appearance of the foot, eliminating discomfort while walking. This type of surgery allows you to quickly restore the physical form, easily migrate the rehabilitation period. At the same time, does not exclude the possibility of the development Tuesday the process of hallux valgus in the distant future. In grade 3 hallux valgus minimally invasive techniques applied.

Minimally invasive surgery (mini-invasive)

The first stage is the surgical removal of bone growth and subcutaneous mucous bags adjacent to the base of the first metatarsophalangeal joint. The operation is performed under x-ray control (image intensifier), without open access to the clinical field. For handling, there are two small puncture wounds on both sides of the first finger (3-4 mm).

Using microtools is the opening of the joint capsule, the lateral release is carried out (the restoration of the correct position of the axis of the first finger), which forms part of the bones presented with microfrezers for the complete elimination of the deformity of the gold. Minimally invasive surgery does not use fasteners (pins, screws, plates or staples).

Types of consultations at the foot while HalluxValgus

Reconstructive surgery for hallux valgus

Teams of reconstructive surgery includes the following steps:

  1. It is a small longitudinal incision (2-4 cm) to the side of the surface of the foot.
  2. Is from the side, the release of the first metatarsophalangeal joint.
  3. Remove the bone growth (exostosectomy) with the subsequent restoration of joint ligaments at the junction of the metatarsal bones and the first toe.

Shaved metatarsal bone in one of the following methods:

  • AUSTIN osteotomy (Chevron, V-shaped or L-shaped contour);
  • Osteotomy SCARF (Z-shaped);
  • SIMILAR osteotomy (wedge cut to the phalanx proximal to the first finger of the foot);
  • The proximal circular (or wedge) osteotomy.

Surgery to remove the bones of the thumb (hanlux valgus) is as follows:

  1. By fixing the joint in a fixed position (for the creation of an artificial ankylosis).
  2. Eliminates the deformation of the foot by the displacement of components of the first metatarsal bone.
  3. Fixate the bone fragments after osteotomy with compression of titanium structures.
  4. Suture capsule, cosmetic stitches.
  5. Superimposed sterile and bandage elastic.

Important point - when doing a chevron osteotomy, the surgeon continuously controls the position of the sesamoid bones with the help of image intensification x-ray, since its displacement is limited.

The type of anesthesia (local anesthesia or General anesthesia) is selected individually for medical reasons, and it was agreed with the patient.

Video: advances in the surgery of hallux valgus

Contraindications for the surgical treatment of Hallux Valgus

Absolute contraindications for surgery are:

  1. Severe peripheral vascular disease (obliterating atherosclerosis);
  2. Disorders of the peripheral nervous system due to diabetes (foot diabetic);
  3. Diseases of the blood;
  4. Purulent infection.

Arthritis and osteoarthritis are not contraindications for surgery, but the choice of the surgical technique that takes into account the possible complications during the surgery and rehabilitation period.

Possible complications

After reconstructive surgeons can develop the same complications that occur with any cavernous operations:

  • Deep vein thrombosis;
  • The infection of the tissues;
  • Aseptic necrosis of head of metatarsal bone (rarely the later);
  • Decreased motor function of the gold;
  • Damage to the nerve bundles;
  • The inflammation allergic;
  • Numbness of the fingers;
  • The pain in the pads of the foot

These complications occur very rarely, especially surgery patients well tolerated - as young people and the elderly.

Recovery after the surgery

The first day after surgery is shown in bed. You can make easy the development of the foot - several times a day the patient performs the movement with the fingers. Walking is permitted on the third day, and only in special orthosis that relieves the load of the operated part of the foot.

The restoration of normal walking (without the use of an orthosis) - not before 6 weeks. Full rehabilitation is achieved in 4-6 months ( after this period you can actively participate in sports, clothes, high-heel shoes). Stay in the clinic, under the supervision of a doctor of 10 days to two weeks. The patient reported knowing that the swelling in the foot and lower part of the ankle joint after the surgery can persist long enough for three months. To reduce the swelling, in moments of relaxation used deck packs

To accelerate the process of rehabilitation of the leg (supine) to keep at the top. When exceeding the recommended loads can be a burning sensation and pain in the area of the foot that sometimes is caused by the displacement of the annotation. Should take responsibility for medical indications after surgery of punctuality accordance with the requirements of the rehabilitation depends on the speed of recovery.

To improve the efficiency of the tissue healing and the restoration of the functionality of the foot, used to the sessions of shock wave therapy of massage (at least 15 procedures) leg (from foot to hips), electrophoresis, exercise therapy. Two months after surgery in the recovery program include the swimming and the exercise bike

06.08.2018