Types of surgical interventions at 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 early stages of therapy are widely used various orthopedic devices. In cases where conservative medicine is ineffective, surgical intervention. Halus valgus operation fixes a serious foot deformity. The type of surgery depends on the severity of disease and presence of comorbidities.

The causes of the disease

Halus valgus inconvenience while walking and spoils the appearance of the foot. In addition, the disease is able to disturb the circulation, to cause the appearance of 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 lesions of the bones;
  • A genetic disposition.

Medical practice finds 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 ballerina. Observed and "nepotism" Halus valgus – often mothers and grandmothers of patients also suffer from such deformation. In men the ligaments more elastic and tighter, so Halus valgus they are diagnosed mostly after the injury.

The symptoms of Hallux valgus

symptoms

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

Stop losing the depreciation function. The further course of the disease is able to cause changes in the intervertebral disks and trigger the manifestation of osteochondrosis, osteoarthritis. Pain whining character in this phase Halus valgus appear in the spinal column. Being without movement, the patient feels numb in the extremities and heaviness, and after the motor load is a pain.

At the same time the joint swells. Increasing it causes the synovial folds. As a result, the cartilage thins, the bones are forced to touch each other. Abrasion of the articular surfaces causes the appearance of osteophytes – abnormal growths of tissue bone.

The development of the disease

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

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

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

Important! The degree of changes in the structure of the foot is the main factor in determining 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 formation of the skeleton, only in children and adolescents. In an adult patient so the disease can only slow down to stop the pain, to resume the load on certain parts of feet and prevent the development of complications.

methods of treatment

To solve the problem with the Halus valgus allows surgical treatment. The plan of operation Halus valgus the foot is developed for a specific 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 serious contraindications. There are over three hundred types of surgery for Halus valgus. They are divided into main groups:

  • Affecting soft tissue.
  • Acting on the bone;
  • Combining the manipulation on the soft tissues and bones.

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

Gentle technique

Minimally invasive operations are shown in the first stages of pathological processes. They involve manipulation, slightly affecting soft tissue and also tendon. The purpose of sparing techniques – the reconstruction of the aesthetics and the elimination of discomfort when moving. Such operations allow patients to recover quickly. But the risks remain to the development of hallux valgus disorders in the future.

During the operation, make two punctures (3-4 mm) on both sides of the first toe. Using microtools, open the joint capsule, which, when disease is often compressed. Its extension through a small incision gives space to setup the axis of the finger in a physiological position. For complete elimination of the curvature of the finger some of the bone rasp micro caedentes. In the implementation of the manipulations used 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 physiological position. Bone growth is liquidated in the area of articulation of the finger and the shank restore the ligament.

On the metatarsal bone is affected in several ways:

  • Austin, aka herringbone (cut V - or L-shaped) – for small displacements of the thumb (less than 17°);
  • Scarf (cut Z-shaped) – in case of medium and severe forms of 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 fixed with a compression screw made of titanium. They do not usually require extraction. If you encounter problems with titanium retainers removed as an outpatient three months later after surgery.

Arthrodesis

This method is the most radical surgery at the Halus valgus on the background of osteoarthritis. It creates a fixed joint. Eliminated and pain, and morbo laborans articulari symptoms and the deformity. The lack of joints does not affect the gait of the patient and his activity.

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

Contraindications and complications

Any surgical manipulation is absolutely contraindicated in:

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

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

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

  • Infection of the tissues;
  • Blood clots in the deep veins;
  • Aseptic necrosis of the head of the metatarsal (extremely rare);
  • The restriction of functional activity of the first finger;
  • Violation of the nervous cords;
  • Swelling of allergic nature;
  • Numbness of the limbs.

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

recovery

Recovery

After surgery, patients are assigned bed rest. On the first day allowed gradually to work – at first to wiggle your toes. On the third day can be a bit like. The doctor will tell you what to wear after surgery Halus valgus. At first – only orthopaedic devices (orthoses) which remove the burden from the affected part of the foot. Under the supervision of a physician in the hospital, the patient is from 10 days to 14 days.

Taking water treatment to removing seams, it is necessary to wrap the leg in plastic. Bandage not to slip and wet, otherwise, it can cause a relapse. To walk without orthopedic devices are allowed, not earlier than six weeks. In the area of the foot and lower ankle joint of up to three months after surgery Halus valgus can persist swelling. They are removed with cold compresses.

For early recovery of function of the foot and healing of postoperative wounds apply:

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

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

Postoperational rehabilitation will accelerate special shoes designed for fixation of the joints of the feet and not having them oppressive effect. To wear such shoes need not less than three months. About the close of the uncomfortable shoes and high heels are best forgotten.

Important! If necessary, surgery on both feet, it is advisable to implement 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 entrust the operation to a qualified technician and follow all of the recommendations in the postoperative period.

11.09.2018