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

Valgus deformity of the foot and orthopedic disorder, manifested in pathological changes in the shape of fingers in which they occupy a position at an angle to each other. The most common form of the disease is valgus deformity of the big toe that 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 Charter. Causes of hallux valgus of the first toe (Hallux valgus) are:

Operation with the deformation of the big toe (Hallux Valgus)
  • Endocrine diseases;
  • Flat feet (transverse and longitudinal);
  • Weakened articular ligaments;
  • Age-related degenerative changes in the bone tissue (13% in patients older than 60 years);
  • Genetic predisposition.

There is ample evidence of the fact that the disease in 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-flat, and as a consequence 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 conservative therapy and orthopedic appliances (orthotics). Appeared soft formation at the base of the first toe is often mistaken for corn, and use traditional methods to get rid of the defect. Of course, such 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 twisted, deviating to the outer edge of the foot and moving 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 over 30 degrees deformation takes place all of the toes (hammer-shaped curvature, corns, ingrowth of the nail).

Stages of deformation,

In Orthopaedics there are three degrees of Hallux valgus:

  • Stage I. The angle of deviation of the first toe outwards at least 25 degrees, the deviation of the metatarsal bone in the inner side of at least 12 degrees.
  • Stage II. The angle of deviation of the first toe outwards more than 25 degrees, the deviation of the metatarsal bone in the inner side of at least 18 degrees.
  • Stage III. The angle of deviation of the first toe outwards more than 35 degrees, the deviation of the metatarsal bone in the inner side of more than 18 degrees.
Indications for surgical treatment

The degree of deformation of bone and articular complex is the main factor in choosing surgery for hallux valgus.

Indications for surgical treatment

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

An adult can only halt the progression of the disease, relieve pain, restore physiological load on different parts of 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 complicating factors, most common of which are: bursitis of the small finger, osteoarthritis of the metatarsophalangeal joint, osteomyelitis, arthritis, infections of soft tissues.

Types of surgeries on the foot while HalluxValgus

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

The goal of surgery is restoration of aesthetics 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 are 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 surgical field. For the manipulation, there is 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), part of the bones filed with microfrezers for complete elimination of deformity of the thumb. Minimally invasive surgery does not use fasteners (pins, screws, plates or staples).

Types of surgeries on the foot while HalluxValgus

Reconstructive surgery for hallux valgus

Equipment reconstructive surgery includes the following steps:

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

Shaved metatarsal bone in one of the methods:

  • AUSTIN osteotomy (Chevron, V-shaped or L-shaped contour);
  • Osteotomy SCARF (Z-shaped);
  • AKIN osteotomy (wedge cut in the proximal phalanx of the first toe);
  • 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 (the creation of an artificial ankylosis).
  2. Eliminates deformation of the foot by shifting components of the first metatarsal bone.
  3. Fixate bone fragments after osteotomy with compression of titanium structures.
  4. Sutured capsule, cosmetic stitches.
  5. Superimposed sterile and elastic bandage.

Important point - when conducting a chevron osteotomy, the surgeon continuously controls the position of the sesamoid bones with the help of image intensification x-ray, given that their displacement is limited.

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

Video: progress in surgery for hallux valgus

Contraindications for 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 (diabetic foot);
  3. Diseases of the blood;
  4. Purulent infection.

Arthritis and arthrosis are not contraindications to surgery, but the choice of surgical technique 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;
  • Infection of the tissues;
  • Aseptic necrosis of the head of metatarsal bone (rarely the later);
  • Decline in motor functions of the thumb;
  • Damage to the nerve bundles;
  • Allergic swelling;
  • Numbness of the fingers;
  • The pain in the pads of the foot

These complications occur rarely, mostly surgery patients well tolerated - as in young and old age.

Recovery after surgery

On the first day after surgery is shown to bed. You can conduct an easy development of the foot - several times a day the patient performs the movement with your 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) - no earlier than 6 weeks. Full rehabilitation is achieved within 4-6 months ( after this period you can actively engage in sports, wear high-heeled shoes). Stay in the clinic under the supervision of a physician from 10 days to two weeks. The patient reported to know that swelling in the foot and lower part of the ankle joint after surgery can persist long enough to three months. To reduce puffiness, in moments of relaxation used deck packs

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

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

06.08.2018