Hallux valgus is so common that in medical practice there are more than four hundred options for surgical solutions to this problem.Of course, not all interventions had equal success and completely solved the patient’s problem, therefore, in modern practice, the most progressive intervention options remain, in which patients have a high chance of recovery.Today, hallux valgus surgery is focused on being as invasive as possible combined with a good therapeutic effect from the intervention.
Indications
Hallux valgus is not only a problem for adults; it can also appear in children.The formation of a lump on the big toe at the initial stage does not bother patients until sharp pain appears when walking, problems with choosing shoes, and periodic inflammation of the bone.At this stage, most patients try to relieve pain using traditional methods.Various compresses and baths only prolong the course of the disease and lead to the only correct solution to hallux valgus deformity - surgical intervention.
Indications for the operation are:
- increased pain in the big toe;
- chronic inflammation that cannot be stopped, constant swelling;
- damage to the skin in the area of valgus curvature (cracks, suppuration, ulcers);
- plana valgus foot with severe curvature of the big toe joint;
- inability to help patients with conservative methods;
- the appearance of a limping gait;
- limitation of motor activity in the foot.
Doctors insist on treating thumb valgus exclusively surgically, since most patients are treated at a stage of the disease when it is not possible to correct the pathology conservatively.At the same time, if left untreated, bunions will eventually lead to a redistribution of the load to other toes, causing the second to fifth toes to suffer and become crooked.Only with timely surgical intervention can such complications be avoided.
Preparing for the intervention
During surgery for hallux valgus, serious preparation is carried out in orthopedics.The patient undergoes all necessary tests.The key one is a blood test, the results of which are important to exclude signs of an inflammatory process in the body.
In some cases, the standard list of tests can be supplemented by determining the level of hormones and cancer markers if doctors suspect the development of a malignant process in the foot.
An obligatory stage of orthopedic operations is X-ray diagnostics - during the study, images are taken in two projections to determine the nature of the deformity and the severity of pathological disorders.
In difficult cases, doctors may resort to magnetic resonance imaging or computed tomography.Such a study gives more accurate results.Based on the results of the tests, doctors decide which method is best to perform the operation.
Classification of surgical interventions
All operations that are performed for valgus can be divided into two large groups - minimally invasive operations and reconstructive interventions.The first type of surgical intervention on the foot is characterized by low trauma.
Surgeries are used to a limited extent - only in the initial stage of development of the disease, if the deformity is insignificant and in the presence of a benign growth of cartilage tissue, which can be easily removed through surgery.In all other cases, minimally invasive operations do not solve the patient’s problems.
Most minimally invasive interventions are performed quickly and do not cause complications.Scars after this operation are minimal.The doctor makes two to three punctures for the intervention, the length of which does not exceed 0.5 cm. After these operations, the skin recovers very quickly, and the period of disability is up to two weeks.
When performing reconstructive interventions, the volume of soft tissue damage is more significant.However, a huge advantage of operations is that they help remove even significant deformities of the legs and help with severe curvature.The incision during reconstructive intervention reaches up to four centimeters and is located on the medial side of the foot.With this type of surgery, doctors completely restore the anatomical position of the big toe.
You can also consider operations depending on the location in which they are carried out.There are three groups of interventions - on soft tissues, on bone tissue and combined surgery.When performing interventions on soft tissues, valgus deformity can be eliminated only if there is no deformation of the metatarsal head.During such an intervention, the doctor works exclusively with soft tissues - tendons, muscles, bursa.
With surgical intervention on bone tissue, it is possible to correct second and third degree deformities.The intervention involves filing down part of the bone or performing an osteotomy.In a combined operation, intervention occurs in both soft tissue and bone.But the possibilities of such surgery are broader - doctors can simultaneously remove a bone growth and perform ligament plastic surgery.
Operational Techniques
Bunions can be eliminated using several surgical techniques, each of which has its own advantages and is selected for certain indications.
OPERATION MCBRIDE
During surgical intervention according to McBride, an incision is made in the first intermetatarsal space just at the level of the heads.Using clamps, the doctor pushes the soft tissues apart and makes an incision in the intermetatarsal ligament, which is located on the surface.After this, the surgeon gains access to the tendon of the muscle that is responsible for abducting the first finger - it is mobilized and stitched with a special suture material - vicryl.
Next, the doctor works with the sesamoid bones; he crosses the deep ligament, which is attached to the sesamoid bone, thereby eliminating its subluxation.Then the capsule of the metatarsophalangeal joint is dissected along the outer surface, after which an incision is made on the inner surface of the foot, approximately 5-6 cm long, through which the nerve is isolated and retracted to the side.
The dissection of the capsule is made in the shape of an English letter V, with its apex directed towards the thumb.Homan's hooks are placed above the bone and below it, and cartilaginous growths on the head of the metatarsal bone are removed.If this is not done, patients will experience joint pain in the future.
In the future, the development of the operation can take place in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a pin that will attach the tendon to the bone fragments.At the final stage, excess capsule tissue is removed, plastic surgery is performed with a certain tissue tension, after which the surgeon sutures the edges of the wound and treats its surface.
This technique was proposed more than eight decades ago, but to this day the operation has not lost its relevance.To prevent relapses after the intervention, patients are recommended to wear special orthopedic shoes after the operation.
SERI METHOD
The surgical technique using the minimally invasive SERI technique was proposed in 1998 by surgeon Cesare Faldini.Now it is also actively used in the surgical practice of doctors in many countries.It is a low-traumatic procedure and is effective at the initial stage of development of the disease and with moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed more than forty degrees.
REFERENCE!The operation is not performed due to severe arthrosis.Patients may also be denied this type of intervention if the first metatarsophalangeal joint is unstable.
Foot surgery is performed under local anesthesia.The doctor makes an incision in the projection of the head of the metatarsal bone of the big toe, opens the joint capsule, and performs an osteotomy with a special file or chisel.During this procedure, it is possible to achieve further redistribution of the load on the distal part of the metatarsal bone.
During the surgical procedure, doctors use Kirschner wires to create the correct position of the thumb - they are inserted into the medial side of the surface in an oblique direction, after which the doctor manually moves the finger and sets it in the desired position.The operation during the rehabilitation process requires wearing a plaster cast - it is applied for at least two weeks.The needle is removed after about 1-1.5 months.
CHEVRON METHOD
The Chevron technique is used for minor deformations if the angle is less than 17 degrees.The main condition for such an intervention is the absence of arthrosis and other serious changes that are caused by foot valgus.
Surgical treatment is carried out as follows: at the initial stage, the doctor cuts the skin just above the metatarsophalangeal joint of the foot.The shortened connections and the joint capsule itself are highlighted.Typically, degenerative changes in tissues and ligaments provoke deformation of the thumb.Callus on the joint is removed using a chisel or saw.
An incision is made on the metatarsal bone at the level of the head, it is shifted outward and placed under the sesamoid bone.The phalanx is then secured using screws or wires and the capsule is closed.Titanium screws do not require removal after surgery, but the wires are removed three months after surgery, unless there is a need to do this earlier.
SCARF METHOD
In most patients, the bunion can be removed using a Scarf osteotomy.This operation is performed for moderate valgus deformity of the first toe.Today, surgery is the most universal method of treating valgus; it has many advantages over other methods.
The positive aspects of the operation are as follows:
- during the procedure, it is possible not only to shift, but also to rotate the head of the metatarsal bone, which allows one to achieve a more progressive result than with other surgical interventions;
- If the size is insufficient, the doctor may perform a bone lengthening procedure;
- with varus deformity, the bone can be shifted to the medial side;
- to reduce the load on the inside of the foot and the area of the first toe, you can move the bone slightly downwards and to the side;
- if necessary, you can shorten the length of the bone;
- When the joint is pronated, the bone elements can be rotated.
The surgery is performed under spinal anesthesia.The surgeon makes an incision on the inside of the foot from the beginning of the toe to the beginning of the metatarsal bone.After this, a zigzag cut is made on the side of the bone of the first toe, after which the head of the bone is shifted to the desired position, its angle changes.At the same time, the doctor also changes the location of the tendons that are attached to the thumb.
Then the deformed articular capsule is separated from the outside and the bones are fixed in the required position using titanium screws.Usually the fastenings are not removed; if they do not cause any discomfort, then patients continue to wear screws.Rehabilitation after surgery takes three to six weeks.Immediately after the intervention, patients are recommended to wear a special orthosis or splint, in which it is necessary to load the foot as early as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
Removing hallux valgus with a laser is also possible, but patients should not place high hopes on this method of surgery.Although it is minimally invasive and the most gentle, it is used exclusively at the early stage of development of the pathological process.
The undoubted advantage of surgical intervention is the small incision that doctors make near the largest point of the protrusion of the bone.After healing, such an injury is practically invisible, which allows for maximum restoration of the aesthetics of the foot.Using a laser, doctors are able to perform limited interventions:
- carry out exostectomy - using a laser, part of the cartilaginous growth that forms at the early stage of valgus is removed;
- make an osteotomy with a large incision - during surgery, the proximal phalanx of the first toe is removed;
- perform resection arthroplasty - the articular surfaces of the metatarsal bone and part of the phalanx of the big toe are removed.
Laser removal is usually performed in clinics where there is special equipment.Recovery after surgery is minimal - patients can walk normally after just a few weeks.
The only drawback of laser intervention is that the incorrect position of the bone cannot be corrected, but it is only ground to the required parameters.In this case, patients are at risk of relapse.
ARTHRODESIS
Surgery to remove valgus using arthrodesis is used quite rarely today, but sometimes it is the only way for patients to get rid of valgus of the big toe.Surgery is one of the most radical methods of intervention.
With the help of such surgery, it is possible to remove the base of the phalanx of the first toe and fix the toes together with special screws.
IMPORTANT! During the operation, the main goal is achieved - eliminating the deformity and giving the joint the correct position, however, not all patients become comfortable after such surgery.
There are serious contraindications to the intervention:
- vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- polyneuropathy.
With arthritis and arthrosis, patients may also be denied surgery if the joints are severely deformed, destroyed, or constantly inflamed.In this case, patients will be advised to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: severe pain, discomfort due to titanium fastening structures installed in the bone, and limping.Rehabilitation after the intervention lasts eight weeks.It is necessary to walk in a cast only in the first days after surgery - this is necessary to fix the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that will relieve stress from the operated leg.
Reviews
If a patient is undergoing surgery to eliminate valgus, he can read reviews and find out what types of interventions are performed and how effective they are.Here are some similar opinions:
“Last year I had to end my career as a ballerina due to a hallux valgus deformity.We did it using the scarf method, everything seemed to go well, but the leg still hurts when exerting itself.”
“I have been suffering from hallux valgus for a long time, but I did not dare to undergo surgery.I had a complex arthrodesis, recovery took more than two and a half months, but after the operation it became much easier.Now I can walk without a cane and have no pain.”
“The bone on my foot is hereditary - my mother and grandmother also suffered from gout.I decided to have surgery as soon as the first signs appeared.The operation was performed using a laser, all the excess growths were removed from me, now my leg looks normal, but the doctors told me to monitor for possible relapses.”
Surgeries for hallux valgus in most cases allow a person to solve the problem of a bunion on the finger.When the first signs of valgus appear, you should not delay treatment - the best results appear at an early stage of the development of the disease.