Surgery deformity of the big toe of the foot (Hallux Valgus)

Valgus deformation of foot - ортопедическое disease is well evident in the патологическом change the shape of the hand, in which at the given position at an angle to each other. The most common form of the disease is a valgus deformity of the big toe the feet, which can be easily determined on the basis of the outward - bulging side bump in the finger establishing.

Pathology not only brings discomfort when walking and spoils the aesthetic appearance, but also leads to the development of arthritis, bursitis, circulatory disorders, injuries in the area of the ankle the flag. The causes of вальгусной deformation of the first finger of the foot (Hallux valgus), are:

Surgery deformity of the big toe of the foot (Hallux Valgus)
  • Endocrine disorders;
  • Flat feet (cross and продольное);
  • Weakened articular ligaments;
  • Age дистрофические changes in the bone tissue (13% in patients over 60 years of age);
  • A hereditary predisposition.

There are numerous confirmations of the fact that the disease is largely exposed to the ballerinas, as well as women, those who prefer to wear shoes with high heels. Imbalance связочно-tendon complex, went in too high elasticity of the joints, leads to поперечному плоскостопию, and in consequence, on the Hallux valgus.

The development of the disease

The slow progression of the disease not always allows to perform diagnosis in an early stage, when the deformation of the inappropriate correction through the application of conservative therapy and orthopedic aids (ортезов). Appeared soft education the founding of the first finger is often mistaken for ' with fingers on your feet, and use traditional methods, how to get rid of defects. Of course, that such treatment does not give results - with time the lump hardens, swells in size, causing pain when walking.

In the next stage, the first finger visibly twisted, deviate to the left to the edge of the legs and смещая the other fingers. Plus-phalangeal joint is subjected to excessive load, which leads to inflammatory and degenerative processes in the bone tissue (Hallux rigidus). In rejecting the thumb at an angle more than 30 degrees is happening deformity of all the fingers of the foot (hammer-shaped curvature, натоптыши, ingrowth of the nail).

Phase deformation

In orthopedics, we distinguish three degrees of Hallux valgus:

  • Even stage. The angle of deviation of the first finger кнаружи less than 25 degrees, the deviation of the metatarsal area of the bone on the inner side less than 12 degrees.
  • II stage. The angle of deviation of the first finger кнаружи more than 25 degrees, the deviation of the metatarsal area of the bone on the inner side of less than 18 degrees.
  • III stage. The angle of deviation of the first finger кнаружи more than 35 degrees, the deviation of the metatarsal area of the bone on the inner side of more than 18 degrees.
Indications for operative treatment

The degree of deformation joint pain complex is the main factor in the selection operation when the вальгусной deformation of the feet.

Indications for operative treatment

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

In the adult it is only possible to suspend the progression of the pathology, partly to alleviate pain, restore physiological burden on the various departments of the feet, and also prevent the development of serious complications. For this purpose are orthopedic accessories (insoles, inserts, фиксаторы, bandages). Completely solve the problem with Hallux Valgus is possible only by surgical methods.

Operation plan is developed individually for each patient, because this type of pathology is different a great variety of manifestations and complicating factors, of which the most common are: small blisters of the fingers, osteoarthritis of the metatarsophalangeal joint, остеомиелит, arthritis, soft-tissue infection.

Types of operations on the стопе in HalluxValgus

The choice of methodology for the implementation of the operations is defined by the nature of the pathology, the severity of the lesion of the tissues, the presence (absence) of relative contraindications. In the first stage is applied sparing technique (mini-invasive), in which in the minimum degree affected by the soft tissue and tendons.

The goal of surgery is to restore aesthetic appearance of the foot, eliminating discomfort while walking. This type of operation allows you to quickly restore the physical form, painlessly convert period of rehabilitation. At the same time, it is not excluded, the probability of the emergence of tuesday the process вальгусной deformation of the legs in the distant future. At 3 degrees вальгусной deformation of the minimally invasive techniques do not apply.

Minimally invasive surgery (mini-invasive)

The first phase - is the excision of the bone of paperwork build-up, and subcutaneous mucous membrane of the bag, adjacent to the base of the first metatarsophalangeal joint. The operation is performed in the x-ray-control (ЭОП), without open access to the surgical field. Carry out manipulation is carried out two minor defect on both sides of the first finger (3-4 mm).

Using microtools done by opening the joint capsule, is held латеральный edition (restores the correct position of the axis of the first finger), the part of the cores filed using microfrezers - for the complete removal of deformation of the big toe. Minimally invasive surgery does not use fixers (штифтов, screws, plates or clamps).

Types of operations on the стопе in HalluxValgus

Реконструктивные operation when the вальгусной deformation of the feet

The technique of reconstructive surgery includes the following steps:

  1. Made a small longitudinal incision (2-4 cm) in the area of the lateral surface of the foot.
  2. Performed латеральный the release of the first metatarsophalangeal joint.
  3. Removed the bone of the game result (exostosectomy) with the subsequent restoration of the articular ligaments in the area of connection of the metatarsal area of the bone and first finger.

Shaved metatarsal area of the bone to one of the methods:

  • Остеотомия AUSTIN (шевронная, In-shape or L-shape of the contour);
  • Остеотомия SCARF (Z-shape);
  • Остеотомия AKIN (клиновидный распил in the area of the proximal phalanx of the first finger);
  • Проксимальная sightseeing (or клиновидная) остеотомия.

Surgery to remove the seeds with your thumb (hanlux valgus) is as follows:

  1. Performed fixation of the joint in неподвижном position (creating an artificial ankylosis).
  2. Is excluded, the deformation of the soles of the feet by shifting components of the first metatarsal area of the bone.
  3. Are set out of the bone fragments after osteotomy using a compression titanium structures.
  4. Зашивается capsule, superimposed on a cosmetic seam.
  5. Superimposed sterile and elastic bandage.

Important point - in the implementation of the chevron osteotomy, the surgeon constantly monitors the situation of the sesamoid bones using ЭОП-Рентгена, due to the fact that the area of their shift is limited.

The kind of anesthesia (local anesthesia or general anesthesia) is selected individually, on the health status, and the obligatory appointment with the patient.

Video: the progress of the operation in вальгусной deformation of the feet

Contraindications to the surgical treatment of Hallux Valgus

Absolute противопоказаниями to the leadership of the operation are:

  1. Severe peripheral vascular disease (obliterating atherosclerosis);
  2. The defeat of the peripheral nervous system due to diabetes (diabetic foot);
  3. Diseases of organs, diseases of hematopoiesis;
  4. Purulent infection.

Arthritis and osteoarthritis are противопоказаниями to the surgical treatment, but when choosing the technique of operation are factored the possible complications during the operation itself, and in the period of rehabilitation.

Possible complications

After the reconstructive surgeons can develop the same complications that exist in each of the cavernous operations:

  • Deep vein thrombosis;
  • Injection of the tissues;
  • Aseptic necrosis of head of metatarsal area of the bone (very rarely the result);
  • A decrease in the motor function of the thumb;
  • Damage to the nervous system;
  • Allergic swelling;
  • Numbness of the fingers;
  • The pain in the pads of the feet

Referred complications occur rarely, basically surgery patients tolerate well - both in young and old age.

Recovery after surgery

The first day after surgery is indicated bed rest. Can be done light development of the feet - several times a day the patient performs the movement of your fingers. Walking is allowed on the third day, and only in a special orthosis, which removes the burden from the прооперированной part of the forefoot.

The recovery of a normal walking mode (without the use of ортеза) - no earlier than 6 weeks. Full rehabilitation is achieved in 4-6 months ( after this time it is possible to actively play sports, wear high-heeled shoes). During the stay at the clinic under the supervision of a doctor - from 10 days to two weeks. The patient доложен know that swelling in the legs and lower part of the ankle joint after surgery can persist long enough within three months. How to reduce the swelling, a moment of rest applying tiles deck

To speed up the process of rehabilitation of legs (supine) holds in height. When exceeding the recommended load may experience a burning sensation and pain in the feet, that is sometimes caused by a shift of the holder. It is necessary to take responsibility for врачебным condition after surgery - from пунктуальности compliance with the rehabilitation requirements depends on the speed of healing.

If you want to increase the effectiveness of tissue healing and restoration of functionality of the feet, apply the session shock wave therapy, massages (not less than 15 procedures) legs (from the feet to the thighs), electrophoresis, therapeutic physical training. Over two months after surgery in the recovery program include swimming and classes on a stationary bike

06.08.2018