Vallus del Pollice dello del Foat Vallus is so common that in medical practice you can count more than four hundred options for the operational solution of this problem.Of course, not all interventions have had the same success and completely solved the problem of patients, so in modern practice the most progressive intervention options remained, in which the possibilities of recovery of patients are high.Today, the Khalus Valgus operation is focused on invasiveness as lower as possible in combination with a good therapeutic effect of the intervention.
Indications
Khalus Valgus is a problem not only for adults, but it can also appear in children.The formation of a cone on the thumb leg in the initial phase does not disturb patients until an acute pain appears during the walk, problems with the selection of shoes, periodic inflammation of the bone.At this stage, most patients are trying to relieve pain with popular methods.Various compositions and bathrooms only tighten the course of the disease and lead to the only true deformation solution of Valgus - surgery.
The indications for the operation are:
- increased pain in the thumb of the foot;
- Chronic inflammation, which cannot be stopped, constant swelling;
- damage to the skin in the curvature of Valgus (cracks, suppuration, ulcers);
- Plana Valgus foot with a pronounced curvature of the thumb joint;
- the inability to help patients with conservative methods;
- the appearance of a lame pace;
- Limiting the motor activity in the foot.
The doctors insist on the treatment of Vallus the thumbs only surgically, since most patients turn in the stage of the disease when it is not possible to correct the pathology in a conservative way.At the same time, if the treatment of the bone on the legs does not start, in the end it will lead to the redistribution of the load on other fingers, which is why the fingers will suffer and bend from the second to the fifth.Only with timely surgery can these complications be avoided.
Preparation for the intervention
During the operation for the Valgus deformation of the thumb joint of the foot, a serious preparation in orthopedics is carried out.The patient leads all the necessary tests.The key of them is a blood test, according to the results of which it is important to exclude the signs of the inflammatory process in the body.
In some cases, the standard analysis list can be integrated by determining the level of hormones and markers for oncology if doctors suspect the development of a malignant process on the feet.
A mandatory phase in orthopedic operations is a diagnosis of X -rays - during the study, the images are taken in two projections in order to determine the nature of the deformation and the severity of pathological disorders.
In difficult cases, doctors can resort to magnetic resonance imaging or computerized tomography.This study provides more accurate results.According to analyzes, doctors decide how it will be better to perform the operation.
Classification of surgery
All operations performed by Valgus can be divided into two large groups: an invasive operation and reconstructive interventions.The first type of surgery on the foot is characterized by a low trauma.
The operations are used limited, only in the initial phase of the development of the disease, if the deformation is insignificant and in the presence of a benign growth of cartilage, which is easily removed through surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most of the minimally invasive interventions are performed quickly and do not cause complications.The scars after this operation are minimal.The doctor acts from two to three drips, whose length does not exceed 0.5 cm.After these operations, the skin is restored very quickly and the period of inability to work is up to two weeks.
During reconstructive interventions, the volume of damage to soft tissues is more significant.However, a huge advantage of operations is that they also help to remove a significant deformation of the legs and help with a serious curvature.The incision in the reconstructive intervention reaches up to four centimeters, is located on the medial side of the foot.With this surgery, the doctors completely restore the anatomical position of the thumb of the foot.
You can also consider operations depending on the position in which they are performed.Three groups of interventions are distinguished: on soft tissues, on bone tissue and combined surgery.When you conduct interventions on soft fabrics, it is possible to eliminate the deformation of Valgus only if there is no deformation of the head of the bone more.During this intervention, the doctor works exclusively with soft fabrics: tendons, muscles, borses.
With surgery on bone tissue, it is possible to correct the deformation of the second and third degree.The intervention is to present a part of the bone or conduct osteotomy.With a combined operation, the intervention occurs both in soft and bone tissues.But the possibilities of this intervention are wider: doctors can simultaneously remove bone growth and create ligaments.
Operational techniques
Different operational techniques can be eliminated on the legs, each of which has its advantages and is selected with certain indications.
McBride operation
With surgery, McBraid is carried out in the first Inter -Flood interval just at the level of the heads.Using the terminals, the doctor spreads soft fabrics and makes a cutting of the ligament between fiodas, which is located on the surface.Subsequently, the surgeon gets access to the muscle tendon, which is responsible for the allocation of the first finger: it is mobilized and sewn by a special suture material - Vikril.
In addition, the doctor works with Sesam's shaped bones, he crosses a deep bundle that is attached to the Sesam -shaped bone, which is eliminated by his subluxation.Therefore, the capsule of the Plusnephalanx joint is sectioned on the external surface, after which the incision is made on the internal surface of the foot of about 5-6 cm in length, the nerve is released through it and is deflected on the side.
The dissection of the capsule is made in the form of the English letter V and its peak is directed towards the thumb.From above the bone and below it, the hooks of the homeman are removed under it, the growth of the cartilage on the head of the metatarsal bone are removed.If this is not done, patients will feel pain in the joint 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 radius that will attack the tendon to the bone fragments.In the final phase, the excess fabric of the capsules is removed, plastic with a certain tension of the tissues is performed, after which the surgeon sews the edges of the wound and transforms its surface.
Such a technique has been proposed more than eight decades ago, but to date the operation has not lost its relevance.So that after the intervention there is no relapse, after surgery, patients are recommended to wear special orthopedic shoes.
Serious technique
The operating technique for the minimally invasive technique of Seri was proposed in 1998 by the surgeon Cesare Faldini.Now it is also actively used in the surgical practice of doctors in many countries.It refers to procedures -low traumatic traumatics and is effective in the initial phase of the development of the disease and with a moderate foot valley curvature, when the corner of diverting the thumb of the foot does not exceed more than forty degrees.
REFERENCE!The operation is not carried out due to severe arthrosis.In addition, patients may refuse this type of intervention with the instability of the first metatarsal joke -falangea.
The operation on the foot is performed under local anesthesia.The doctor makes an incision in the projection of the head of the bone more than the thumb, opens the joint capsule, leads osteotomy with a special file or a chisel.In the process of this procedure, it is possible to obtain a further redistribution of the load on the distal part of the more bone.
In the surgery process, doctors use Kirshner's knitwear needle to create the correct position of the thumb: they start on the medial side of the surface in the direction of the spit, after which the doctor brings a finger in manual mode and set it to the right position.The operation in the rehabilitation process requires the use of a plaster dressing: it is applied for at least two weeks.The removal of the radius is carried out after about 1-1.5 months.
Chevron technique
The Chevron technique is used for minor deformations if the corner is less than 17 degrees.The main condition for the implementation of this intervention is the lack of arthrosis and other serious changes that the valgus of the foot causes.
The operational treatment is carried out as follows: in the initial phase, the doctor cuts the skin just above the joint joint of the foot.The abbreviated connections and the joint capsule itself are distinguished.Usually degenerative changes in the tissues and ligaments cause the thumb deformation.The bone corn on the joint is removed using a chisel or file.
On the metatarsal bone, an engraving at the head is performed, moves outside and is installed under the sesamoid bone.So, with the help of screws or thread, the phalanx is fixed and the capsule closes.After the operation, the titanium screws do not require removal, but eliminate the thread three months after surgery, if it is not necessary to do it first.
Scarf technique
In most patients, it is possible to remove the bone on the leg using scarf-oosteotomy.This operation is performed with a moderate valgus deformation of the first finger in the foot.To date, the operation is the most universal method for the treatment of Valgus, has many advantages compared to other methods.
The positive aspects of the operation are as follows:
- In the process, it is possible not only to move, but also turn the bone head more, which allows to obtain a more progressive result than with other surgical interventions;
- The doctor can with insufficient value to carry out the extension procedure;
- With the varin of deformation, it is possible to move the bone to the medial side;
- To reduce the load on the inside of the foot and the first area of the finger, you can move the bone a little downwards and on the side;
- If necessary, you can shorten the length of the bone;
- When the joint is pronounced, the bone elements can be rotated.
The surgery is carried out under spinal anesthesia.The surgeon inside the foot makes a cut from the beginning of the finger at the beginning of the metatarsal bone.Subsequently, a zigzag -shaped incision is made on the side of the bones of the first finger, after which the bone head is moved to the desired position, its corner changes.At the same time, the doctor changes the position of the tendons, which are attached to the thumb.
Therefore, a deformed joint capsule is separated from the outside and the bones are fixed in the required position using the titanium screws.Generally, the fixing devices are not removed, if they do not bring any discomfort, therefore patients and therefore go with screws.The rehabilitation after the operation takes three to six weeks.Immediately after the intervention, patients are recommended to wear a specialty or a special tire, in which it is necessary to load the foot as soon as possible.The tire rushes continuously while the recovery period passes.
Laser intervention
Valgus deformation is also possible with a laser, however, patients should not be highly hopes for such a method of surgery.Although it is minimal and more delicate, it is used exclusively in the initial phase of the development of the pathological process.
An undoubted advantage of the surgical intervention is a small incision, which doctors make close to the largest point of the protrusion of the bone.After healing, such an injury is not practically evident, which allows you to restore the aesthetics of the foot as much as possible.With the use of a laser, doctors have the opportunity to conduct a limited intervention:
- Existence is carried out - with the help of a laser, part of the cartilage growth is removed, which is formed in the initial phase of Valgus;
- Make osteotomy with a large cut: in the surgery process, the proximal phalanx of the first finger is removed;
- Perform the reset arthroplasty: the articular surfaces of the bone more and part of the thumb phalange are removed.
The removal of the laser is generally carried out in clinics where there are special equipment.The recovery after surgery is minimal: in a few weeks, patients can walk normally.
The only drawback of the laser intervention is that the incorrect position of the bone is not subject to correction and grows only under the desired parameters.In this case, patients are threatened with recurrence.
Arthrodesis
The operation to remove Valgus for Artodesi is used quite rarely, but sometimes this is the only way for patients to get rid of the big finger of the foot.The operation belongs to the most radical intervention methods.
With the help of this surgery, it is possible to remove the base of the phalanx of the first finger of the foot and fix the fingers with special screws.
IMPORTANT! During the operation, the main objective is achieved: by eliminating the deformation and giving the joint the correct position, but not all patients feel comfortable after this surgery.
There are serious contraindications for the intervention:
- vascular atherosclerosis and other circulatory disorders;
- Diabetic foot;
- Polyuropatia.
With arthritis and arthrosis, patients can also refuse surgery if the joints are very deformed, destroyed, constantly inflamed.In this case, patients will recommend minimally invasive surgery.
Among the complications of the surgical intervention, the following pathologies can occur, the discomfort due to the fixing structures in titanium installed in the bone.The rehabilitation after the intervention lasts eight weeks.Walking in plaster is necessary only in the first days after surgery: this is necessary to repair the elements.You can use a baroka boot.These are specially designed orthopedic shoes that will remove the load from the operated leg.
Reviews
If the patient has an operation to eliminate Valgus, he can read reviews and find out which types of intervention are performed and how effective they are.Here are some similar opinions:
"Last year, I had to finish the dancer's career because of the deformation of the Valgus finger. They made a scarf according to the method, it seems that everything went well, but the leg still hurts the load."
"I have been suffering for a long time for a long time, but I didn't dare to go to the operation. I made a complex arthrodesis, the restoration required more than two and a half months, but after the operation it became much easier. Now I can walk without a stick and I have not tormented pain."
"The bone on my leg is hereditary - My mother and grandmother also suffered from Gotta. I decided to do the operation as soon as the first signs appear. The operation was using a laser, all the extra jumpers have been removed, now the leg has a normal appearance, but the doctors said that they followed recent possible possible."
Valgus deformation operations in most cases allow a person to solve the problem of the bone on the finger.When the first signs of Valgo appear, do not postpone the treatment: the best results appear in the initial phase of the development of the disease.