Bunions are so common that there are over four hundred surgical solutions available in medical practices.Of course, not all interventions are equally successful and completely solve the patient's problem, so in modern practice there are still state-of-the-art interventions with which the patient's chances of recovery are high.Today, the focus of bunion surgery is to be as invasive as possible combined with good therapeutic intervention.
Indications
Bunions are not just an adult problem;It may also occur in children.A lump that forms on the big toe does not initially bother the patient until severe pain occurs when walking, problems with shoe selection, and periodic inflammation of the bone.During this stage, most patients try traditional methods for pain relief.Various dressings and baths will only prolong the course of the disease, leading to the only correct solution for bunion deformity - surgical intervention.
The operating instructions are:
- Increased pain in big toe;
- Chronic inflammation and persistent swelling that cannot be stopped;
- Skin lesions (cracks, suppurations, ulcers) in the area of valgus curves;
- The foot is flat and everted, and the big toe joint is severely bent;
- Inability to help the patient with conservative methods;
- Lameness of gait;
- Foot movement is limited.
Doctors insist on treating hallux valgus only with surgery, since most patients are treated at a stage of the disease where conservative correction of the pathology is not possible.Also, if left untreated, bunions can eventually cause the load to be redistributed to the other toes, causing the second through fifth toes to be affected and become crooked.Only timely surgical intervention can avoid such complications.
Prepare to intervene
When performing bunion surgery, orthopedics will perform careful preparation.The patient undergoes all necessary examinations.The key is a blood test, the results of which are important for ruling out signs of inflammatory processes in the body.
In some cases, if a doctor suspects a malignant lesion in the foot, a standard list of tests can be supplemented by measuring levels of hormones and cancer markers.
An essential stage of orthopedic surgery is diagnostic X-ray - during the study, images are taken with two projections to determine the nature of the deformity and the severity of the pathological disease.
In difficult cases, doctors may turn to magnetic resonance imaging or computed tomography.Such studies give more accurate results.Based on the test results, doctors decide which method is best for surgery.
Classification of surgical intervention
All surgeries performed for valgus can be divided into two broad categories: minimally invasive surgery and reconstructive intervention.The first type of foot surgery is characterized by minimal trauma.
The use of surgery is limited - only in the initial stages of disease development, when the cartilage tissue can be easily removed surgically if the deformity is not obvious and a benign growth of the cartilage tissue is present.In all other cases, minimally invasive surgery does not solve the patient's problem.
Most minimally invasive interventions can be performed quickly and without complications.The scar after surgery is minimal.The doctor will perform the intervention by performing two to three punctures, no longer than 0.5 centimeters in length.After these surgeries, the skin recovers quickly and the period of disability can last up to two weeks.
The volume of soft tissue damage is more significant when reconstructive intervention is performed.However, a huge advantage of surgeries is that they can help eliminate even severe deformities in the legs and help treat severe curvatures.The incisions made during the reconstructive intervention are up to four centimeters long and are located on the inside of the foot.With this surgery, doctors can completely restore the anatomical position of the big toe.
You can also think of actions based on where they are performed.Interventions were divided into three groups: soft tissue interventions, bone tissue interventions, and combined procedures.When performing interventional treatment on soft tissue, valgus deformity can be eliminated only if the metatarsal head is not deformed.During such an intervention, doctors deal exclusively with soft tissues - tendons, muscles, bursae.
Second- and third-degree deformities can be corrected through surgical intervention of the bone tissue.Interventions include filing away part of the bone or performing an osteotomy.In a combined procedure, both soft tissue and bone are intervened.But the possibilities for this surgery are broader - doctors can remove the bone growth and perform ligament reshaping surgery at the same time.
Operation skills
Bunions can be eliminated with a variety of surgical techniques, each with its own advantages and selected for specific indications.
Operation McBride
According to McBride, during surgical intervention, an incision is made in the first metatarsal space at the level of the head.The doctor uses clips to push the soft tissue away and makes an incision in the intermetatarsal ligament, which is located on the surface.After this, the surgeon enters the muscle tendon responsible for abducting the first finger - mobilizes it and sutures it with a special suture material - vicryl.
Next, the doctor treats the sesamoid bones; he cuts through the deep ligaments that attach to them, eliminating their subluxation.The metatarsophalangeal joint capsule is then dissected along the outer surface, and an incision about 5-6 cm long is made on the inner surface of the foot, through which the nerve is isolated and pulled laterally.
The anatomy of the capsule is in the shape of the English letter V, with its apex pointing toward the thumb.Hohmann's hooks are placed above and below the bone and remove the cartilage growth at the top of the metatarsal head.If this is not done, the patient will develop joint pain in the future.
In the future, depending on the need for osteotomy, surgical development can proceed in two ways.When an osteotomy is performed, pins are used to secure the tendon to the bone fragment.In the final stage, excess capsular tissue is removed, plastic surgery is performed under a certain tissue tension, and then the wound edges are sutured and its surface is processed.
This technology was proposed more than eight years ago, but it still has its relevance today.To prevent recurrence after intervention, patients are advised to wear special orthopedic shoes after surgery.
Serifa
The surgical technique using the minimally invasive SERI technique was proposed by surgeon Cesare Faldini in 1998.It is now also actively used in the surgical practice of doctors in many countries.This is a low-invasive procedure that is effective in the initial stages of disease development, when the foot is moderately everted and the big toe is not deflected more than forty degrees.
refer to!Due to the severity of the joint, no surgery was performed.Patients may also be unable to undergo 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 big toe metatarsal bone protrusion, opens the joint capsule, and then uses a special file or chisel to perform an osteotomy.During this procedure, further redistribution of the load on the distal portion of the metatarsal can be achieved.
During the surgical procedure, the doctor uses Kirschner wires to determine the correct position of the thumb - they are inserted in an oblique direction on the inside of the surface, and then the doctor manually moves the finger and sets it in the desired position.A cast will be required during recovery from surgery - for at least two weeks.The needles are removed after approximately 1-1.5 months.
chevron method
If the angle is less than 17 degrees, use the V-shape technique for minor deformations.The main condition for this intervention is the absence of arthropathy and other serious changes caused by foot valgus.
Surgical treatment works like this: In the initial stage, the doctor cuts the skin above the metatarsophalangeal joint of the foot.The shortened connections and the joint capsule itself are highlighted.Often, degenerative changes in tissues and ligaments cause thumb deformation.Use a chisel or saw to remove callus from the joint.
An incision is made on the metatarsal bone at the level of the head, which is moved laterally and placed under the sesamoid bone.Screws or wires are then used to secure the phalanges and close the capsule.The titanium screws do not need to be removed after surgery, but the wires will be removed three months after surgery unless removal is required earlier.
scarf method
In most patients, bunions can be removed using a Scarf osteotomy.This surgery targets moderate valgus deformity of the first toe.Today, surgery is the most common method of treating ectropion.It has many advantages compared to other methods.
The positive aspects of the action are as follows:
- Not only can the metatarsal heads be moved but also rotated during surgery, allowing one to achieve more progressive results than other surgical procedures;
- If the size is insufficient, your doctor may perform bone lengthening surgery;
- In varus deformity, the bone may shift medially;
- To reduce the load on the inside of the foot and the first toe area, the bones can be moved slightly downward and sideways;
- If necessary, the length of the bone can be shortened;
- As the joint pronates, the bony elements can rotate.
The surgery is performed under spinal anesthesia.The surgeon makes an incision on the inside of the foot from the toes to the beginning of the metatarsal bone.After that, a zigzag cut is made on the side of the bone of the first toe, after which the head of the bone is moved to the desired position, its angle changing.At the same time, the doctor also changes the position of the tendons that attach to the thumb.
The deformed joint capsule is then separated from the outside and titanium screws are used to fix the bones in the desired position.The fasteners are usually not removed; if they do not cause any discomfort, the patient can continue to wear the screws.Recovery after surgery takes three to six weeks.Immediately after the intervention, the patient is recommended to wear a special orthosis or splint, in which it is necessary to load the foot as early as possible.The splint wears out throughout the recovery period.
laser intervention
Laser removal of bunions is also possible, but patients should not have high hopes for this surgical method.Although it is minimally invasive and the most gentle, it is used only in the early stages of the development of pathological processes.
The undoubted advantage of surgical intervention is the small incisions made by the doctor near the largest point of protrusion of the bone.Once healed, this damage is virtually invisible, allowing for maximum restoration of the foot's aesthetic appearance.Using lasers, doctors are able to perform limited interventions:
- Perform an exostosis - using a laser to remove some of the cartilage growth that forms early in the valgus;
- A large incision osteotomy is performed - during the surgery, the proximal phalanx of the first toe is removed;
- A resection arthroplasty is performed - removing the articular surface of the metatarsal bone and part of the big toe phalanx.
Laser removal is usually performed in a clinic with special equipment.Recovery after surgery is very limited—patients can walk normally after a few weeks.
The only disadvantage of laser intervention is that it does not correct the incorrect position of the bone, but only grinds it to the desired parameters.In this case, the patient is at risk of recurrence.
Arthrodesis
Today, surgery to remove valgus via arthrodesis is rarely used, but sometimes it is the only way a patient can eliminate big toe valgus.Surgery is one of the most fundamental intervention methods.
With the help of this surgery, the base of the phalanx of the first toe is removed and the toes are fixed together with special screws.
Important!During the surgery, the main goal is achieved - eliminating deformities and giving the joints the correct position, however, not all patients will feel comfortable after the surgery.
The intervention has serious contraindications:
- Vascular atherosclerosis and other circulatory diseases;
- diabetic foot;
- Polyneuropathy.
For arthritis and joint disease, patients may also be unable to undergo surgery if the joint is severely deformed, destroyed, or persistently inflamed.In this case, the patient will be advised to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following conditions may occur: severe pain, discomfort due to titanium fastening structures installed in the bone, and lameness.Rehabilitation after the intervention lasted eight weeks.Walking in a cast is only necessary for the first few days after surgery - this is necessary for immobilization of the elements.You can use Baruch's boots.These are specially designed orthopedic shoes that take the pressure off the surgical leg.
Comment
If the patient is undergoing surgery to eliminate ectropion, he can read reviews and learn about the type of intervention performed and its effects.Here are some similar sentiments:
"Last year I had to end my career as a ballerina due to bunion deformity. We were using the scarf method and everything seemed to be going well, but my legs still hurt when I pushed."
"I have been suffering from bunions for a long time, but I have always been afraid to have surgery. I had a complex joint fusion surgery and recovered for more than two and a half months, but it became much easier after the surgery. Now I can walk without crutches and there is no pain."
"The bones in my feet are hereditary and my mother and grandmother also suffered from gout. When the first signs appeared I decided to have surgery. The surgery was done with a laser and all the excess growth was removed from my body and now my legs look normal, but the doctor told me to monitor for possible recurrence."
In most cases, bunion surgery can resolve the problem of finger bunions.You should not delay treatment when the first signs of ectropion appear - the best results occur at an early stage of the development of the disease.