Types of surgical interventions at the Halus valgus

hallux valgus

Hallux valgus (Halus valgus) – a pathological transformation of the first metatarsophalangeal joint. With the development of the disease after thumb for the transformation of the other fingers. In the early stages of therapy are widely used various orthopedic devices. In cases, when conservative medicine is ineffective, surgical procedure. Halus valgus surgery fixed a severe deformity of the foot. The type of surgery depends on the severity of the disease and the presence of comorbidities.

The causes of the disease

Halus valgus inconvenience while walking and spoils the look of the foot. In addition, the disease, which can impede circulation, causing the formation of bursitis and arthritis. Look Halus valgus can cause:

  • Disorders in the endocrine system;
  • The weakening of the ties;
  • The omission of longitudinal and transverse arches of the foot;
  • The age of the injuries to the bones;
  • Genetic disposition.

Medical practice finds much evidence that Halus valgus is more common in women, who prefer shoes and boots with high heels. Often stop transformirovalsya representatives of some professions, for example, the ballerina. Observed and "nepotism" Halus valgus – often mothers and grandmothers of patients who also suffer from such deformation. In men the ligaments, the more elastic and firm, so Halus valgus are diagnosed mostly after an injury.

Symptoms of Hallux valgus

symptoms

In the early phase of the Halus valgus inherent stiffness and discomfort when walking. The progression of Hallux valgus is often accompanied by bursitis, the inflammation of the lining of the bag in the region of the joint, aggravantes the course of the disease. In addition to pain when walking and sometimes at night. But they differ in severity, from barely noticeable to unbearable, cutting or longer hurt.

Stop loss amortization feature. The further course of the disease may cause changes in the intervertebral disks and trigger the manifestation of osteochondrosis, osteoarthritis. Pain whining character in this stage of the Halus valgus occur in the spine. Without movement, the patient feels numb limbs and weight, and when the engine load is pain.

At the same time the joint swells. The increase causes the synovial folds. As a result, the cartilage thins, the bones are forced to touch each other. Wear of articular surfaces causes the appearance of osteophytes – abnormal growths of tissue bone.

The development of the disease

The gradual development of the Halus valgus often do not diagnose the disease at an early stage, when pathological disorders can still be adjusted with the help of traditional therapy and the use of special devices. A small seal at the base of the thumb is often think corn and trying to get rid of with conventional methods. But over time, the "corn" increasingly solidifies and expands, causing pain during movement.

The excessive load experienced by the joint, causing inflammation of the bone tissue. When the big toe shifts angle more than 30°, all of the deformed toes. Orthopedists divide by Halus valgus in three stages:

  • I – the finger moves to the outer edge at an angle less than 25°, the metatarsal bone inward, at an angle less than 12°;
  • II – the finger moves to the outer edge at a 25° angle of the metatarsal bone inward at an angle less than 18°;
  • III – the finger moves to the outer edge at an angle above 35°, the metatarsal bone inward, to an angle larger than 18°.

Important! The rate of change in the structure of the foot is the main factor in determining the methods of surgical treatment Halus valgus.

Indications for surgery

The main indications for surgical treatment Halus valgus – pain, inflammation and damage to the tissues of the bones. Hallux valgus can be cured by conventional methods to complete formation of the skeleton, only in children and adolescents. In the adult patient, so that the disease can only slow down to stop the pain, if you want to continue with the load on certain parts of the foot and prevent the development of complications.

methods of treatment

If you want to solve the problem with the Halus valgus allows for surgical treatment. Operational plan Halus valgus of the foot was developed for each patient, the disease, arising from the different manifestations and complications.

Types of surgical interventions

A method for surgical intervention affect the nature of the disease, the degree of adverse tissue changes, the presence of a serious contra-indications. There are more than three hundred types of operations for the Halus valgus. They are divided into main groups:

  • Affect the the soft tissue.
  • It works on the bone;
  • Combines the manipulation on the soft tissues and the bones.

Before surgery Hallux valgus excised condyles. Such traumatic effects resulted in a consequential impairment of the function of the foot. Now the orthopedists prefer to do less traumatica of the operation.

Gentle technique

Minimally invasive operations are shown in the first stage of pathological processes. Include manipulation, slightly affecting the soft tissue and also tendon. The purpose of sparing techniques – the reconstruction of the aesthetics and the elimination of discomfort when moving. Such operations, which allow patients to recover quickly. However, the unacceptable risk for the development of hallux valgus disorders in the future.

During the operation, that the two holes (3-4 mm) on both sides of the first toe. The use of microtools, open the joint capsule, which, when disease is often compressed. Its extension through a small incision gives room for setting the axis of the finger in a physiological position. For the complete elimination of the curvature of the fingers of some of the bone rasp micro caedentes. In the implementation of the manipulations, which uses x-ray control. Special clamps are not used.

Reconstructive surgery

removal

In this type of surgical interventions produce a longitudinal incision with a length of 2-4 inches in the area of the lateral plane of the foot. The big toe is installed in a physiological position. The growth of the bones has been agreed upon in the field of the articulation of the finger and the shank restore ties.

On the metatarsal bones, affects in several ways:

  • Austin, aka the bone (cut In - or L-form) – for small movements of the thumb (less than 17°);
  • Scarf (cut a Z-shaped) – in the case of medium and severe forms of deviation of the finger (from 17° c up to 40°);
  • Like (dissection of the sphenoid) is often combined with minimally invasive methods.

After the osteotomy of the bone fragments fixed with a compression screw made from titanium. They do not usually require extraction. If you encounter problems with titanium retainers removed as an outpatient three months later, after surgery.

Arthrodesis

This method is most radical surgery on Halus valgus on the background of osteoarthritis. This creates a fixed joint. Remedied and pain, and morbo laborans articulari symptoms and deformity. The lack of joints does not affect the walking of the patient and his activities.

Arthrodesis is used if other therapies Halus valgus did not bring the expected result. When is a surgical procedure fragments of the articulation of the rigid connection with the special screws. Before you install the screws and remove the joint surfaces of the first metatarsal head and the proximal phalanx of the first toe. The physiological structure of the foot is restored, the symptoms of osteoarthritis disappear.

Contra-indications and complications

Each surgical manipulation is absolutely contraindicated in:

  • Serious illness of the extremities of the arteries (atherosclerosis);
  • Diabetic effects on the peripheral nervous system (diabetic foot);
  • Purulent infections;
  • In diseases of the hematopoietic organs.

When arthritis and arthritis surgical treatment feasible. But, the choice of the mode of operation of the Halus valgus, take into account the occurrence of possible complications during the operation itself and the recovery.

After the surgery Halus valgus reconstructive form can appear complications, which are part of the open cavity of the female intervention:

  • Infection of the tissues;
  • Blood clots in deep veins;
  • Aseptic necrosis of the head of metatarsal (very rare);
  • Limitation of the functional activity of the first finger;
  • Violation of the nervous cords;
  • Swelling of allergic nature;
  • Numbness of the extremities.

Complications arise rarely. Typically, patients after surgery feels good, both in youth and in adulthood.

recovery

Recovery

After surgery patients are assigned bed rest. On the first day you can gradually work – in the first move of the fingers. On the third day you can do something similar. Your doctor will tell you what to wear after surgery Halus valgus. At first only for orthopaedic devices (orthoses), which is to remove the burden from the affected part of the foot. Under the supervision of a physician in the hospital, the patient from 10 days to 14 days.

At the water treatment for removing the seams, it is necessary to wrap the legs in plastic. The bandage not to slip and wet, otherwise it can cause a recurrence. If you want to walk without orthopedic devices are allowed, not earlier than six weeks. In the area of the foot and lower ankle joint a maximum of three months after the surgery Halus valgus can persist swelling. They are removed with cold compresses.

For early refund of the function of the foot and treatment of postoperative wounds, which are used:

  • Massage;
  • Electrophoresis;
  • The procedures extracorporeal shock wave therapy;
  • Exercises from the physiotherapy.

Two months after surgery Halus valgus, the patient may recommend preventive swimming and an exercise bike. Full recovery after surgery Halus valgus takes four to six months. However, from time to time the foot should be set at a level above the head. For the load is worth it. At night you can use a corrective splint. After the surgery, Halus valgus, it is advisable to massage the arch of the foot to the ball for tennis.

Postoperational rehabilitation will accelerate the special boots, designed for the continuity of the joints of the feet and not having them repressive effect. Wear such shoes need not less than three months. On completion of the uncomfortable shoes and high heels are best forgotten.

Important! If necessary, the surgery on both legs, it is recommended to implement them with a break from three to six months.

After operating Halus valgus advanced methods patients almost immediately able to walk. It is important, however, to entrust the operation to a qualified technician and follow all recommendations in the postoperative period.

11.09.2018