When you see bones on his feet in a timely appeal to the orthopedist allows you to correct the deformity by conservative methods
Unfortunately not all people pay attention to the changes in the foot before the appearance of symptoms of pain, and the doctor is forced to admit that the situation is running, and only the removal of the bones in the big toe can correct the pathology (surgery allows not only to get rid of pain and prevent progression of the disease, but also to restore the arch of the foot).
Types of surgical treatment of bunions on the foot
Surgery to remove the bones in the foot takes place after additional diagnostics, which allows you to accurately assess the degree of deformation, for the identification of the comorbidities and disease.
The choice of surgical technique (there are about 100 different ways) is affected by:
- type of deformation;
- the status of the bone and the soft tissues of the patient;
- the presence of systemic diseases.
As for removing the bones of the feet, which are currently in use in most cases, less traumatic techniques and modern anesthetics, the patient's age does not affect the choice of method for surgical intervention.
- Osteotomy, which is used in most cases as the most effective method. In all types of osteotomy during surgery, the deformed joint is dissected tissues, bone intersects (transversely closer to the nail, or at its other end, Z-shape or along the main phalanx), fragments of bones are installed in the correct position and fixed with clips or special screws.
- Arthrodesis. This type of surgery is performed in very rare cases, since the main purpose of the activities: creating a fixed connection that does not allow to restore completely the foot. Indications for this type of operation is badly damaged big toe joint that cannot be returned to the correct position using osteotomy. Metatarsophalangeal joint during surgery is removed and the bones are united. The disadvantage of this method are caused by exertion pain sensation at the site of adhesions, as well as the need to wear orthopedic shoes.
- Arthroplasties Resection, which removes part of the articular surface. So between the parts of the bone is hollow, which is in the healing process fills in the connective tissue (so to form a false joint). Full restoration of function of the foot, this activity does not.
- Correction of the transversal arch of the foot. In this type of surgical intervention should be adjusted, not joint, and the bones and the soft tissues around the problem areas. During the operation, with thumb on 1. metatarsal bone is transplanted tendons of the adductor muscles of the thumb, the muscles cease to have the big toe in the deviated position, the angle between the bones of the foot change, and the arch of the foot to regain its normal shape. This method is effective in the initial stage of the disease.
- Exostectomy, which removes the lump itself (part of the metatarsal head), and soft tissue surrounding the affected joint. Walking after surgery is restored, pain eliminated, but relapses.
Operation on bone of great toe, crossing the bone is most commonly performed with the use of the method:
- Scarf-osteotomy. Use with moderately severe hallux valgus. It allows you to move in the longitudinal direction and rotate a part of the metatarsal head, to lengthen or shorten the first metatarsal bone, to shift the bone fragments, thereby achieving greater proportionality of the joint and reduce pressure on the joint and the inner part of the foot. Good results the method gives, in combination with the correction of the soft tissues.
- Osteotomy the Austin/Chevron, in which is In the form of the intersection of the first metatarsal bone. In the case of minor hallux valgus, and allows you to move the heads of the metatarsal bones to 1/2 its width (a shift of more than 1/2 of the width of bone necessary for bone fusion stability may not be enough).
- Like osteotomy, which is performed on the main phalanx (at the level of the proximal, adjacent to the epiphyseal plate of the long bone part). Accompanied by a manual correction of hallux valgus. Bone crossed parallel to the metatarsophalangeal joint and the nail bed a great a finger, the wedge-shaped fragment is removed.
Surgery to remove the bunions on the big toes but can also occur:
- According to the method of Vale (oblique metatarsal osteotomy of a small bone). It allows you to shift the bones toward the center in the longitudinal direction, returns the head of the metatarsal bone to its normal position and helps eliminate malleus informibus deformation of the fingers.
- According to the method of Schede-Brandes (regional resection of the medial curvature of the bone (exostosis')). During the operation removed the bone on the side of the surface 1. metatarsal bone and the proximal part of the proximal phalanx of the thumb, the set locking the foot in a certain position plaster splints, and then for 2 weeks, traction for the nail phalanx of the thumb.
A good cosmetic result gives the operation to remove the bone on the legs by the method of the Worth-Mayo (is to remove the head 1. metatarsal bones together with the flat), but the removal of the main base pad of the foot while walking after surgery is a violation of the support function of the foot.
The removal of bunions on big toe by the method of Calcina (the intersection of the bone with the rotation of the head 1. metatarsal) and the trapezoidal wedge resection 1. metatarsal bones by the method of Bohm and Reverdens not the proper medium deviation of 1. metatarsal bones and restore the arch of the foot, so often accompanied by relapses.
The patient may be offered reconstructive surgery, which are intended for the correction of several components of the deformity:
- Method Kramarenko and knights, that after the operation according to the mode Schede-Brandes, to the proper central deviation of 1. metatarsal bone distal to the planetinvader joint is made a transverse osteotomy, and in the resulting wedge-shaped gap score is generated from previously distant parts of the bone. From Mylar tape, which is formed by the transverse ligaments of the foot, which has a 1. metatarsal bones in the right position (tape stitched to the edge of the capsule 1 St and 5 th metatarsophalangeal joints). After surgery on the foot for 4-5 weeks in a plaster bandage.
- The operation of the Cake and Eremenko, in which the bone does not overlap, as the defect is removed, after the removal of 1. planetinvader joint. The transverse ligaments of the foot is formed from the tendons of the long extensor 4. finger of the foot.
- Operation by the method of CITO, which is accompanied by the formation of transverse ligaments of the foot of the Mylar strip in the form of eight on Klimov.
If necessary, the endoprosthesis, in which the deformed joint is completely removed and replaced with artificial.
How is the destruction of the bones in the foot
Currently, to remove the bones in the legs, it is possible, with a minimum of damage to the:
- Minimally invasive technique, where the cut does not exceed 3 mm (with an important strain – 10 mm). Surgical procedures (the intersection of bone and the displacement of its parts), is performed through a small incision under the supervision of the radiography. The advantages of the minimal invasive osteotomy include a short recovery period and nearly imperceptible scarring, pain and risk of complications is minimal. Minimally invasive surgery does not require General anesthesia (using local or epidural), but can be used only with a mild deformity of the thumb.
- The Laser, which allows you to remove the bones by very thin layers, thus keeps the wearer. The rehabilitation period is shorter than when using the traditional setting for surgery (the drill, the needle screwdriver clamp). Laser removal of bone in the legs is used when the patient has no other deformities of the foot and complications of hallux valgus.
Access during operation, you can:
- open the (fabric is cut to the bone with a scalpel, the surgeon, by visual inspection, control of the process of correction);
- closed (manipulation is performed through a small incision, control is carried out by x-ray).
Removal of bone in the legs of the laser – grinding the bumps on the legs to complete the comparison with the side surface of the foot, passing through a small incision. Removal of bone with the help of laser resurfacing is accompanied by:
- resection arthroplasty.
Advantages of laser removal of hallux valgus include:
- disinfection of the wound, under the influence of the laser, which reduces the risk of infection to the lowest possible level;
- minimal loss of blood due to the small size of the incision through which the manipulation is carried out;
- does not affect the surrounding tissue;
- fast recovery;
- shorter duration of action (duration of 1 hour, while removing the bumps the traditional surgery takes about 2 hours);
- there is no need to wear a cast.
Remove the bones in the foot using any method, which consists of several phases. Often during the operation:
- On the inner side of phalanx of great toe, a cut is performed.
- The capsulotomy (incision of the capsule of the first metatarsophalangeal joint).
- Performed excision of bone curvature (deleting cones).
- Cut the first metatarsal bone (osteotomy is performed).
- The surgeon repositions the bone fragments of the shank with the change of the axis of the deformed area.
- The bone is attached with screws from titanium or buckle.
- Capsule and the incision sutured.
- For access to the sterile bandage.
- Stop used down the bandage or patch (depending on the type of operation).
Titanium screws, in the absence of discomfort is not removed.
Although the operation on his leg to remove the bone, is usually performed with the use of minimally invasive techniques, there are a number of contraindications for its implementation. Surgery is contraindicated in:
- thrombosis, which accompanies the inflammation of veins and blood clotting;
- diabetes, obesity;
- cardio-vascular failure;
- violation of blood circulation in the tissues of the foot;
- diseases of the musculoskeletal.
Removal of bone on the foot with a laser has virtually no contraindications, however, before the procedure, it is necessary preoperative examination.
Preparation for the surgery
Before you can remove the bones in the legs, should be a thorough diagnosis, allowing to identify all foot pathology – radiography of the foot from different sides or magnetic resonance imaging.
In addition to the removal of bumps on feet from thumb surgery may involve removal of the deformation in the form of other hammer toes, etc ..
The patient is in the order of the preoperative examination is sent for testing:
- blood (General, biochemical, sugar, blood coagulation);
- urine (General analysis);
- for the detection of hepatitis and HIV;
- chest x-rays.
The duration of the rehabilitation period depends on:
- the number of removed tissue;
- the mode of action.
In any case, in the postoperative period requires the fixation of the foot. If the patient has been removed, only part of the metatarsal bone and the operation was carried out without the use of the laser, the stop is limited to 4 weeks, when you remove it, with a total this period increased up to 10 weeks.
Rehabilitation after minimally invasive or laser surgery takes less time and, judging by the reviews, running more smoothly.
The load on the foot in the postoperative period is limited walking is allowed on average per week (the pressure on the operated foot is limited). Regular walking is allowed after consultation with the attending physician (average per month). After Scarf-osteotomy of the permitted loads on the foot in a special brace after surgery.
The patient shall be granted:
- complex therapy (antibacterial, anti-inflammatory and painkillers);
- medical-physical complex that the doctor selects individually;
- wearing soft wide shoes with thick arch support, or orthopedic shoes;
- wearing orthopedic insoles.
Physical therapy in the postoperative period, which is assigned to a, still, but the beginning of its implementation is depending on the mode of operation is:
- During the operation Schede-Brandes therapeutic gymnastics is conducted by 4., 5. the day after surgery. The patient is recommended to constantly wear a liner, which has a 1. the toe in the correct position.
- In the application of procedures Kramarenko and the knights began to perform physical therapy for 1. toe on 5. day. After the removal of the determination of the plaster bandage, the leg is provided with a rubber sleeve, which supports the transversal arch.
- Using the method of the cyto plaster immobilization lasts for 1-1. 5 months. LFK starts to work with the 4-th, 5-th day after surgery.
Exercises in the postoperative period similar to the exercises that are used for the prevention of hallux valgus.