When you see the bone on his leg a timely appeal to the orthopedist allows you to correct the deformity with conservative methods
Unfortunately, not all people pay attention to 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 the progression of the disease, but also to restore the arch of the foot).
The types of surgical treatment of bunions on the foot
Surgery to remove the bones in the foot takes place after additional diagnostics, which allows to accurately estimate the degree of deformation, to identify comorbidities and disease.
The choice of surgical technique (there are about 100 different ways) is affected by:
- type of deformation;
- the condition of the bones and soft tissues of the particular patient;
- the presence of systemic diseases.
As for removing the bones on the feet are currently used in most cases, less traumatic techniques and modern anesthetics, the patient's age does not affect the choice of method of surgical intervention.
- Osteotomy, which is used in most cases as the most effective method. In any type of osteotomy during surgery on the deformed joint is dissected tissue, bone intersects (transversely closer to the nail, or at its other end, Z-shape or along the main phalanx), bone fragments 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 operation: creating a fixed connection that does not allow to restore completely the foot. The indication for this type of surgery 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 joined together. The disadvantage of this method are arising after 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. Thus between parts of the bone is hollow, which is in the healing process fills in connective tissue (thus forming a false joint). Full restoration of function of the foot, this operation does not.
- The correction of the transverse arch of the foot. In this type of surgical intervention is to be adjusted, not joint and the bone and soft tissue around problem areas. During the operation, with thumb on the 1st metatarsal bone is transplanted tendons of the adductor muscles of the thumb, the muscle ceases to hold the big toe in the deviated position, the angle between the bones of the foot change, and the arch of the foot regains its normal shape. The method is effective in the early stages of the disease.
- Exostectomy, which removes the lump itself (part of the metatarsal head), and soft tissue surrounding the affected joint. Gait after the operation is restored, pain is eliminated, but relapses.
Operation on bone of the great toe, crossing the bone is most commonly performed using the method:
- Scarf-osteotomy. Use with moderately severe hallux valgus. Allows you to shift in the longitudinal direction and rotate a portion 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 decrease strain on the joint and the inner part of the foot. Good results the method gives, in combination with correction of the soft tissues.
- Osteotomy the Austin/Chevron, in which is a V-shaped intersection of the first metatarsal bone. Applies in the case of minor hallux valgus, allows you to shift the head of the metatarsal bone on 1/2 of its width (the displacement of more than 1/2 of the width of bone necessary for bone fusion stability may not be enough).
- Akin osteotomy, which is carried out on the main phalanx (at the level of the proximal adjacent to the epiphyseal plate of the long bone part). Is accompanied by a manual correction of hallux valgus. Bone crossed parallel to the metatarsophalangeal joint and the nail bed of a large finger, wedge-shaped fragment is removed.
Surgery to remove bunions on the big toe, but may also occur:
- According to the method of Vale (oblique metatarsal osteotomy of small bones). 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 to eliminate the 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 a bone on the lateral surface of the 1st metatarsal bone and proximal part of proximal phalanx of the thumb, superimposed locking foot in a certain position plaster splints, and then for 2 weeks is traction for the nail phalanx of the thumb.
A good cosmetic result gives the operation to remove the bones on the legs by the method of Vreden-Mayo (is to remove the head of the 1st metatarsal bone together with the lump), however, due to the elimination of the main base pad of the foot during walking after the surgery there is a violation of the support function of the foot.
Removal of bunions on big toe according to the method of Calcina (the intersection of the bone with the rotation of the head of the 1st metatarsal) and the trapezoidal wedge resection of the 1st metatarsal bone by the method of Bohm and Reverdens not correct the medial deviation of the 1st metatarsal bones and restore the arch of the foot, so often accompanied by relapses.
The patient may be offered reconstructive surgery, aimed at correcting several of the components of the deformity:
- Method Kramarenko and knights, which after the operation according to the method of Schede-Brandes to correct the medial deviation of the 1st metatarsal bone distal to the planetinvader joint is made transverse osteotomy, and in the resulting wedge-shaped gap score is generated from previously remote portions of bone graft. Of Mylar tape is formed by the transverse ligament of the foot, which holds the 1st metatarsal bone in the right position (tape stitched to the edges of capsules the 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 by removal of the 1st planetinvader joint. Transverse ligament of the foot is formed from the tendons of the long extensor of the 4th 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 tape in the form of eight on Klimov.
If necessary an endoprosthesis, in which the deformed joint is completely removed and replaced with artificial.
How is destruction of bone on the foot
Currently, to remove bones in the legs is possible with a minimum of injury by:
- Minimally invasive techniques where the incision does not exceed 3 mm (with significant strain – 10 mm). Surgical procedures (the intersection of bone and the displacement of its parts) are done through this small incision under the control of radiography. The advantages of minimally invasive osteotomy include a short recovery period and nearly imperceptible scarring, pain and risk of complications is minimal. Minimally invasive surgeries do not require General anesthesia (use of local or epidural), but can be used only with a mild strain of the thumb.
- Laser that allows you to remove the bone with very thin layers, thus preserving joint mobility. The rehabilitation period is shorter than when using the traditional set for surgery (the drill, the needle screwdriver clamp). Laser removal of the bones in the legs is used when the patient has no other foot deformities and complications of hallux valgus.
Access during the operation can be:
- open (the fabric is cut to the bone with a scalpel, the surgeon by visual review controls the process of correction);
- closed (the manipulations are performed through a small incision, control is carried out by x-ray).
The removal of the bones on the legs with laser – grinding the bumps on the leg to complete the comparison with the side surface of the foot, which is done through a small incision. Removal of bone with the help of laser resurfacing is accompanied by:
- resection arthroplasty.
The advantages of laser removal of hallux valgus include:
- disinfection wounds under the influence of the laser, which reduces the risk of infection to a minimum;
- minimal loss of blood due to the smallness of the incision through which the manipulation is conducted;
- no effect on surrounding tissue;
- quick recovery;
- the shorter the duration of the operation (takes 1 hour, while removing the bumps traditional surgery takes about 2 hours);
- no need to wear a cast.
Remove the bones in the foot with any of the method consists of several stages. Often during the operation:
- On the internal side of the phalanx of the big toe, the incision is performed.
- Is 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 by altering the axis of the deformed area.
- The bone is fixed with titanium screws or staples.
- Capsule and the incision sutured.
- To access sterile bandage.
- The stop is applied fixing bandage or plaster (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 minimal invasive techniques, there are a number of contraindications to its conduct. Surgery is contraindicated in:
- thrombosis, which is accompanied by inflammation of veins and blood clotting;
- diabetes, obesity;
- cardiovascular failure;
- violation of circulation of the tissues of the foot;
- pathologies musculoskeletal.
Removal of bone on the foot with a laser has virtually no contraindications, however, before procedure it is necessary preoperative examination.
Preparing for surgery
Before you can remove the bones in the legs, need to have a thorough diagnosis, allowing to identify all foot pathology – radiography of the foot from different sides or magnetic resonance imaging.
In addition to removing bumps on legs from big toe surgery may involve removal of deformation in the form of other hammer toes, etc.
The patient is fine preoperative examination is sent for testing:
- blood (General, biochemical, sugar, clotting);
- urine (General analysis);
- for the detection of hepatitis and HIV;
- chest x-rays.
The duration of the rehabilitation period depends on:
- the number of the removed tissue;
- the method of operation.
In any case, in the postoperative period requires fixation of the foot. If the patient was removed only part of the metatarsal bone and the operation was conducted without the use of a laser, the stop is fixed at 4 weeks, when you remove the joint, this period is increased to 10 weeks.
Rehabilitation after minimally invasive or laser surgery takes less time and, judging by the reviews, flows more smoothly.
The load on the foot in the postoperative period is limited walking is permitted on average in a week (the pressure on the operated foot is limited). Regular walking is allowed after consultation with the attending physician (average in a month). When Scarf-osteotomy of the permitted load on the foot in a special brace after surgery.
The patient is assigned:
- 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 is assigned always, but the beginning of its carrying out depends on the method of operation is:
- During the operation Schede-Brandes therapeutic gymnastics is conducted with 4th, 5th day after surgery. The patient is recommended to constantly wear a liner that holds the 1st toe in the correct position.
- When using operations Kramarenko and knights begin to carry out physical therapy for the 1st toe on the 5th day. After removing the fixing of the plaster bandage, the forefoot is fixed with a rubber sleeve, which supports the transversal arch.
- Using the methods of cyto plaster immobilization lasts 1-1. 5 months. LFK starting to do with the 4-th, 5-th day after surgery.
Exercises in the postoperative period similar to exercises used to prevent hallux valgus.