Surgery for removal of bone at the big toe

If you bone the leg of timely treatment, the orthopedist allows the conservative distortion fix

Unfortunately, not all people are alert to changes of the foot up to the occurrence of painful symptoms, and the physician must determine that the Situation started and to fix only the removal of the bone on the big toe can pathology (Operation allows you to not only get rid of the pain and the progression of the disease to prevent, but also arch of the foot).

Types of surgical treatment of the bone in the leg

Operation

Surgery for removal of bone in the leg, according to a further diagnostics that allows to assess exactly the degree of Deformation, show the accompanying pathologies and diseases.

The choice of surgical technique (there are about 100 different methods):

  • Type of Deformation;
  • Condition of the bones and soft parts of the individual patient;
  • the presence of systemic diseases.

As for the removal of bone on the legs less trauma currently apply in the majority of cases, tables, methods, and modern anesthetics, the patient's age has no influence on the selection of the techniques of surgical intervention.

Possible Use:

  • Osteotomy, which is considered in most cases as the most effective method. Any Form of osteotomies during surgery on deformed joint tissue, bone crossed (cross closer to the nail or on its other end, Z-shaped, or along the Phalanx), fragments of bone are decomposed.in the correct Position and fixed with staples or a special screw
  • Arthrodesis. This type of surgery is used in very rare cases, since the primary aim of the Operation: the creation of solid compounds which do not fully restore the stop. The indication for this type of surgery is severely damaged joint of the big toe, which is not in the correct Position with the help of the osteotomy. Metatarsophalangeal joint during the Operation is removed and the bones connect to each other. The disadvantage of this method according to the burden of pain at the site of the Association, as well as the need to constantly orthopedic shoes.
  • Resection arthroplasties, in which the part of the joint surface away. It is between the bones is a cavity, formed in the process of healing the connective tissue fills in (pseudarthrosis). The complete restoration of the functions of the foot is not out there this process.
  • Correction of the transverse arch of the foot. In this type of surgery, the joint and the bone and the soft tissue around the problematic Zone is not corrected. During the Operation, with the thumb on the 1. metatarsal bone transplanted tendons of the adductor muscles of the thumb, the muscles of the thumb hold it in the tilted Position, the angle between the bones of the foot changes, and foot arch back to its normal shape. The method is effective in the early stages of the disease.
  • Exostectomy, in the case of the self-bump (part of the heads of the metatarsal bones) are deleted, as well as the soft tissue around the affected joint. The gait after the surgery, recovers, and eliminates the pain, however, relapses.

Common Methods

Surgeon

Surgery on the bones of the big toe with the crossing of the bones is most common with the method:

  • Scarf Osteotomy. It is in the case of moderate Hallux valgus. Allows you to slide in the longitudinal direction and rotate a portion of the heads of the metatarsal to lengthen the bone, or to shorten the first metatarsal bone, sliding the bone fragments, you will achieve a greater proportionality of the joint and reduce stress on the joint and the inner part of the foot. Good results, the methodology in combination with correction of the soft parts.
  • Osteotomy the Austin/Chevron, the V-shaped crossing of the first metatarsal bone. Valgus, is for slight Hallux slipping the midfoot to the bones of the head to 1/2 of the width (in the case of a displacement of more than 1/2 of the width of the bone, the bone fusion stability may be inadequate).
  • Akin osteotomy of the main Phalanx (at the level of the proximal adjacent to the epiphyseal plate part of the tubular bone). Accompanied by the obligatory manual correction of the Hallux valgus. Bone cuts parallel metatarsophalangeal joint and nail Lodge of the thumb, wedge-shaped Fragment is removed.

Surgery for removal of bone at the big toe can also be carried out:

  • According to the method of Weyl (oblique osteotomy of small metatarsal bones). The sliding of the bone in the direction of the center and in the longitudinal direction allows the metatarsal is the bone head in the normal Position, and helps in the removal of the exhibition informibus deformation of the Finger.
  • After the method of Schede-fire (regional resection of the medial bone dislocation (exostosis')). During the Operation, the bone is removed on the side surface of the 1. Metatarsal bone and the proximal part of the Phalanx of the big toe, is superimposed on the foot in a certain Position, plaster-splint, and then within 2 weeks of the extension for the nail Phalanx of the thumb.

Good cosmetic results of the surgery, after the removal of the bones of the legs according to the method of Vreden-Mayo (consists of the removal of the head of the 1. Metatarsal bone together with the knob), but because of the elimination of the main Support platform of the foot when walking after the surgery, there is a violation of the support function of the foot.

Delete the bones on the big toe, according to the method Calcina (the point of intersection with the bone by turning the crown to move the 1. Metatarsal bones) and the trapezoidal wedge resection of the 1. Metatarsal bone cannot eliminate by the method of Boma and Reverdens medial deviation of 1. Metatarsal bone and not the arch of the foot, often relapse.

The Patient may be foot deformities offered reconstructive surgery for the correction of several components:

  • Method Kramarenko, and boyars, in the implementation of after the Operation, after the method of Schede-fire for the elimination of medial deviation of 1. metatarsal distal to the planet invader of the joint is the transverse osteotomy, and in the wedge-shaped gap formed plug from the previously removed parts of the bone graft. Made of Mylar tapes are formed, the lateral ball of the foot, keeps the 1. metatarsal bones in the correct Position (Band sewn to the edges of the capsules 1. and 5. MTP joints). After surgery on the foot for 4-5 weeks in a plaster cast.
  • The Operation of the cake and Eremenko, in which the bone is not exceeded, since the defect consists in the removal of help of 1. planet invader articulation. Cross ball of the foot formed from the tendon of the long extensor tendon of the 4. Toe.
  • The Operation according to the method of Cito, the by the formation of transverse ligaments of the foot of the Mylar tape in the Form of an eight by Klimov.

If necessary, the endoprosthesis can be removed, the deformed joint is completely and artificially.

How is the removal of the bone in the leg

Legs

Currently, the bones of the legs you can remove with a mini injury paint with the help of:

  • Minimally invasive techniques where the incision is not greater than 3 mm (in the case of significant deformations – 10 mm). Surgical manipulations (intersection of the bone and displacement of its parts) through this small incision under the control of the x-ray diagnostics. Among the advantages of the minimally invasive osteotomies a short period of rehabilitation, and almost imperceptible scars, the pain and the risk of complications is minimal. Minimally invasive operations require General anesthesia (local or epidural), but can only be applied in the case of slight degree of deformation of the big toe.
  • Laser, the stores remove the bone tissue thin layers, so it is the mobility of the joints. Rehabilitation time is shorter than when using the traditional rate for a surgical procedure (drill, needle, screwdriver, Clip). Laser removal of bone on the legs used, if no other Patient malposition, and complications of Hallux valgus.

Access during the Operation can be:

  • Open (fabric cut to the bone with a scalpel, the surgeon by visual inspection monitored the process of correction);
  • closed (Manipulation is done through a small incision, the control is carried out with the help of x-rays).

Of bone in the legs of a Laser, a grinding lumps on the leg is removed up to the full compared with the side surface of the foot via a small skin incision. To remove the bone with the help of Laser Resurfacing:

  • exostectomy;
  • osteotomy;
  • resection arthroplasty.

Among the advantages of the Laser Hallux valgus:

  • Disinfection of wounds under the action of Laser, thereby minimizing the risk of infection;
  • minimal loss of blood due to the small size of the incision, through the Manipulation carried out;
  • no influence on the surrounding tissue;
  • quick recovery;
  • a shorter duration of Operation (lasts 1 hour, during the removal of bumps traditional surgery techniques, it will take about 2 hours);
  • no need, after surgery a plaster to wear.

Removal of bone at the leg in each method consists of several phases. Mostly during the Operation:

  • On the inner side of the Phalanx of the big toe is cut.
  • Is capsulotomy (cutting the capsule of the first metatarsophalangeal joint).
  • The excision occurs the bone dislocation (removal of the lump).
  • Saw the first bone metatarsal bone (osteotomy).
  • The surgeon to move the fragments of bone metatarsal bone, by the axis of the deformed Phase.
  • Bone fixed titanium screws or brackets.
  • Capsule and the incision are sutured.
  • At the point of access, sterile Dressing.
  • On the foot-fixing launched in the end of bandage or plaster (depending on the type of surgery).

Titanium screws to remove in the absence of complaints.

Contraindications

Update

Although the Operation on his leg to remove the bone is usually done with the use of low-traumatic methods, there are a number of contraindications for its implementation. The Operation is contraindicated in:

  • Thrombosis, which is due to inflammation of the veins, and bleeding disorders;
  • Diabetes, obesity;
  • Cardiovascular Insufficiency;
  • Disorders of blood circulation of tissue of the foot;
  • Pathologies of the musculoskeletal system.

Removal of bone in the leg-Laser-virtually no contraindications, however, before the procedure, preoperative examination.

The preparation for the Operation

Prior to the removal of the bone on the legs, you need a thorough diagnosis, all pathology of the foot x – ray images of the foot with the various parties, or magnetic resonance imaging.

In addition to the removal of bumps on the legs, the thumb in the Operation, the elimination of the deformation in the Form of a hammer, other toes, etc.

The Patient is in the order of preoperative examination embarks on the delivery of analysis:

  • Blood (General, biochemical, sugar, clotting);
  • Urine (General Analysis);
  • for the determination of Hepatitis and HIV;
  • ECG;
  • Chest x-rays.

Rehabilitation

The duration of the recovery phase is dependent on:

  • the number of the extracted tissue;
  • Method of operation.

In any case, in the post-operative Phase requires the fixation of the feet. If the Patient withdraws only a portion of the metatarsal bone and the Operation was without the use of Laser, the foot is fixed at 4 weeks, in the removal of the joint, this period increases to 10 weeks.

Rehabilitation after a minimally invasive laser eye-surgery takes less time, and judging by the reviews, the more smoothly it runs.

The load on the foot in the postoperative period is limited, walking may be limited, on average about a week (pressure on the operated foot). Regular walking is allowed after consultation with the treating doctor (on the average in a month). In the case of the Scarf osteotomy the load of the foot allowed in a special Orthez immediately after the Operation.

The Patient is assigned to:

  • integrated therapy (anti-bacterial, anti-inflammatory, and pain relievers);
  • medical-sports-complex, the doctor selects individually;
  • you wear soft shoes with wide, thick arch support or special orthopedic shoes;
  • wearing orthopedic Shoe inserts.

Movement therapy is appointed in the post-operative period, but the deadlines for the beginning of its implementation, depending on the method of Operation:

  • In the implementation of the Operation Schede-fire, physiotherapy is carried out with the 4., 5. The day after the Operation. Patients in the future, it is recommended that between location, the the 1. Finger in the correct Position.
  • In the case of using the Operation Kramarenko boyars and movement therapy, the expenditure for the 1. Toe on 5. Day. After the removal of the anchoring plaster the front part of the foot rubber sleeve is fixed, which supports the transverse arch.
  • In the case of use of the method of the cyto-plaster immobilization lasts for 1-1,5 months. Movement therapy start, with 4-th, 5-th day after the Operation.

Exercises in the postoperative period are similar to exercises used to prevent Hallux valgus.

18.09.2018