Hallux valgus is a common condition that is also known by several other names. Doctors talk about hallux valgus and hallux valgus. People not associated with medicine simply call it “ossicle” or hallux valgus.
The pathology is easy to determine. A thickening in the form of a callus appears on the inside of the foot. It hurts periodically and gradually increases in size. At the same time, the big toe begins to deviate towards the second toe and, in advanced cases, crosses with it. Along with aesthetic imperfections, a serious problem arises: the inability to use shoes, even everyday ones. The next stages in the development of the disease are arthritis and bursitis, the inability to move independently.
Most often, the first toe is deformed in women who prefer to wear high-heeled shoes (above 4 cm). In addition, this is an occupational disease of ballerinas. Excessive loads do not make themselves felt immediately, but after a while, when it is already difficult to correct the situation.
Surgical methods of treatment
Globally, all operations to remove hallux valgus are divided into minimally invasive and open. Minimally invasive ones are performed through small incisions in the skin. In most cases, there is no need for stitches. Recovery is quick and easy.
There are three categories of open surgical interventions:
Manipulation of soft tissues.
An example is the McBride operation. The muscles and ligaments of the foot are cut. Bones are not affected. The intervention is effective for minor deformities and can be performed in case of contraindications from the osteoarticular system.
Osteotomy.
An artificial fracture of the metatarsal bone is performed. The doctor selects the location of the fracture. Due to this, the position of the metatarsus is corrected
Arthrodesis.
The operation is used in advanced stages of hallux valgus deformity, when it is necessary to return the physiological shape of the joint.
The doctor, from all the methods of surgical intervention available to him, selects the one that best solves the problems of a particular patient.
The operation requires preliminary preparation. We need to get some test results. These include clinical and biochemical blood and urine tests, a blood test with a detailed coagulogram, and tests for blood-borne infections. Electrocardiography is prescribed, and x-rays of the foot are performed (necessarily in two projections).
If no contraindications to surgery to remove hallux valgus are identified, the method of anesthesia is agreed upon. Most often, local anesthesia is sufficient.
Indications and contraindications for surgery
Surgery to correct hallux valgus is prescribed for the following symptoms:
- severe pain syndrome;
- damage to the bone tissue of the foot;
- inflammation of the synovial bursa.
Surgical operations are not performed for rheumatoid arthritis, diabetic foot, obliterating atherosclerosis, purulent infections, and pathologies of the hematopoietic system.
Distal osteotomy
The most common surgical method for correcting hallux valgus deformity is distal osteotomy. The operation takes place in several stages:
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First stage
Exostoexotomy or removal of the “bone”. In untreated cases, this stage may be the only one. Through a small skin incision or even without an incision, endoscopically, the exostosis itself (bone) and the inflamed joint capsule are removed.
Second phase.
Remote osteotomy. Using an artificial fracture, the position of the first metatarsal bone is leveled. The fracture site is secured with titanium screws. They are removed a month later, after the bone has completely healed.
Third stage.
Dissection of the muscle responsible for abducting the thumb.
Fourth and final stage.
Securing the thumb in a physiological position.
Types of operations for hallux valgus using screws
The most common bone surgeries using fixators include:
- Chevron osteotomy is a relatively simple operation with long-lasting results. It consists of a V-shaped cut of the first metatarsal bone, combining bone fragments in an anatomically correct position with fixation with titanium screws. The technique is used for mild to moderate hallux valgus deformity.
- Ludloff's operation is based on a wedge-shaped cut of the first metatarsal bone with moving its distal part inward to solve the main problem - too large an angle between the 1st and 2nd metatarsals. The bone fragments are secured in the required position with screws.
- SCARF osteotomy involves a Z-shaped cut of the first metatarsal bone. The bone fragment can be mixed in three planes, which provides advanced anatomy modeling capabilities. Once placed in the correct position, the fragments are secured with two screws.
Arthrodesis of the metatarsophalangeal joint should also be highlighted. The essence of this operation is to create a fixed connection by fixing the head of the metatarsal bone and the phalanx of the big toe. After surgery, the joint with valgus deformity is aligned and becomes immobile. In order for the 2 bones to fuse, complete removal of the cartilage from the articular surfaces is required. Next, they are compared in such a way that the most correct and advantageous functional position is obtained. To fix the bones, use 2-3 screws or a metal plate.
Surgical treatment of hallux valgus: indications
It is possible to correct the position of the thumb using conservative methods in childhood, when the bone skeleton is still developing. In all other cases, only surgery will help. The main indications are:
- discomfort when walking due to unbearable pain;
- deviation of the joint by several tens of degrees;
- a significantly protruding bone, making it impossible to wear shoes;
- violation of the position of the foot, making it difficult to move;
- swelling of the thumb;
- inflammatory manifestations and other complications of hallux valgus.
The doctor determines the indications individually for each patient. Typically, surgical methods are used when conservative methods (conventional methods, without surgery) become ineffective.
Myths about surgery to remove hallux valgus
There are many myths among people regarding surgical removal of a bunion. Let's dispel some of them.
You cannot have surgery if you have arthritis or arthrosis. In fact, these diseases are considered relative contraindications. The operation is possible, the doctor will just treat you with more attention.
It is useless to operate: the bone will soon grow anyway. With a high-quality intervention, the probability of re-development of hallux valgus deformity tends to zero. Relapses occur, but are extremely rare.
You will have to sit for a long time without moving and wear a cast. Modern technologies make it possible to move independently within a few hours after the procedure. The bones are held together by special structures, so there is no need for plaster.
Foot deformity
Valgus deformity of the first toe (from the Latin valgus - curved, directed outward) is a clinical manifestation of transverse flatfoot, in which the forefoot expands and turns outward, the big toe deviates to the side and a painful bone growth begins to grow at its base - a “bump”. "
Causes
Among the main reasons for the development of hallux valgus, experts name the following: • hereditary predisposition (congenital weakness of the musculo-ligamentous apparatus of the forefoot); • frequent and prolonged wearing of uncomfortable shoes (narrow, hard and/or with a heel higher than 5 cm) provokes the development of transverse flatfoot, i.e. hallux valgus deformity.
Risk factors
In addition, there are so-called risk factors that can accelerate and/or aggravate the development of hallux valgus: • excess body weight; • regular physical activity in uncomfortable shoes (carrying heavy objects, running, etc.). For example: women in everyday life often practice running for public transport in heels and with large bags in their hands as a burden; • sedentary lifestyle (sedentary work leads to weakening of the muscles of the associated apparatus of the foot, which leads to deformities); • flat feet in all its forms and manifestations; • incorrect gait (“on your toes”), normally there should be a roll from heel to toe; • “professional” foot deformity (ballet, sports dancing). According to statistics, in 85-90% of cases of hallux valgus, the patient is a woman, which is understandable due to the predilection of the fair half of humanity for stiletto heels and narrow shoes.
Manifestation of hallux valgus deformity
Hallux valgus makes itself felt not only through pain in the foot when walking, but also noticeably visually.
Depending on the degree of deviation of the big toe in relation to the first metatarsal bone, experts distinguish 3 degrees of severity of hallux valgus: • I degree - 15 degrees; • II degree – 20 degrees; • III degree – 30 degrees; • IV degree - more than 30 degrees. To determine the exact degree of deviation of the first toe (and, consequently, the severity of the pathology), the doctor prescribes an x-ray examination. Stages II-IV of hallux valgus may also be accompanied by complications: • hammertoe deformity (when the second and third toes cease to participate in the walking process); • ingrown nails; • the appearance of various kinds of painful calluses and corns, which can become inflamed and even fester; • swelling of the foot, pain while walking.
About methods of treating hallux valgus deformity
If hallux valgus develops, experts recommend seeking help from orthopedic doctors as early as possible, because The sooner treatment for transverse flatfoot is started, the less traumatic surgical interventions will be required.
Surgical treatment of hallux valgus deformity
There are about three hundred methods of performing operations for transverse and mixed flat feet, proposed by various authors, the indications for use of which are determined by the degree of deformation of the foot. Such a number of surgical options for the same problem is explained by the dissatisfaction of doctors and patients with the results of correction of hallux valgus deformity.
More recently, only the most desperate “sufferers” decided to correct hallux valgus: a difficult operation, a long painful recovery period, requiring wearing a plaster cast, a bulky metal structure and crutches.
It is extremely rare that such operations were performed on both legs at once because The patient went from being sedentary to immediately becoming “lying down” for a fairly long period of time, with all the ensuing consequences. However, the saddest thing is that even after all the suffering endured, not a single doctor ruled out a relapse.
One of the most recent developments in “minor” orthopedics is the Scarf operation with additional surgical procedures by Akin and Weil in complicated cases of hallux valgus.
These operations truly became a breakthrough in solving almost all the problems that arose during almost classic Hallus Valgus operations.
Benefits of Scarf surgery
• low invasiveness of the operation, small cosmetic incision; • absence of bulky metal structures, both during surgery and during the recovery period; • there is no need to use crutches during rehabilitation; • the use of small titanium implants that do not require repeated surgery to remove them; • early activity of patients after surgery (the ability to walk from the second day); • short hospital stay (from 2 to 4 days, depending on the severity of hallux valgus before surgery); • preservation of the arteries supplying the first metatarsal bone, which significantly reduces the rehabilitation period, allowing the patient to quickly return to their usual work schedule; • extremely low percentage of postoperative complications and relapses; • the result of the operation fully satisfies the patients' expectations, not only with an aesthetic effect, but also with an increased quality of life.
Rehabilitation after surgery for hallux valgus deformity
Rehabilitation usually takes four to eight weeks after surgery. This time is necessary for the healing of artificially made fractures. It includes:
• Limitation of loads in the early postoperative period; • Wearing postoperative shoes with unloading of the forefoot; • Compression hosiery to reduce swelling; • Wearing wide shoes until complete recovery (about 4 months after surgery).
The second most common problem is hallux valgus. Most often observed in adolescents. Treatment with insoles is possible only with minimal deformation. With a long course, the disease leads to pathology of the knee joints from improper load on the feet, arthrosis of the foot joints, and pain.
Surgical treatment (subtalar arthroeresis) involves installing a specially shaped implant to correct the deformity and return the foot to normal biomechanics. An interesting fact is that the operation is performed through small incisions from 1 to 3 cm.
The possibilities of minimally invasive percutaneous foot surgery are used in the surgical treatment of painful corns or metatarsalgia of the feet, heel spurs, Haglund's disease, and Taylor's deformity. Correction of foot deformities is individual in each case, and to select surgical tactics, consultation with an orthopedic traumatologist is necessary.
Course of inpatient treatment: 2 - 5 days.
Postoperative rehabilitation period: 1 -3 months.
For this type of treatment you can make an appointment by phone. 45-88-00 to the following specialists:
Travkin Sergey Nikolaevich
Shilin Vladimir Alexandrovich
Kurbanov Vusal Mamedovich
Team of Doctors
First and second day. Bed rest. You can move around, but it’s better not to get active. It is recommended to keep your leg elevated and occasionally, if there is no pain, move your toes.
The third day. You can start moving slowly. It is important to choose a comfortable orthosis and shoes, which after surgery should be special, removing the load from the operated part of the foot. In most cases, Baruk shoes (the French surgeon who invented them) are used, which relieve the load on the forefoot when walking. At first, to get used to it, you can provide yourself with additional support in the form of a cane or crutches. After three to five days they will no longer be needed.
10-14 days. Period of doctoral supervision. In the case of a serious operation, the patient may spend all this time in the clinic. Physical therapy and physiotherapy sessions are recommended. It is not advisable to stand on your feet for a long time.
After 1-1.5 months, there is no need for an orthosis, but after surgery it is better to use shoes with suitable orthopedic insoles.
After 2 months, you can exercise on exercise bikes and swim in the pool.
Swelling of the foot and ankle may persist for up to three months. At this time, it is recommended to use cool compresses and wear compression stockings.
After 4-6 months, it is possible to move around without an orthosis, resume sports, and wear high-heeled shoes. High-quality recovery and quick rehabilitation require choosing comfortable wide shoes. Don’t forget to create comfortable conditions for your feet so that the unpleasant situation does not happen again.
How long will I be on sick leave?
It all depends on the nature of your work and how much time you need to be on your feet. If you can work from a laptop while lying in bed, then you will not have much need for a sick leave. With a predominantly intellectual nature of work, the minimum recommended period of incapacity for work is 2 weeks - until postoperative wounds heal and swelling begins to subside. On average, the time spent on sick leave is 8 weeks, 6 weeks in special shoes and another 2 to adapt to regular shoes. In some cases, with a large volume of surgery, the time on the certificate of incapacity for work can be extended to 12 weeks.
You can see examples of operations to remove a bunion on the big toe in this section.
If you suffer from bunions and want to undergo treatment at the foot surgery center, come for a consultation, or get an online consultation by writing an email
Cost of surgery to remove hallux valgus
The doctor calculates the exact cost of the operation. It is very difficult to name a specific figure - it varies from twenty to eighty thousand rubles. This depends on the type of surgical intervention chosen by the attending physician (in accordance with the stage of the disease and physiological characteristics of the patient), the type of anesthesia, outpatient or inpatient stay, materials and instruments used. To keep the price low, come get rid of hallux valgus in a timely manner, on an outpatient basis, using minimally invasive intervention.
Rehabilitation after osteotomy
Let's consider the recovery period after surgery using the example of corrective osteotomy.
The patient is in the hospital under the supervision of doctors for 3 to 7 days. At this time, regular treatment of the surgical wound is carried out, painkillers, antibiotics and anti-thromboembolism drugs are given. It is important to start getting up as early as possible and not to lie around.
After discharge, the patient must continue taking the prescribed medications at home. On the 10-14th day, the sutures are removed. Next, rehabilitation is indicated - the use of crutches for up to 6-12 weeks, regular visits to the doctor for examinations. Heavy physical activity will be allowed only 6-8 months after the operation. Sometimes installed metal structures are removed after 1-2 years.