Removing the “bone” from the big toe: Dr. Tsukanov’s technique

Hallux valgus is a disease in which the metatarsophalangeal joint of the big toe becomes bent, followed by the formation of a “bump” at its base. This condition is popularly known as “thumb bone.”

It is important to understand that a protruding bone is not just a cosmetic defect. This is a full-fledged disease that requires specialized treatment. In its absence, there is a risk of developing bursitis and curvature of other toes.

Causes of bunions in the foot

The following factors can provoke the development of hallux valgus:

• osteoporosis;
• genetic predisposition;
• flat feet;
• hormonal disorders;
• wearing tight shoes with narrow toes;
• diseases of cartilage tissue;
• excess body weight.

According to statistics, a protruding bunion bothers approximately 40% of women over 30 years of age. In men, the deformity is extremely rare. This is due to the greater elasticity of the ligaments in the fairer sex.

After operation

Dosed loads on the leg are possible from the next day after surgery. Despite this, in the first two weeks of the postoperative period it is recommended to use additional support for movement (cane) for better and faster healing of the postoperative wound. Complete restoration of the supporting function of the lower limb occurs by 4-6 weeks after surgery.

Recommendations for the prevention of Hallux Valgus from our doctors

There are certain preventive measures that can be taken to avoid or stop the progression of a “bump on the foot.”

1. 1. Eat right.
   Eliminate spicy and salty foods from the menu, limit your intake of carbohydrates and sugar. Add vegetables and fruits to your diet. Watch your weight, because as we wrote earlier, extra pounds increase the load on the feet and provoke deformation.
2. 2. Do exercises for your feet.
   Spend 5-10 minutes doing simple exercises. The main condition for gymnastics is its regularity. Daily exercise strengthens the muscles and ligaments of the foot:

1. — scatter small objects on the floor and collect them with your fingers (pens, pencils, eraser, sheet of paper);
2. - walk on your toes and heels;
3. — draw with your fingers in the air or on the sand (floor) whatever your heart desires;
4. - spread your fingers so that they do not touch. Hold in this position for at least a minute;
5. - Roll a water bottle with your foot.

1. 3. Foot massage.
   You can do foot massage yourself at home. Follow the basic rules:

1. — Hands should be warm and dry.
2. — Massage 2 times a day: morning and evening.
3. - Rub your feet and toes. Use tapping and stroking movements, focusing on the inner surface of the sole.
4. — Fingers should be massaged from the tips towards the foot.
5. - Finish the massage by bending and straightening your toes.

1. 4. Foot baths.
   After a hard day, warm foot baths are wonderfully relaxing and soothing. Add herbs, salt or soda. After completing the procedure, rinse your feet with cool water and gently rub the soles with a soft towel.
2. 5.Wear the right shoes.
   Fashionistas need to minimize wearing high-heeled shoes with a narrow toe. Everyday shoes should have a stable heel - no higher than 4-5 cm, with a rounded toe, with a soft and flexible sole.
3. 6. Choose orthopedic insoles.
   Orthopedic insoles are recommended for all people and can be worn at any age. The insoles relieve the toes, redistributing pressure along the foot. Properly selected insoles are insoles that are made using a special machine to fit your foot.
4. 7. Use orthoses.
   Orthoses are special interdigital separator inserts that are located between the thumb and second toe. There are also different types of pads that protect the feet from corns. You can purchase them and get a consultation at any orthopedic salon in St. Petersburg.
5. 8. Give your legs a rest.
   If work requires constant standing, it is necessary to warm up your legs at certain intervals (lower and raise your toes, “fan out” your toes, etc.).

Our Clinic provides treatment under federal quotas, which means that citizens of the Russian Federation have the opportunity to receive help free of charge. Make an appointment with an orthopedic traumatologist or on the website.

How to recognize the disease?

The following changes indicate the development of a bone in the leg:

• the thumb deviates outward, while forming a “ball” at its base;
• there is constant aching pain in the area of ​​deformity;
• fast fatiguability;
• difficulties with choosing shoes.

In the absence of treatment and progression of the pathology, a hammer-shaped shape of the remaining toes is observed. The appearance of the slightest signs of disease should be a reason to contact an orthopedist.

The most common areas of pain on the foot

Pathologies often develop in areas of protruding bones due to a number of factors:

• The projections are the attachment sites for large muscles. If the muscle is in hypertonicity, it pulls harder on the bone and tears its shell-periosteum. It is in the periosteum that pain receptors are located, but they are not normally found in the bone itself.
• There is no protective fat layer on the “bones”; only thin skin separates them from the environment. Any blow, even a small one, directly hits the same particularly sensitive periosteum.
• The more fat and muscle there are around, the greater the blood circulation in the bone. Where there is little other tissue around the bone, blood flow is weaker. And this in turn slows down regeneration and healing.

Typical sites of pain in the foot include the bony prominence of the ankle (ankle), the styloid process of the fifth metatarsal on the outside of the foot, and the head of the first metatarsal at the base of the first toe. All of them can disturb, become inflamed and affect gait. Despite the fact that each problem has its own characteristics, any pain in the “bones” can have very typical causes.

Stages of hallux valgus deformity

The disease is divided into several stages depending on the severity of symptoms:

Stage 1 – the phalanx deviates by 20˚, there is aesthetic discomfort. Stage 2 – the finger deviates 30˚ from the normal position, pain appears with prolonged exertion. Stage 3 – deviation of the phalanx up to 50˚, there are problems with choosing shoes, the lump constantly hurts. Stage 4 – displacement of the big toe over 50˚, signs of bursitis are observed, severe discomfort is present even in the absence of any physical activity, curvature of the entire foot is noticeable.

If bunions begin to appear on your feet, do not put off visiting a specialist.

Arthrosis of the toe joints - what is it?

Osteoarthritis of the interphalangeal and metatarsal joints of the legs is a chronic degenerative disease that begins with the destruction of cartilage tissue and can disfigure the patient’s fingers and feet beyond recognition. Regardless of the causes of this condition, it leads to complete degeneration of cartilage and its replacement by bone growths - osteophytes.

Since the foot and toes - the load-bearing supports of the human body - are subject to enormous stress, arthrosis of the toes is extremely common. According to some estimates, it affects up to 10% of the human population over 60 years of age. It’s not surprising, because the foot doesn’t rest even when we sit!

Typically, the disease begins in the big toe or little toe and primarily affects the metatarsophalangeal joint. Osteoarthritis of the second or third finger is less common. In recent years, there has been a trend towards “rejuvenation” of the disease - arthrosis of the big toe is increasingly found in patients aged 30-35 years.

Treatment of a bunion on the big toe

The development of a treatment program is carried out by an orthopedic surgeon after examining the patient and establishing the stage of disease progression. At the initial stages, deformation of the metatarsophalangeal joint can be eliminated using conservative methods.

The following methods for eliminating bunions are effective:

• abductor bandage – ensures fixation of the big toe in an anatomically correct position using a special device, used during sleep, since it is difficult to move with it;
• corrective pads and interdigital partitions – intended for use throughout the day, they provide correction of the position of the phalanx and prevent pressure on the pathological area;
• orthopedic insoles - used at any stage of hallux valgus, necessary for proper distribution of the load on the foot and spine during walking; ideally, insoles should be made individually, taking into account the characteristics of the anatomical structure of the patient’s foot.

The following are used as auxiliary methods for treating a protruding thumb bone:

• massage;
• physiotherapeutic treatment;
• exercise therapy;
• hardware traction.

In advanced stages of pathology, when there is severe deformation of the joints, effective treatment is only possible through surgery. In modern medicine, closed operations performed through several punctures are widely used. During the intervention, the bone is removed and the phalanx of the finger is fixed in the correct position.

After surgical treatment, the patient must always wear comfortable shoes with arch support and orthopedic insoles to avoid relapse of the pathology.

Removing the “bone” from the big toe: Dr. Tsukanov’s technique

What does enlargement of the big toe lead to? Is it possible to stop the process on my own? If surgery is performed, at what stage? When can you walk? How much does it cost?

Orthopedist-traumatologist, surgeon at Frau Klinik tells Vladimir Evgenievich Tsukanov.

Hallux valgus

– curvature of the thumb with the growth of a lump at its base. This is not only a change in the shape of the foot and difficulty in selecting/wearing regular shoes, but also a violation of the shock-absorbing functions of the foot, which leads to an increase in the load on higher joints and the spine. In the future, deforming arthrosis of the foot and constant pain often develop. That is, the basic function of the foot is disrupted - the person cannot walk normally.

What is a “bone” and why does it appear?

With hallux valgus, the bunion (first metatarsal bone) increases in size and becomes curved. A growth of bone and connective tissue appears on its head, which is called exostosis.

. The thumb deviates outward, then the remaining fingers become deformed. Sometimes the deviation of the bone is minimal, but the growth (“bone”) is large. It also happens the other way around - with a very pronounced deformation there is a small “bump”. Deformation always develops according to an individual scenario.

In men, hallux valgus deformity occurs 50-60 times less often than in women. This is a genetic predisposition. Incorrect shoes (heels, shoes with narrow toes) are also considered one of the development factors. However, the leading role still belongs to the genetic program, which has little chance of changing.

Orthopedic shoes?

Orthopedic shoes cannot reduce bunions. Such shoes artificially distribute the load on the arch of the foot, thereby reducing the load on the higher joints. The shock-absorbing function of the foot is duplicated by orthopedic shoes and the muscles that are responsible for shock absorption relax. They relax and stop working at the required level. Therefore, an external fixator is prescribed only for a short time, and after withdrawal, physical therapy is prescribed to restore the destroyed musculo-ligamentous apparatus. Manufacturers of orthopedic shoes lobby for their production and purpose, but you need to select orthopedic shoes under the strict supervision of a doctor so as not to damage your own shock-absorbing function.

Orthoses delay the development of deformity, but they cannot eliminate the developed deformity or restrain further curvature.

Treatment of hallux valgus

Valgus deformity of the first toe can only be eliminated surgically. Currently there are 3 main methods:

1. Closed osteotomy through a skin puncture:
   Through a puncture with a special cutter, the exostosis is removed and an osteotomy is performed: a wedge-shaped segment is cut out from the deformed bone.
   Then the bone is moved to the correct position and a special rigid bandage is applied to the finger. The closed Italian technique does not involve the installation of any fixatives into the bone. This method has its drawbacks:
   Firstly, the “bump” is not only bone growth, but also a thick skin part and a hypertrophied joint capsule. When removing a “bump” in a closed way, thickened skin remains, so the cosmetic effect is not complete. This skin bag may become a little smaller, but it will not dissolve at all. With other methods of performing the operation, all excess tissue is removed through an incision and a cosmetic suture is applied, obtaining the maximum possible cosmetic effect. Secondly, in the absence of a fixator, pain during the rehabilitation period lasts longer, since bone fragments are not fixed. Modern fixators ensure complete immobility of bone fragments. The bone, of course, will not heal in a few hours, but functionally such immobility already on the operating table gives the bone an “almost fused” state. That is, a person returns to his usual life and workload much earlier.
2. Osteotomy with bone fixation with screws:
   In this technique, the bone is sawed over a large area. The wedge-shaped segment is also removed, and then the bone is secured with titanium screws in the correction position. The large area of ​​the incision and bone cut means that the blood supply to the bone is greatly disrupted. The traumatic nature of the operation increases the likelihood of complications. Even if the surgery went well and the bones were fixed correctly, it is impossible to predict whether the body will cope with this amount of damage without problems. The result of a major bone injury can be: the development of aseptic necrosis with recurrence of deformity; instability of the fixators, leading to repeated displacement; and the most serious complication is inflammation of the postoperative wound.
3. Osteotomy without the use of screws is the “golden mean”:
   This technology was developed by the Central Institute of Traumatology and Orthopedics (CITO) more than 50 years ago, and extensive experience has been accumulated. The main difference between our modern practice and what was done 30-40 years ago is the use of high-precision equipment, which allows us to minimize damage to soft tissues. We operate on a living person, all of whose tissues are supplied with blood. Therefore, I consider minimizing the volume of damaged tissue around the bone a matter of principle. We make an incision about 15 mm in size and through it we eliminate both bone deformation and exostosis. A small incision area means a lower likelihood of complications, bleeding, and damage to internal vessels. Accordingly, the rehabilitation period is shorter - the artificial fracture heals and healing proceeds faster. The prospect of a positive outcome from the operation increases significantly. I only use screws if I can’t do without them. But our technique allows you to do without them almost always. I install a knitting needle that fixes the bones. Osteosynthesis is more durable and less traumatic. When walking, a person does not feel the spoke, since it is located inside the bone. The operated area is motionless, the finger is fixed firmly and straight. After 6 weeks, when the pin has completed its function, it is removed. Technically, this is a simple procedure: the wire stands inside the bone, and its tip protrudes out from the nail phalanx under the soft tissue. The needle is removed through a small incision (2-3 mm), the fracture zone is no longer affected by the operation. The painfulness of the procedure is determined by the pain threshold - some require local anesthesia, others require short-term anesthesia. After the needle is removed, the finger begins to move. Restoration of full range of motion occurs within 2-3 weeks. Read more about the methodology...

Rehabilitation

You can walk after the operation the very next day in regular loose shoes that do not put pressure on the operation area. What happens next depends on the pain threshold. There are patients who already after 3 days

they come for dressing without any additional support and without limping, but some need more time.
As a rule, after 2 weeks
a person leads a normal life in everyday life - he can walk freely, drive, take a shower, and work.
You can run and jump 6 weeks
after the brace is removed.

Cost of the operation

Price range at Frau Klinik at this time – 65 000-130 000

rubles for one leg. The cost of an operation is determined not so much by the operation as such, but by the conditions under which it is performed. We have a comfortable clinic in the center of Moscow, expensive high-precision equipment, and complete sterility of all components. We use only synthetic disposable materials, and never biological ones - this eliminates bacterial infections and generally reduces the likelihood of risks.

When is the best time to have surgery?

As with any treatment, the smaller the stage, the easier and simpler the correction. However, there is another factor: the later in age the operation is performed, the less likely it is to relapse. Genetics is responsible for hallux valgus deformity, and a young body strives more strongly to return to a given program. A mature organism - less.

But in general, of course, it is better to eliminate hallux valgus deformity at small stages and not bring the matter to the 2nd, 3rd degree and a serious violation of the quality of life. In this case, everyone decides for themselves when it is more convenient for them to undergo the operation.

Contraindications to the elimination of hallux valgus are the same as for any other operation - general somatic, plus the presence of severe inflammatory processes in the foot. Problems with veins are not a contraindication.

Works by Tsukanov V. E.:

Before and in the early postoperative period

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Treatment of arthrosis of the toes

Based on the tests performed, the observing doctor draws up an individual treatment strategy, which depends on the stage of the disease, the presence of concomitant health problems, age, weight, lifestyle and anatomical characteristics of the patient. The general course of treatment for arthrosis of the toe joints may include taking chondroprotectors and vitamin-mineral complexes, diet adjustments, therapeutic exercises, and teaching the patient an orthopedic regimen. At stages 2 and 3, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), painkillers, hormonal corticosteroid injections, and physical therapy is indicated. If a joint completely loses its functions, endoprosthetics (usually of the metatarsophalangeal joints) may be prescribed.

At the 1st stage of arthrosis of the joint of the big toe, complete recovery is still possible - the main thing is to consult a doctor in time. At the 3rd stage, as a rule, surgical intervention is indicated - without it, the patient’s quality of life and level of activity drop significantly, and unremitting pain leads to sleep disturbances and decreased mood.

For successful treatment of arthrosis of the toe joints, it is important to follow three principles:

1. Seeing a doctor earlier increases the chances of recovery or stable remission.
2. Treatment is carried out continuously, over a long period of time.
3. Outpatient therapy occurs with regular consultations with the attending physician. Don't self-medicate!

Treatment of arthrosis of the toes with medications

For moderate symptoms, in the drug treatment of arthrosis of the toes, preference is given to local NSAIDs in the form of ointments, creams, and gels. In advanced cases with severe pain, anti-inflammatory drugs together with analgesics can be injected directly into the diseased joint. For systemic joint damage or as part of complex therapy, NSAIDs are also prescribed in the form of tablets or intramuscular injections. This allows you to quickly relieve swelling, improve nutrition of the tissues around the joint, and facilitate warm-up. In addition to relieving symptoms and treating toe joints, the use of any non-steroidal anti-inflammatory drugs slows down cartilage degeneration.

Ointments in the treatment of arthrosis of the toes with medications can be used daily. Short courses of NSAIDs in tablets aimed at relieving an acute inflammatory process are prescribed by a doctor. If taken for a long time, they can lead to stomach ulcers.

If more serious therapy is required to relieve inflammation, the doctor may prescribe hormonal injections with glucocorticosteroids (their use on their own is extremely dangerous!). Analgesics (systemic or local) are used to relieve pain and are selected taking into account its intensity. The main treatment for arthrosis of the big toe is usually supplemented with vasodilators, which improve the nutrition of periarticular tissues and serve to prevent foot diseases (for example, fungal).

It is also recommended to take lifelong dietary supplements based on cartilage tissue components - glucosamine and chondroitin (for at least 3-6 months a year). Effective at stages 1 and 2.

Which doctor treats gout on the legs?

Having discovered manifestations of pathology, a person first goes to a therapist. In his office, an examination takes place, an anamnesis is collected and a primary diagnosis is made. Based on the test results, the patient is referred to a rheumatologist. But it is quite likely that it is necessary to consult with doctors of other specializations. For example, with:

• Cardiologist. Since the patient is prescribed diuretics and salt-removing drugs, the optimal one should be selected that would not harm the heart
• A surgeon who helps in very difficult cases
• Nutritionist. He gives advice on the diet required for this disease.
• An orthopedist is needed if the pathology has caused complications in the bones and muscles
• A urologist - to prescribe drugs that remove salts well, but do not harm the kidneys.

Gout treatment method

Today, a rational three-stage scheme for ridding the patient of the disease has been developed. There will be no complete recovery, but doctors can protect themselves from exacerbations and slow down damage to joints.

1. The first thing they do is relieve pain. Even a special medicine for gout has been developed. You can’t attribute it to yourself because of possible side effects. The doctor will prescribe the required dosage and frequency of administration so as not to harm the patient’s body
2. Then comes the second stage, the task of which is to remove uric acid. It is likely that the drugs created for this will have to be taken for life
3. The third stage involves undergoing physiotherapeutic procedures, massages, and performing gymnastic exercises. All this is aimed at improving the motor functions of the joints.

It is clear which doctor to contact if a person suspects he has gout. But no matter what specialist is on the staff of the clinic, he will definitely focus on the need to adjust the diet. Purines are known to deposit in joints due to consumption of animal protein and alcohol. The diet is to reduce their number on the menu as much as possible. The patient will have to switch to vegetable and dairy foods, eliminate alcohol, chocolate, and canned food.

Only with a united front: medication and physiotherapeutic treatment, diet and exercise can improve the health of a patient attacked by gout. Treatment prices may vary depending on what medications and physical therapy methods are prescribed.