Chevron osteotomy is a modern method for eliminating foot pathologies

Osteotomy is a surgical operation aimed at eliminating deformity or eliminating anatomical and functional disorders by artificially breaking the bone and correct fusion. This operation is performed to treat both congenital and acquired pathologies, for example, in case of improperly healed fractures.

Indications for osteotomy:

• improperly healed bone fractures;
• ankylosed joints;
• change, shortening of the limb;
• rachitic curvatures;
• formation of a false joint;
• osteomyelitis;
• osteoarthritis, spondioarthrosis;

Depending on the surgeon’s goal and the patient’s clinical picture, the following types of osteotomy can be performed:

• wedge-shaped;
• linear (oblique and transverse);
• hinged (can be arc-shaped, that is, made in one plane, or angular, spherical - in several planes);
• staircase;
• Z-shaped;
• derotational.

By purpose they are distinguished:

• Corrective osteotomy - to correct deformity after complications that led to malunion.
• Hinge osteotomy is an operation to lengthen the limbs.

Osteoplasty techniques are also divided into closed and open. The first is performed with minimal access, through a 2-3 cm incision. The open method involves wide access - an 8-12 cm incision is made exposing the bone. In some cases, when there is a risk of damage to nerves and large vessels, preference is given to open osteotomy, despite its low invasiveness, over closed one.

The choice of method depends on the type of pathology, volume and area for surgical intervention - pelvis, jaw, hip, etc. Most often, the operation is aimed at restoring the function of the musculoskeletal system and removing bone deformations.

To equalize the lengths of the lower extremities, osteotomy is performed according to the principle of oblique cutting of the bone in mandatory combination with extrafocal compression-distraction osteosynthesis. The design for osteosynthesis is selected individually for each patient.

Osteotomy: a scientific view

How does it work and why trim the bones? The entire human musculoskeletal system is penetrated by thin axes. They can only be seen in an anatomical atlas, but it is by them that the correct formation of the skeleton is determined. With pathologies, bones deviate from the anatomical axis. This is expressed by crooked legs, protruding joints, and other symptoms. In addition to aesthetic aspects, deviation from natural axes leads to diseases of the musculoskeletal system and disability. Bone tissue has an amazing ability: it is renewed throughout life. This happens quickly in childhood, but the ability decreases with age. However, bones can repair themselves by growing new tissue. This happens after injuries, fractures, operations with the help of nature. But sometimes the bones need help. Bone tissue is a material. It is the task of an orthopedic surgeon to mold it into beautiful shapes, adjust it and set the direction of correct growth. This is what corrective osteotomy does. An incision is made through the skin into the bone at the site where bone tissue needs to be built up. This position is fixed with a special device. There are many varieties of such devices. The only task is to hold the limb in this position long enough for new bone tissue to form. This usually takes 1-3 months. During this period, the patient can move independently with the device. Then it is removed. In leg surgeries, osteotomies of the femur and tibia are most often performed.

Chevron osteotomy is a modern method for eliminating foot pathologies

What is a chevron osteotomy?

Osteotomy is a surgical procedure that involves artificially breaking a bone and then fixing it in the correct position. This helps eliminate pathological changes in the musculoskeletal system.

The history of the appearance of chevron osteotomy

Among the many surgical treatment methods used to correct deformities that occur in the first metatarsal bone, chevron osteotomy has gained particular popularity. It was first held in 1962 in the United States of America. Since the 80s of the last century, similar treatment began to be used in Europe.

The osteotomy was named chevron after the V-shaped military patch called a chevron. It also has another name - “Austin osteotomy” (Austin osteotomy), since it was first performed by Dr. Dale W. Austin.

Advantages of chevron osteotomy

It has become widespread due to its ease of implementation and the ability to obtain good results that last for a long time.

During surgery:

• bring the heads of the first and second metatarsal bones closer, taking into account the decrease in angular dimensions, called dorsoplantar displacement;
• reconstruct the anatomical position, taking into account the biochemical characteristics of the sesamoid bones;

The operation allows:

• get rid of cones, subluxations, incongruity and medial pseudoexostosis of the first head of the metatarsal bone;
• increase the range of motion of the foot.

Osteotomy of the foot is quite often prescribed to patients who have been diagnosed with the initial stage of hallux valgus. For the operation, a small incision (3-5 centimeters in length) is sufficient. The method ensures reliable fixation of the phalanges of the fingers. Basically, bolts and wire are used for this purpose.

Types of surgery

According to the type of section it is divided into:

• elongated plantar and dorsal;
• with equal shoulders.

With an elongated plantar cross-sectional area, it is much easier to fix bone fragments. In addition, it is possible to obtain a stable result: the screw enters the cancellous bone of the metatarsus and securely secures its head. If the length of the shoulders is the same, then it is difficult to achieve stability. When connecting the fragments, the screw is inserted into a thin section of the cancellous bone, which can cause its destruction. In this case, there is no point in using a chevron: a much better effect will be achieved by using a knitting needle.

Treatment method

To secure the bone fragments, they use a variety of fixators. It is possible to use an intracortical Brauk screw, a cortical screw with a diameter of 3.5 mm, wires, wires or vicryl cerclages.

Modern treatment methods have undergone significant changes towards improvement. What changed the most was the length and direction of cutting the bones. The changes also affected the shape of the chevron; today many of its variations are known. This made it possible to give the first metatarsal bone a normal length and adjust the correct angle of inclination in the articulation.

These types of surgery are used to eliminate mild and moderate hallux valgus deformities. In severe cases, it is more advisable to perform a scarf-osteotomy. To achieve maximum efficiency in the treatment of pathology, it is recommended to carry out correction of soft tissues together with chevron surgery. It will help the thin sesamoid bones move into the desired position faster and easier.

When performing a chevron osteotomy, there is no need to apply a plaster cast. The very next day after surgery, patients walk on their heels. You can return home after 12 days. Over the next month, it is recommended to walk on your heels. The duration of the rehabilitation period is influenced by the degree of pathology, as well as the age and weight of the operated person.

Contraindications for osteotomy

Osteotomy is an operation. Like any intervention, it has contraindications. According to ISAKOS (International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine), bone correction cannot be performed with the following diagnoses:

• Rheumatoid arthritis;
• Osteoporosis;
• BMI more than 40;
• Impaired blood flow in the lower extremities;
• Extra-articular deformities;
• Previous infection;
• Reduced bone regeneration ability;
• Operations on the meniscus;
• Limitation of flexion more than 25 degrees;
• Some types of arthrosis.

In other situations, surgery can be performed, because for many, corrective osteotomy remains the last chance to return to motor activity, beautiful legs and a full life.

I. Relapse or insufficient correction of hallux valgus

Main reasons:

• Wrong choice of surgical treatment method for hallux valgus.
• Violation of surgical technique: insufficient correction (displacement of the distal fragment after osteotomy) of the deviation and length of the first metatarsal bone (M1) after osteotomy.
• Failure of patients to follow the surgeon’s recommendations, violation of the postoperative regimen.
• Lack of special tools and equipment.

Symptoms

• Curvature of the first toe, “return” of the deformity after surgery.
• Presence of postoperative scars.
• Some patients develop a lump (bone) at the base of the first finger.
• Pain in the forefoot.
• Discomfort, inconvenience when wearing shoes.

Diagnostics

• Clinical examination, medical history, data from primary surgery, patient complaints.
• Radiography, including in special projections.
• Plantography is a foot print that can reveal areas of overload.
• In rare cases, computed tomography (CT) and MRI are used.

Conservative treatment

Treatment always begins with the use of conservative methods:

• NSAID ointments and tablets are used, and steroid drugs (Diprospan, Kenolog) are administered locally.
• They use orthopedic insoles, insoles, silicone interdigital inserts, and other devices.
• Therapeutic exercises, wearing comfortable shoes.
• Physiotherapeutic procedures, massage, warm baths with sea salt.

Surgery

Criteria for choosing a method of surgical correction:

• Condition of M1, its length, quality of bone tissue, previous method of operation.
• Angle between I and II metatarsal bones (M1M2).
• Condition of the phalanges of the first finger, the angle between the phalanges.
• Condition of soft tissues.
• State of the metatarsal parabola.
• Deformation of other fingers.
• Results of instrumental research methods.

Corrective osteotomy at the Ladisten clinic

The clinic specializes in minimally invasive orthopedic surgeries. More than 6,000 patients from all over the world have already undergone osteotomy and are satisfied. Each patient is offered a tour of the facility, a separate room during rehabilitation, and 24-hour medical supervision in the first days after the procedure. The operation itself is bloodless: a small puncture is made in the leg, through which doctors correct the bone. For fixation, a unique device from Dr. Veklich is used. This is an improved design of the Ilizarov apparatus. It is less bulky, weighs little and does not involve dangerous knitting needles. Doctors at the Ladisten Clinic have been performing corrective osteotomy procedures for more than 30 years; the price varies depending on the pathology and severity of the case. To find out the exact diagnosis, consult about contraindications and discuss the cost of osteotomy, just make an appointment by calling us at: +38 +38 or Write to WHATSAPP Write to VIBER We will choose a convenient time for you to visit the clinic or online consultation.

How is the operation performed?

Scarf involves cutting the bone and then correcting the deformity and connecting the bones in the correct position.

The operation is performed under general anesthesia or local anesthesia. Its duration is about 1-2 hours.

The surgeon makes an incision on the inside of the foot, starting at the base of the big toe and ending near the beginning of the metatarsal bone. After this, having gained access to the bone, a Z-shaped section of the first metatarsal bone is cut out with a special microsaw. This ensures the separation of the head of the bone from its main part and makes it possible to return the bone to its correct position. To do this, the head of the first metatarsal bone is shifted at the desired angle.

The bone fragments are secured using special titanium screws, which ensure maximum stability of the connection. If these screws do not cause any discomfort or allergies, then they are not removed from the body.

In cases where the screws cause any inconvenience, they are removed after complete fusion of the bone. The part of the metatarsal bone of the big toe that protrudes is removed.

During the operation, special attention is paid not only to the bones, but also to the nearby tendons. After all, for the normal functioning of the feet, it is very important to give them the correct position.

In particularly difficult cases, Scarf is supplemented with other techniques to achieve the highest quality results.

Osteotomy of the proximal phalanx of the first finger

Osteotomy of the first metatarsal bone SCARF

• The reason for the relapse is insufficient correction of M1 deviation after surgery.
• No correction of other deformities.

Proximal osteotomy of the first metatarsal bone

• The reason for the recurrence of hallux valgus is insufficient correction of M1 deviation after surgery.
• A proximal osteotomy was performed, given that the metatarsal bone is thin and there is metatarsal adduction.

Arthrodesis of the medial metatarsal-wedge joint.

• The reason for relapse is the wrong choice of surgical method.
• If the angle between the first and second metatarsal bones (M1M2) is large, a distal osteotomy was performed.
• Arthrodesis of the metatarsocuneiform joint was performed, taking into account that the metatarsal bone is short and the M1M2 angle is large.

Prognosis and complications after surgical treatment of hallux valgus

Treatment of hallux valgus: Possible postoperative complications

• Chronic pain.
• Painful sensations due to the use of titanium screws or fixing titanium wires.
• Changes in gait due to load redistribution.
• Stress fractures or stress fractures due to changes in load after surgery.
• Stress fractures or stress fractures due to changes in load after surgery.
• Infections

In order for the treatment of hallux valgus to be successful, it is necessary to weigh the pros and cons of the upcoming surgery to correct hallux valgus. According to international studies, treatment of hallux valgus helped more than 80% of patients regain their former lifestyle. Despite postoperative complaints, approximately 10%-15% felt much better than before surgery. Approximately 5% of patients showed no improvement. In any case, it is always necessary to pay attention to the experience and qualifications of the operating surgeon: Only then can you be sure that the treatment of hallux valgus will be successful.

Specialists at our clinic have found that with the help of special exercises for the feet, the result of surgery to correct hallux valgus deformity is significantly improved.

Treatment of hallux valgus

The goal of surgical treatment of hallux valgus is to restore a mobile, weight-bearing foot with a cosmetically beautiful shape.

In this article we will tell you what are realistic goals for hallux valgus surgery.

Please note that more severe hallux valgus deformity requires more complex treatment. Therefore, if you suffer from an unpleasant disease, we recommend that you contact a specialist in advance, who will tell you about gentle methods of correcting the disease.

Preparing for surgery

During preoperative preparation, doctors examine the patient and select the optimal treatment plan for him. After this, specialists must coordinate it with the patient himself. Before surgery, each person undergoes a full examination.

List of necessary analyzes and studies:

• general blood and urine analysis;
• determination of blood group, Rh factor;
• blood tests for RW and HbAg;
• coagulogram;
• blood chemistry;
• ECG;
• radiography in 2 projections;
• magnetic resonance imaging (MRI) of the affected segment;
• consultations with a neurologist, cardiologist, endocrinologist, allergist and other necessary specialists.

The more thorough the examination, the lower the risk of complications.
While waiting for surgery, doctors advise patients to perform special exercises. They help stretch and strengthen the muscles, which makes it possible to avoid the appearance of contractures in the postoperative period.

Some doctors refuse to operate on patients with severe obesity. The reason is high intraoperative risk, difficulties during rehabilitation and a high probability of complications. Such patients are usually operated on after they have lost weight.

The patient is hospitalized in the hospital 1 day before surgery. There he communicates with the attending physician, signs informed consent for anesthesia and surgical intervention. After this, the patient is prescribed the necessary medications, which he takes under the supervision of medical staff.

The evening before the operation, the person is prohibited from eating. In the morning he is asked to remove all jewelry. Immediately before surgery, the patient is changed into sterile clothing and taken to the operating room.