The surgery to remove the bone in the big toe

When you see the bone in the lower leg to resort to orthopedic to correct the deformation of conservative methods

Unfortunately, not all people pay attention to the changes of the foot until the onset of symptoms of pain, and the doctor is forced to admit that the situation is running, and that only the elimination of the bones in the thumb of the foot may correct the pathology (operation allows you to not only get rid of the pain and prevent the progression of the disease, but also to recover the arch of the foot).

Types of surgical treatment of the bone in the leg

The operation

The surgery to remove the bone of the leg is performed after more diagnostic that enables you to assess with precision the degree of deformation, identifying the pathology and the disease.

In the choice of the operating methodology, there are over 100 different methods) affect:

  • the type of deformation;
  • the state of the bones and soft tissues of a particular patient;
  • the presence of somatic diseases.

Because for the removal of the bones in the feet nowadays, it is used in most of the cases less traumtico and modern techniques anesthetics, the patient's age does not influence the choice of the methodology of the surgical intervention.

Perhaps the use of:

  • Failed osteotomies, which is applied in the majority of cases as the most effective method. For any other kind of failure of osteotomies during an operation on the joint is deformed to cut tissue, bone crossed (cross section closest to the nail, or at its other end, the Z-in a figurative sense, or along the main phalanx), the bone fragments are installed in the correct position and fix the brackets, or with a screw.
  • Arthrodesis. This type of surgery is performed in very rare cases, since the main objective of the operation: the creation of the appearance of the connection, which does not allow to restore completely the foot. An indication of this type of operations is very destroyed the thumb joint that cannot be returned in the correct position with the help of failures of osteotomies. Metatarsophalangeal joint in the process of the operation is deleted, but the bones are joined together. A disadvantage of this method are arise after the load of pain at the site of fusion, as well as the need to wear orthopedic shoes.
  • Resection arthroplasties, which removes the portion of the articular surface of the. In this case, between the parts of the bones remains a cavity, which in the healing process fills in the connective tissue (hence it generates a false joint). The full recovery of the functions of the foot this operation is not given.
  • The correction of the cross-section of the arch of the foot. For this type of surgery does not adjust to the joint and the bone and the soft tissue around the problematic area. In the process of the operation with the thumb in the 1st metatarsal bone that transbordan tendons abductor of the thumb, the muscle stops to keep the thumb in the declined position, the angle between the bones of the foot changes, and the arch of the foot, recovers its normal shape. The method is effective in the early stages of the disease.
  • Exostectomy, which removes the lump (the part of the head metatarsal bones), as well as of soft tissues surrounding the affected joint. The gait after the operation is recovering, the pain it solves the problem, however, there may be relapses.

Common methodology

The surgeon

The operation on the bone of the big toe with the intersection of the bones most often is carried out using the following method:

  • Scarf-failed osteotomies. It is used when the moderate deformities valgus deformation. Allows you to slide in the longitudinal direction and to rotate the portion of the head metatarsal bones, to lengthen or shorten the first metatarsal bone, to shift the fragments of the bones, which allows you to achieve a greater proportionality of the joint and reduce the load on the joint and the inner part of the foot. Good results the methodology given in combination with the correction of the soft tissue.
  • Failures of osteotomy the Austin/Chevron, in the taurus intersection of the first metatarsal bone. Applies in the case of the small deformities in valgus deformation, allows you to move the head of the metatarsal bone in the 1/2 of its width (the displacement of more than 1/2 of the width of the bones is necessary for bone fusion stability may be enough).
  • Failed osteotomies Akin, which is performed in the main the phalanx (proximal, adjacent to the epiphyseal plate of the part of tubular bone). Accompanied mandatory manual correction of deformities in valgus deformation. The bone traversed in parallel metatarsophalangeal joint and the nail bed of the thumb trapezoidal fragment is deleted.

The surgery to remove the bone in the thumb of the foot can also be carried out:

  • By the method of weil (diagonal osteotomy small metatarsal bones). Allows you to move the bone in toward the center and in the longitudinal direction, returns the crown metatarsal bones in their normal position, and helps to eliminate the malleus informibus the deformation of the fingers.
  • By the method of Schede-Brandes (average marginal resection of bone curvature (exostoses')). During the operation is removed the bone on the lateral surface of the 1st metatarsal bone and proximal of the main part of the phalanx of the thumb, is fixed to the foot in a certain position of the plaster splint and then in a period of 2 weeks is made applying traction for nail phalanx of the thumb.

A good cosmetic result gives the operation of removal of the bones in the foot by the method of Vreden-may (involves the removal of the head, 1st metatarsal bones along with the head), however, due to the elimination of the main platform of the foot when walking after the surgery occurs the violation of the base of support of the function of the foot.

The elimination of the bones in the toe of the foot by the method of Sears (the intersection of the bone with the rotation of the head, 1st metatarsal bones), and trapezoidal wedge resection of the 1st metatarsal given by the method of boma and Reverdens not addressed by medial deviation of the 1st metatarsal bone and not recovering to the arch of the foot, often accompanied by relapses.

The patient may be proposed a reconstruction of the operation, aimed at the correction of several components of the deformation of the feet:

  • The method of kramarenko and Aristocratic, realizing that after the operation by the method of Schede-Brandes to resolve the average of the deviation of the 1st metatarsal bone distal planetinvader joint performed osteotomy cross section, and in the resulting wedge-shaped cleft is hammered-formed by previously removed parts of the bone of a transplant. Of lavsan ribbon to form the transverse ligament of the foot, which keeps the 1st metatarsal, the bone in the correct position (the tape is presented to the edges of the capsules 1-5th metatarsophalangeal joints). After the surgery the foot in 4-5 weeks, put a bandage of plaster.
  • The operation of Korzha and eremenko, in which the bone does not cross, because the defect is corrected by the removal of the 1st planetinvader joint. Transverse ligament of the foot is formed by the tendons of the long extensor, 4 of the toe.
  • The operation of the methodology of QUOTE, which is accompanied by the formation of transverse ligament of the foot of lavsan ribbon in the form of an eight by Klimov.

If necessary, performs joint replacement surgery of the joint, deformed by full, is deleted and replaced by an artificial one.

How to perform the removal of the bone in the leg

The legs

Now, remove the bones of the legs can be with a minimum of injury with the help of:

  • Minimally invasive techniques in which the court does not exceed 3 mm (with large deformation – 10 mm). Surgical placement (the intersection of bone and the displacement of its parts) are performed through this small incision under the control of the x-ray. The advantages of minimally-invasive failed osteotomies are a short period of rehabilitation, and almost imperceptible scars, the pain and the risk of complications is minimal. Minimally invasive operations do not require general anesthesia (using local or epidural), but can be applied only when the light of the magnitude of the deformity of the thumb.
  • Laser, that allows to eliminate the bone tissue in layers, thus maintaining the mobility of the joints. Shorter recovery period than when using the traditional set for the early intervention of the drill bit, the bolt, screwdriver, clamp). Laser removal of the bones in the legs is used when you do not have the patient of other deformities of the feet and the complications deformities valgus deformation.

The access to the realization of the operation can be:

  • open (the fabric is cut to the bone with the help of a scalpel, the surgeon thanks to the visual of the patch controls the process of correction);
  • closed (manipulations are performed through a small incision, the control is performed with the help of x-rays).

The elimination of the bones in the legs with laser is the milling of potholes in the leg before a full comparison with the lateral surface of the foot, which is performed through a small incision. For the removal of the bone with the help of laser rejuvenation accompanied by the following:

  • exostectomy;
  • osteotomy;
  • resection arthroplasty.

The advantages of laser removal of deformities in valgus deformation are:

  • the disinfection of the wound while under the effects of the laser, which reduces the risk of infection to a minimum;
  • minimal blood loss thanks to the low magnitude of the incision, through which are performed the manipulation;
  • the lack of influence on the surrounding tissue;
  • the rapid recovery;
  • the more short term of the operation (which lasts about 1 hour, while the elimination of potholes traditional surgical methods takes about 2 hours);
  • it is not necessary after the surgery to carry the plaster.

The removal of the bone in the leg when any methodology consists of several stages. More often in the process of the operation:

  • In the interior of a proximal phalanx of the thumb, the incision is made.
  • Is capsulotomy (dissection of the capsule of the first metatarsophalangeal joint).
  • Performed the resection of the bone of the curvature (deleting cones).
  • Saw first bone of the metatarsus (performed osteotomy).
  • The surgeon moves fragments of bone of the metatarsal, changing the axis of the deformed plot.
  • The bone was fixed with titanium screws or staples.
  • The capsule and the cut is sewn.
  • In a place of access is placed a sterile bandage.
  • At the foot applies a retention bandage or plaster (depending on the type of operation).

Titanium screws in the absence of discomfort is not removed.

Contraindications

The correction

Although the operation on the leg of the removal of the bone is normally carried out with the application of less traumatic techniques, there are a number of contraindications for its realization. The operation is contraindicated in case of:

  • thrombosis, which is accompanied by inflammation of the veins and the violation of the coagulation of the blood;
  • diabetes mellitus, obesity;
  • cardiovascular failure;
  • the violation of the circulation of the blood from the tissues of the feet;
  • pathologies of the locomotor apparatus.

The removal of the bone in the leg laser has practically no contraindications, however, before the procedure must be preoperative.

Preparation for surgery

Before you remove the bones of the legs, must pass through a diagnosis that allows to identify all pathologies of the foot x-rays of the feet with different parts or magnetic resonance imaging.

In addition to the elimination of potholes in the legs in the thumb, surgery may include removal of the deformation in the shape of a hammer, others of the fingers, toes, etc

The patient in the order of the inquisicin is directed to the delivery of the analysis:

  • of blood (general, biochemistry, sugar, clotting);
  • urine (general analysis);
  • for the detection of hepatitis and hiv;
  • Ecg;
  • fluorography.

Rehabilitation

The duration of rehabilitation depends on:

  • the amount remote of the fabric;
  • the method of operation.

In any case, in the postoperative period requires the attachment of the soles of the feet. If the patient is away only a part of the metatarsal bones, and the operation is performed without the use of the laser, the stop is fixed in 4 weeks, when you remove the joint of this period increases to 10 weeks.

Rehabilitation following a minimally invasive or laser surgery takes less time and, judging by the comments, it is more soft.

The load on the base of the foot in the postoperative period is limited to, is allowed to walk in the middle of the week (the pressure in the operated foot is restricted). Normal walking settled after the consultation with the attending physician (average month). When Scarf-failed osteotomies allowable load on the foot, especially Orthez immediately after the surgery.

The patient is assigned to:

  • combination therapy (antibiotics, anti-inflammatories and painkillers);
  • medical-physical complex that the doctor collected in the form of the individual;
  • the use of soft wide shoes with a thick arch support, or special orthopedic footwear;
  • the use of orthopaedic insoles.

Physiotherapy in the postoperative period is always assigned, but the time of the start of the test depend on the method of operation:

  • During the operation Schede-Brandes gymnastics is performed with the 4th, 5th days after the surgery. The patient in the future, it is recommended to wear the lining, which keeps the 1st finger in the correct position.
  • When used in the operation of kramarenko and the Aristocratic physiotherapy start to happen in the 1st finger of the foot in 5 days. After the removal of fixing of the plaster cast department front of the foot is fixed to the rubber cuff, which supports cross-vault.
  • When using the methodology of QUOTE of plaster immobilization lasts for 1-1,5 months. Lfk begin to be made of the 4°, 5 ° day after surgery.

Exercises in the postoperative period are similar to the exercises used for the prevention of deformities in valgus deformation.

18.09.2018