When it appears a blister on the leg of a timely appeal to the podiatrist allows you to correct the deformation of the conservative methods
Unfortunately, not all people pay attention to changes in the legs before the arrival of the pressure symptoms and the doctor is forced to conclude that the situation is running, and just remove the bunion on the big finger of the foot can correct the pathology (operation allows you to not only get rid of the pain and prevent the progression of the disease, but also to restore the arch).
Types of surgical treatment of a bunion on the foot
Surgery to remove a bunion on the foot is carried out after further diagnosis, which allows to exactly evaluate the degree of deformation, to determine the related pathology and disease.
The choice of surgical technique (there are about 100 different methods) the influence of:
- type of deformation;
- the condition of the bones and soft tissues of the particular patient;
- the presence of somatic disease.
Because for removal to my feet, currently applies in most cases, less traumatic methods and modern anesthetics, the patient's age does not affect the choice of methods of surgical intervention.
- Osteotomy, which is applied in most cases as the most effective method. In any osteotomy in surgery over the deformed joint dissected tissue, bone intersects (transversely closer to the nail or at the other end, From-figuratively either along the main phalanx), the bone fragments are set to the correct position and fix with staples or with a special screw.
- Arthrodesis. This type of surgery is performed in very rare cases, because the main aim of the operation: creation of a stationary connection, which is not possible to completely restore the station. An indication of this type of surgery is heavily ruined joint of the thumb, which cannot return to the correct position using osteotomy. Metatarsophalangeal joint during surgery is removed, and the bone – are linked among themselves. The disadvantage of this method are incurred after load pain in the stitches and also it is necessary to constantly wear orthopedic shoes.
- Resection arthroplasties, in which removes a portion of the articular surface. In this case between parts of the bones remains a cavity, which in the process of healing fills the connective tissue (i.e., formed a false joint). Full restoration of function of the foot, this operation gives.
- Correction of the transverse arch of the foot. In this type of surgery adjusted, not joint and bone and soft tissue around the problem area. During the operation with the thumb for 1-yu instep transplanted bone tendon the head of the muscles of the thumb, the muscle ceases to hold the thumb in a declined position, the angle between the bones of the legs are changing, and the arch resumes its normal shape. The method is effective in the early stages of the disease.
- Exostectomy, in which she removes herself cones (part of the head of the metatarsal bone) and soft tissue located around the affected joint. Walking after surgery will recover, the pain is removed, but they are a possible relapse.
The most common techniques
Operation on bone of the thumb feet with the the crossroads bone is most commonly performed using the methods:
- Scarf-osteotomy. It is used when moderately expressed valgus deformity. Allows you to shift in the longitudinal direction and rotate a portion of the head of the metatarsal bone, extend or shorten the first metatarsal bone, to shift bone fragments, which allows to achieve greater symmetry of the joint and reduce the load on the joint and the inner part of the legs. The good results of the technique allows in combination with correction of the soft tissues.
- Osteotomy the Austin/Chevron, in which is carried a V-shaped intersection of the first metatarsal bone. Applies in the case of negligible valgus deformation, allows you to slip the head of the metatarsal bone on 1/2 of its width (when biased more than 1/2 of the width of bone needed for bone the seams for stability may be enough).
- Osteotomy the Akin, which takes place at the main phalanx (at the level of the proximal department adjacent to the epiphyseal plate of the tubular bones). Accompanied by the obligatory manual correction of the valgus deformity. Bone moves in parallel metatarsophalangeal joints between and the nail house inch, a wedge piece is removed.
Surgery to remove the seeds on the large finger of the foot can also take place:
- According to the method of Vale (oblique osteotomy of small metatarsal bones). Allows you to shift the bones toward the center and in the longitudinal direction, returns the head of the metatarsal bone in the normal position and helps eliminate the malleus informibus deformation of the fingers.
- According to the method of Schede-Brandes (marginal resection of the medial bone curvature (exostosis')). During the surgery is removed on the lateral surfaces, 1-st metatarsal bone and the proximal portion of the main phalanx of the finger, superimposed mounting station in a certain position, a plaster splint, and then in the course of 2 weeks takes place traction for the nail phalanx of the thumb.
A good cosmetic result gives the operation to remove the stones on the legs by the method of Vreden-Mayo (involves the removal of the head of 1-st metatarsal bone together with the bulge), however, due to the removal of the main thrust washer of the feet when walking after the surgery, there was a violation of the support function of the foot.
Removal of a bunion on the big finger of the foot according to the method of Calcina (the transition of the dice with the rotation of the head 1-st metatarsal bone) and the trapezoidal wedge resection 1. the metatarsal bone by the method of Boma and Reverdens do not eliminate the medial deviation of the 1-st metatarsal bone and not undelete the arch, therefore, is often accompanied by relapses.
The patient may be offered were operations aimed at correcting the several components of the deformation of the legs:
- Method Kramarenko and Boyarsky, in the course of which after surgery by the method of Schede-Brandes for the removal of the medial deviations of the 1-st metatarsal bone distal planetinvader joint is performed a transverse osteotomy, and created a wedge slit clog formed from the distant earlier parts of the bone graft. From lavsan tape to form the transverse ligament of the foot, which holds the 1-st metatarsal bone is in the correct position (the tape is sutured to the edges of the capsule 1-th and 5-th metatarsophalangeal joints). After the operation stops for 4-5 weeks applied plaster bandage.
- Operations Korzh and Eremenko, in which the bone is not cross, because the defect is removed by using the removal of 1. planetinvader the completion of the joints. Transverse ligament the foot consists of the tendon of the long extensor 4. finger feet.
- Operation by the method of CITO, which is accompanied by the formation of transverse ligaments of the foot from lavsan tape in the shape of a figure eight on Klimov.
If necessary, is carried out of the joint, in which the deformed joint is completely removed and replaced with an artificial one.
How is carried out the removal of a blister on the foot
Currently, to remove a blister on the foot, it is possible with a minimum of injury by:
- Minimally invasive methods, in which it is cut is not greater than 3 mm (when large deformation – 10 mm). Surgical manipulation (junction of the bone and alignment of its parts) is performed through a small incision under the control of the x-ray. The advantages of a minimally invasive osteotomy include a short period of rehabilitation, and almost unnoticeable scars, feelings of pain and the risk of complications is minimal. Minimally invasive surgery does not require general anesthesia (using local or epidural), but they can be only in a light degree of deformation of the big toe.
- The Laser, which allows to remove the bone tissue best layers, while maintaining the so the mobility of the joints. The rehabilitation period is shorter than when using traditional sets for rapid intervention (drill, needle, screwdriver, clamp). Laser removal on my feet is used in the absence of the patient's other deformation of feet and complication of a valgus deformity.
Approach in the implementation of the operation can be:
- open (the fabric is cut into cubes with the help of a scalpel the surgeon thanks to the visual review monitors the repair process);
- closed (manipulation is performed through a small incision, control is carried out using x-ray).
The removal of the cores on the leg with a laser – grinding the bumps on the legs up to complete compared with the side surface of the foot, which is performed through a small incision. For the removal of the stone using laser resurfacing is accompanied by:
- resection arthroplasty.
The advantages of laser removal of valgus deformity include:
- disinfection wounds under the influence of the laser, which reduces the risk of infection to a minimum;
- minimal blood loss thanks to the negligible largest incision, through which are performed the manipulation;
- the lack of influence on the surrounding tissue;
- quick recovery;
- the shorter the duration of the operation (it takes 1 hour, while removing the bumps by traditional surgical methods takes about 2 hours);
- not required after surgery to wear a plaster.
Removal of a blister on the foot with each method consists of several stages. Most often in the course of the operation:
- On the inner side of the phalanges of the feet is made an incision.
- Performed capsulotomy (dissection of the capsule of the first metatarsophalangeal joint).
- Performed excision of bone curvature (removing the bumps).
- Cut the first bone of the hock (performed osteotomy).
- The surgeon moves the fragments of the bones of the hock, by changing the axis of the strain of the plot.
- The bone is fixed by titanium screws or staples.
- The capsule and the incision sutured.
- On the access point overlaps with a sterile bandage.
- The stop overlap the retaining bandage or plaster (depending on the type of surgery).
Titanium screws in the absence of discomfort is not removed.
Although the operation on the leg removal of a bunion is usually done with the use of less traumatic methodologies, there are a number of contraindications to its implementation. The operation is contraindicated when:
- thrombosis, which is accompanied by inflammation of the veins, and violation of blood clotting;
- diabetes, obesity;
- cardiovascular insufficiency;
- violation of the blood supply to the tissues of the foot;
- pathologies of the musculoskeletal system.
Removal of a blister on the foot laser has virtually no contraindications, however, before the procedure, it is necessary preoperative examination.
Preparation for surgery
Before how to remove a blister on the foot, must undergo a thorough diagnosis, which allows to detect all pathology of the foot – chest x-rays of the feet from different sides, or magnetic resonance imaging of the chest.
In addition to the removal of the wound on the foot at the big toe surgery may involve removal of the deformation in the form of a hammer the other fingers of the feet and so on
The patient is in good pre-surgical examination is sent to the handover analysis:
- blood (general, biochemical, on sugar, on blood clotting);
- urine (general analysis);
- for identification of hepatitis and HIV;
The duration of the rehabilitation period depends on:
- the amount of remote tissue;
- the methods of operation.
In any case, in the postoperative period it is necessary to fixation of the foot. If the patient with which it is removed only part of the metatarsal bone and the procedure was conducted without the use of a laser, the dog is set at 4 weeks, when removing the joint of this period increases up to 10 weeks.
Rehabilitation after minimally invasive or laser surgery takes less time, and judging by the ratings, runs more than smoothly.
The load on the foot in the postoperative period is limited, it is allowed to walk on average over a week (the pressure on the operated station is limited). Normal walking is allowed after consultation with the attending physician (average per month). When the Scarf-osteotomy of the permitted load of the foot in a special Orthez immediately after surgery.
The patient you are appointed to:
- integrated therapy (anti-bacterial, anti-inflammatory and painkillers);
- medicinal natural complex, which is the doctor selects individually;
- wear soft wide shoes with thick arch support or a special orthopedic shoes;
- wear orthopedic inserts in my shoes.
Exercise therapy in the postoperative period is appointed always, but the timing of the beginning of its holding depends on the method of operation:
- In the implementation of the operations of Schede-Brandes physiotherapy is carried out with 4Guo, 5-th day after surgery. The patient further it is recommended to wear insoles, which holds 1. finger in the correct position.
- When using the operation Kramarenko and Boyarsky movement therapy start for 1. finger legs on the 5-th day. After removal of the fixing plaster bandages to the front of the front foot is fixed with a rubber sleeve, which supports the transverse state.
- When you use the CITO plaster immobilization lasts for 1-1,5 months. LTV start to perform with the 4-th and 5-th day after surgery.
The exercises in the postoperative period are similar to the exercises used for the prevention of valgus deformity.