Edema after surgery valgus

What is Hallux Valgus?

Term Hallux Valgus translated from Latin means a departure to the outsidethe big toe. In this case, the joint formed by the first metatarsal bone of the foot and the proximal phalanx of the thumb (joint at the base of the thumb) increases in size, bone growths appear around it, and soft tissues located near it become inflamed. The result of this process is the deformation of the joint, its increase in size, pain and swelling. In the people, this deformation is often called "bone stones" or "cones" on the feet. Another name for Hallux Valgus is the valgus deformity (valgus deviation) of the first toe.

In our time, the most common causeThis condition - Hallux Valgus - is considered the wearing of a poorly matched, uncomfortable shoe that pereguzhaet the forefoot, compresses your fingers and makes them stay for a long time in an uncomfortable position. As a rule, these are shoes with a narrow pointed toe and high heels. Heredity is also given a significant role in its formation, however, only in a small number of cases.

Unfortunately, the exact reasons for Hallux Valgusnot reliably determined. Why does this condition arise? Why do members of one family suffer from deformity, and others did not hear about it? If the cause of the disease is uncomfortable shoes with narrowed socks, then why do not everyone who wear such shoes or shoes have "bones"?

Here's what we know at the moment: according to some studies, it has been proven that wearing uncomfortable shoes is a reliable risk factor for the development of Hallux Valgus. Reliable, but not unique - after all, some people who do not deal with such shoes, deformities of the fingers also occur.

A study conducted by the Americanorthopedic doctors, found that 88% of women in the United States prefer to wear shoes that are certainly smaller than required, and 55% have problems with the first metatarsal joint (joint at the base of the big toe). Not surprisingly, this pathology is nine times more likely to affect women than men.

From the point of view of anatomy, the problem of wearingSimilar footwear consists in an overload of an anterior part of the foot and a distortion of the alignment of the components of the metatarsophalangeal joint (deviation of the first metatarsal bone to the inside, and the thumb to the outside). Between the bones forming the first metatarsophalangeal joint (the joint at the base of the thumb), an angle appears that opens to the other fingers. After that, the foot muscles react: there is an overstrain of some and excessive relaxation of others, which further exacerbates the problem. This muscular imbalance helps to maintain the wrong position of the metatarsal and phalanges of the fingers, as a result of which the external mechanical effect on the metatarsal and phalanx joint is strengthened (with support to the ground and the pressure of the shoes), the process of growth of scar and bone tissue in the joint region begins - "bones" . As a result of bone deformity and muscular imbalance, dysplasia of ligaments that fix the joint arises, a violation of the elasticity of the joint capsule.

There is one more significant problem,resulting from the anatomical features of the foot bones. As a rule, most people under the base of the thumb have two small - sesamoid - bones. Despite the small size, their function is very significant. Sesamoid bones are part of the "transmission mechanism" needed to implement thumb movements during walking. Thanks to them, we practically do not feel pressure on the foot, rendered by the surface at each our step. In the case of Hallux Valgus, an incorrect redistribution of tendon traction on the bones of the metatarsals and phalanges of the fingers leads to the displacement (dislocation) of the sesamoid bones, which ultimately provokes a violation of the supporting function of the thumb and foot as a whole.

There are many studies onthe problem of Hallux Valgus, in which the role of anatomical features and biomechanics disorders, which to a certain extent determine the development of pathology, was studied in detail.

Further study of this problem is needed,to fully answer questions about the causes of its occurrence, conditions of manifestation, pathogenesis. The ultimate goal is to improve the methods of preventing the deformities of the toes and effective treatment if the pathology is already taking place.

Can the development of Hallux Valgus be prevented?

In some cases, the progression of valgusdeformities of the big toe (Hallux Valgux) can also be prevented without surgery. But sometimes conservative procedures are not enough, and only the operation will help get rid of the pain, fix the position of the toes and normalize its functionality as a whole. If you are interested in the problem of treating this pathology, or if you are already recommended for surgery, our article will help you learn more about the nature of the disease and about the methods of its treatment.

When the disease progresses, the jointthe bases of the big toe are deformed, inflamed and often very, very painful. However, the deformation does not progress in all cases. Many of the symptoms that occur while doing this, can be eliminated even without surgery. Reduce the pain and other unpleasant feelings in the vast majority of cases can be through the following activities:

  • use a fairly loose shoe that does not squeeze the fingers, with a small heel;
  • Special shoe inserts and other orthopedic appliances can also alleviate pain;
  • for the treatment of Hallux Valgus, accompanied byarthritis, in addition to special shoes, non-steroidal anti-inflammatory drugs are used as prescribed by the doctor, which calms the pain and reduces swelling.

When is the operation shown at Hallux Valgus?

If conservative (without an operation) methodsit is possible to achieve improvement of the condition and relief of pain, it is necessary to consider the possibility of surgical intervention. According to the results of postoperative follow-up, 85 to 90 percent of patients are fully satisfied with the results.

Indications for operative treatment with HalluxValgus include: severe pain in the affected joint, which significantly limits daily activities, including walking and wearing shoes; chronic inflammation and edema of tissues surrounding the joint; visible tumor, which can not be treated with analgesics and anti-inflammatory drugs; impossibility to move the thumb of the foot.

If you are interested in the problem of surgicaltreatment of Hallux Valgus, know that the so-called "minimal" surgical interventions are an inadequate solution to the problem, and can do more harm than good. Do not think that surgery is a panacea, the way to achieve an ideal result. The purpose of the operation is to remove the pain symptoms and correct the wrong position of the toe as far as possible.

Types of operations with Hallux Valgus

Currently, varioussurgical techniques for treating Hallux Valgus and the complications caused by it. However, the overall goal of these techniques is joint unloading, pain relief, giving the thumb the right position, correcting the deformity of the foot. Among the methods used to correct Hallux Valgus, the following main types can be distinguished:

  • Osteotomy
    Osteotomy is a surgically performed bone crossing and restoration of its right axis.
  • Atrodesis
    Arthrodesis is one of the most radical waystreatment. It consists in removing the damaged joint surfaces, and then rigidly connecting the head of the proximal phalanx of the thumb and the first metatarsal to each other (using screws, wires, plates) until the time of complete adhesion. Used to treat patients with severe bursitis, arthritis, when other treatments do not work.
  • Surgical removal of bone growths (resection of exostosis)
    The procedure does not eliminate the radical defect and itsthe reason, in its essence, is practically a "cosmetic" operation aimed at improving the quality of life (the foot acquires a more natural appearance, does not occur by rubbing it with shoes, walking becomes less painful).
  • Joint resection with subsequent arthroplasty
    The operation consists in removing the damagedarticular surfaces with subsequent replacement of the joint by an artificial one. They are used mainly in relation to patients of advanced age who have a history of surgical procedures on the foot for bursitis or arthritis of the joint of the thumb.
  • Soft tissue surgery
    At present, as a rule, do not have independent value, they are used in combination with other (above) methods.

Orthopedic evaluation of Hallux Valgus

The orthopedist evaluates the patient's condition based onthree main factors. The first of them is the collection of anamnesis (information about the state of health, the disease itself, the time of the onset of pain and its intensity, shoes that do not cause pain). Other conditions that may affect the outcome of the operation are also important. These include diabetes mellitus and rheumatoid arthritis, which, for example, increase the risk of infection and hinder healing. Violation of blood circulation in the foot also interferes with recovery after surgery and promotes the intensification of postoperative pain.

The second factor is a physical examination,aimed at assessing the degree of bone displacement and soft tissue damage, as well as to check for a different pathology, for example, hammer-shaped deformation of the fingers or the most common corns.

The third is X-ray examination for more accurate determination of the degree of damage and deformation of the joint.

Your doctor will review the results of the survey.together with you and help you decide on the operation. He will also explain the possible risks and complications that may occur after surgery.

What to expect from the operation?

A very important point for the patient isa clear understanding of what to expect from the operation, and which is not worth it. The vast majority of patients after surgery note a significant reduction in foot pain and improved mobility of the thumb. However, do not think that after the operation you will be able to lead the same lifestyle as healthy people. Unfortunately, some restrictions must be observed. You will not be able to wear fashionable, but uncomfortable shoes with pointed noses - remember that the main cause of the disease is just such shoes, and by returning to it, you will re-provoke the aggravation.

If you decide on a surgery to correct HalluxValgus, the most urgent measure - a medical examination to exclude pathology (for example, from the heart and lungs), which can affect the recovery time.

Before surgery, tell the operating surgeon about the medications that you are taking.

Blood tests, urine, cardiogram, chest x-ray, chest radiographs - mandatory studies before surgery.

Before the operation, you will be examined by an anesthesiologist. Most such operations are performed under conductor or spinal anesthesia, when consciousness is preserved, but pain sensations in the foot and shins are completely absent. And only in exceptional cases there is a need for anesthesia.

The operation takes about one hour.

To prevent the development of infection within a few days after the operation, antibiotics are prescribed, and analgesics are used to reduce discomfort and pain.

Possible complications after surgery to correct Hallux Valgus

Number of postoperative complicationsHallux Valgus is usually small. These include infection, relapse and the resumption of pain. Complications, if they arise, are certainly amenable to treatment, but can affect the time of full recovery.

Recovery after surgery at home

The success of the operation depends to a large extent on thehow well you will follow the instructions of the operating surgeon, especially during the first few weeks after the operation. During this time, you should visit your doctor regularly so that he can make sure that the healing is proceeding properly and, if necessary, adjust the treatment.

After discharge from the hospital, a stack is appliedbandage for fixing a sore thumb. In some cases it is necessary to wear special postoperative footwear. The sutures are removed approximately two weeks after the operation. When taking a shower, protect the foot before removing the seams by placing it in a plastic bag. To ensure proper quality of treatment, it is very important not to displace the dressings and keep them dry and clean. If these simple rules are not observed, relapse of deformation may occur.

During the first few days after surgeryUse a walker, cane or crutches in order not to overload the sick leg. As the healing progresses, gradually move more weight to it, but do it very carefully and carefully - only go for short distances within the first week after the operation. After this time, you probably will be able to load the sick leg in full.

To reduce edema, try to keepthe operated limb in an elevated position, apply the ice to the foot in accordance with the recommendations of your doctor. However, some swelling of the foot can persist for about another six months. After the bandage is removed, wear only soft and comfortable sports shoes or leather shoes for several months until complete healing. Do not wear uncomfortable (even very fashionable) shoes, including high heels, until it passes (at least) six months.

To restore the strength of the muscles of the foot and its mobility after the operation, physical exercises are recommended under the supervision of the physiotherapist.

How to avoid complications after surgery?

Although this situation is rather rare, howevercomplications after the surgery to correct Hallux Valgus can take place. Immediately consult a doctor if the dressing is soaked with a liquid; there were signs of infection (fever, chills, local warming and redness of the skin around the bandages, severe pain, swelling).