Shortening toes: what is done and what is it. All About Surgical Treatment to Remove a Bulging Bone on the Big Toe Snap Toe Symptoms


Commonly referred to as a bump, this is a common problem in orthopedics. In medicine, such a deformation is called valgus pathology or exostosis. In some cases, the pathology does not lend itself to conservative treatment and requires surgical intervention.

Indications for Bone Surgery on the Big Toe

Surgical intervention for hallux valgus is required in several cases:

  • severe pain that interferes with walking;
  • deflection of the finger by more than 50 °;
  • inflammatory process;
  • bone damage;
  • seals in the joints;
  • ineffectiveness of conservative treatment;
  • curvature of other bones on the foot;
  • pain and swelling even at rest;
  • bleeding callus on a protruding bone;
  • severe redness of the skin;
  • correction of a cosmetic defect.

Surgical intervention is required for the most part to relieve pain and restore finger mobility.

Varieties of operations to remove a bone on the big toe

One of the following techniques can be used to surgically remove exostosis on the toe:

Depending on the technique, operations are minimally invasive and reconstructive. Surgical removal can concern only soft tissues or exclusively bone structure, or combine these manipulations. Each technique has its own characteristics, advantages and disadvantages.

Exostectomy

Such an intervention means the excision of part of the joint and the removal of the soft tissue around it. If the situation is rather neglected, then additional fixation with the help of stitches, plates, screws or wire is possible.

The operation usually lasts no more than an hour. It is performed under local anesthesia. Such an intervention can be carried out minimally invasive (make a puncture in the skin) or open access.

Exostectomy is used when the outgrowth is still small, and the thumb is slightly deviated.

The main advantage of this technique is quick relief. This applies not only to the elimination of pain, but also to restore gait.

A significant drawback of exostectomy is the reappearance of the bone. Complete cure is rare.

Osteotomy

The first metatarsal bone or the proximal phalanx can undergo such an intervention. In the first variant, the aim of the operation is to reduce the angle between the metatarsal bones. This intervention is distal and proximal.

In the case of a distal osteotomy, an artificial fracture of a part of the metatarsal bone (its distal part) is made and its displacement. The operation can be performed by open access or minimally invasive (punctures). After establishing the fragments in the required position, fixation is performed with screws, which are removed after a month.

The proximal osteotomy is performed similarly to the distal intervention, only the proximal bone is affected.

The main benefit of this intervention is significant pain relief. The disadvantage of this technique is the possible asymmetry of the joint, as well as difficulties with its subsequent replacement (if required).

Endoprosthetics

Such an intervention is referred to as prosthetics - the deformed joint is removed and replaced with an implant.

The main advantages of endoprosthetics include:

  • elimination of pain syndrome or its significant reduction;
  • restoration of motor function;
  • return to work.

This technique has some disadvantages:

  • the joint should be changed approximately every 15-20 years;
  • possible limitation of physical activity;
  • incomplete elimination of pain syndrome;
  • complications (secondary infection, displacement of the prosthesis).

Arthrodesis

Such a surgical intervention is the most radical and is used in the background. They resort to arthrodesis when other methods of treatment have failed.

During the surgical procedure, the cartilaginous surfaces are excised to securely fix the joint. For this, screws are used. Such complete immobility is provided for the fusion of surfaces.

The main disadvantage of arthrodesis is a difficult and long recovery period. At this time, the patient needs complete rest, the slightest exertion is prohibited.

The advantages of this technique are in restoring the physiological structure of the foot, in the disappearance of symptoms of arthrosis. Arthrodesis is an open cavity intervention, so some complications are possible. They appear quite rarely.

Resection arthroplasty

During such an operation on the big toe bone, the joint from the metatarsal bone is partially truncated, and then its biomechanics are restored and a new articular surface is modeled. A complex of tissues, including ligaments and fascia, is introduced between the articular surfaces.

The main benefit of resection arthroplasty is long-term pain relief. The disadvantage of the operation is that it requires long-term rehabilitation and no stress.

Correction of the transverse arch of the foot

This is the most commonly used technique. The essence of the operation is to change the angle between the bones, as a result, the joints take the right place. For this, the bony outgrowth is excised or the metatarsal bones are dissected for subsequent correction of their position and fixation in it.

The advantages of such an operation are many:

  • independent movement within a few hours after the operation;
  • fast recovery;
  • extremely rare relapses;
  • no complications;
  • the ability to operate on both feet;
  • no need to apply plaster;
  • no artificial materials are used.

If the operation is performed correctly, then it has no drawbacks.

Laser resurfacing

This technique is not traumatic, since the soft tissues of the foot do not have to be excised. The bone tissue of the build-up is removed with a laser in layers, therefore this technique is called resurfacing.

The main advantages of such an operation are the minimum rehabilitation period, painlessness and the absence of the need for plaster cast. The only downside to laser resurfacing may be its cost.

Recovery period

Features of the recovery period after surgery depend on the applied technique. There are general guidelines that should be followed in any case:

  • Avoid heavy loads. With some techniques, the patient cannot even get out of bed for several days.
  • A gradual increase in physical activity.
  • Wearing special orthopedic shoes. This is necessary to distribute the load evenly over the entire foot, as well as improve blood circulation. Of course, due to the high cost, orthopedic shoes are not available to everyone - in this case, orthopedic insoles can be purchased. They also give a good effect, although not comparable to shoes.
  • Choose shoes made of soft materials with a dense instep support. Naturally, heels must be discarded.
  • Medication therapy. Usually, after the operation, the patient needs a course of anti-inflammatory and antibacterial agents. In some cases, pain relievers are also required.
  • Gymnastics:
    • roll objects on the floor - sticks, rolling pins, balls, pencils;
    • lift objects with your feet;
    • walking on uneven surfaces;
    • standing on one leg alternately;
    • walking on the outside of the feet.
  • Cold compresses for swelling.
  • Laying the operated leg just above the bed level.
  • Physiotherapy (massage, shock wave therapy).

After some surgical techniques, it is necessary to fix the joint for about a month. This process is called immobilization. If the operation was rather extensive, then the patient is recommended to lie down most of the time, and to use crutches for movement.

Possible complications

As with any surgery, removing a thumb bone can lead to several complications:

  • infection (for prevention, a course of antibiotics is usually prescribed);
  • relapse - resumption of deformity (often observed when the rules of the rehabilitation period are not followed);
  • sharp stabbing pain with some movements (means displacement or incorrect position of the screw);
  • damage to nerves or blood vessels;
  • aseptic necrosis (manifests itself on the head of the metatarsal bone in violation of the blood supply);
  • joint contracture, that is, limitation of its mobility (special gymnastics and exercise equipment helps);
  • migration of screws (in case of improper fixation or excessive loads until complete recovery);
  • impaired skin sensitivity;
  • incorrect fusion or its complete absence.

Contraindications to big toe bone surgery

It is not always possible to perform an operation to remove a bone on the big toe. Common contraindications include:

  • diabetes;
  • impaired blood clotting;
  • heavy weight;
  • problems with the cardiovascular system;
  • impaired blood supply to the foot;
  • thrombophlebitis.

You can remove the bone on the big toe using various techniques. Each of them has certain characteristics. The method of carrying out the operation is chosen individually. In any case, after surgery, a rehabilitation period is required. The subsequent condition of the patient largely depends on compliance with its rules.

Shortening of the bones of the hand and foot, including the phalanges of the fingers, is a congenital or post-traumatic pathology. Deformation causes in a person, in addition to feelings of inferiority, pain, limitation of movement of nearby joints, discomfort. The lengthening of the short bones of the hand and foot, including the phalanges of the fingers, is a difficult task that requires a serious approach and strict control.

At the Volgograd Orthopedic Center, patients with this defect are treated by means of transosseous osteosynthesis according to the improved Ilizarov technique. The gradual lengthening of the short bones of the hand and foot, including the phalanges of the fingers, using special distraction constructions has a number of obvious advantages. Ilizarov's technique is very effective, it is used:

  • for almost all types of corresponding deformations
  • in a wide age category
  • in cases of cicatricial deformities of soft tissues and concomitant trophic abnormalities

Treatment of patients at VTsORKh is carried out according to the following scheme:

  • diagnostics
  • development of an individual operation plan
  • preparation of the patient for surgery
  • imposition and fixation using the Ilizarov apparatus
  • gradual lengthening (distraction) of bones by metered adjustment of the device configuration
  • rehabilitation

The period of distraction depends on the type of bone being lengthened, with an average of 14 to 32 days. The subsequent fixation takes approximately 28-54 days. As a result of the operation, the metatarsal bones are lengthened by 24 (± 5 mm), the phalanges of the fingers - by 7 (± 2 mm).

Elongation of the short bones of the hand and foot, including the phalanges of the fingers, according to the improved Ilizarov technique, has the following advantages:

  • is characterized by low trauma
  • does not affect blood supply
  • enables clear comparison and movement of bone elements
  • provides reliable and rigid fixation of the corresponding fragments
  • has optimal terms of treatment and rehabilitation

Bone lengthening operations performed by VTsORKh specialists are distinguished by good results. With the help of high professionalism of doctors, excellent technical base and the latest developments, patients increase the anatomical and functional capabilities of bones and joints, eliminate clinical manifestations of abnormalities, and return mobility. All this improves a person's health, allows him to lead a full-fledged lifestyle, instills a sense of confidence.

Hypertension 1 degree is a mild form of the disease and manifests itself in a slight increase in blood pressure.

Hypertension 1 degree refers to the mild form of the disease. The increase in pressure occurs within small limits, systolic - up to 140-159 mm Hg, diastolic - 90-99 mm Hg. In this case, the defeat of target organs is not observed, in contrast to the foam. Target organs are the heart, brain, kidneys, eyes.

The main symptoms are episodes of an increase in blood pressure. Patients feel it as a headache in the back of the head, which may be accompanied by flashing flies before the eyes, dizziness, tinnitus.

Therapy of hypertension 1 degree

Currently, therapy consists of several components, this includes lifestyle changes, correction of cardiovascular risk, lowering blood pressure to the target level using drugs (requires lifelong therapy), improving the patient's quality of life.

When therapy hypertension 1 degree great attention is paid to non-pharmacological methods of blood pressure regulation. This includes lifestyle and nutritional changes:

  • Reduction of excess body weight to normal parameters (ideally). With a decrease in weight by only 1 kg, there is a decrease in systolic blood pressure by 3 mm Hg, and diastolic by 1-2.
  • Smoking cessation.
  • Limiting alcohol consumption to a maximum of 20-30 g per day for men, and 15 ml for women, because they absorb alcohol faster and, in addition, women tend to have less body weight than men. Alcohol is not only a risk factor for the development of hypertension, but also causes resistance to therapy.
  • Increase physical activity - at least 30-40 minutes of walking at a brisk pace every day.

It used to be thought that controlling stress and relaxation can also lead to lower blood pressure, but subsequent clinical studies have not confirmed this fact.

  • Reducing the consumption of table salt to 4.5 g per day. For older people, this figure is even less - 2 grams per day. 6 grams of salt is contained in one teaspoon. Therefore, for better control, it is possible to recommend abandoning salt when cooking, and adding salt to food in the process of taking it from a metered portion.
  • Increasing consumption of foods rich in potassium, magnesium and calcium.
  • Increased consumption of vegetables and fruits.
  • Decreased consumption of caffeine.
  • Limiting animal fats.
  • Limiting the use of easily digestible carbohydrates.

Treatment of hypertension 1 degree

First of all, you need to see a doctor. Based on your medical history, he will prescribe individual treatment for you. It could be like

Evaluation of plastic surgery methodsfor fingertip loss are given below.

Thirsch skin flap due to the reduced resistance of the epidermis, it is not used at all. The Reverden method also gives good results when replacing a defect in the tip of the fingers, however, in the presence of defects reaching the bones, due to the absence of adipose tissue, the results of such plastics are unsatisfactory. Therefore, this method is used only in the presence of surface defects. The advantages of the Reverden method in the domestic literature are known from the works of Erzi and I. Zoltan.

Free skin grafting according to the Krause method is considered by most authors as a suitable method for replacing any defect in the fingertip. Kirchner and Gorband, even Meltzer and Fillinger use the thick Thirsch skin flap, which also includes the skin papillae. The disadvantage of this method is that in an inexperienced surgeon, the skin flap often does not take root, and since the transplanted skin does not have a lining of adipose tissue, it cannot be used to replace the volar surface defect.

a - Replacement of a defect in the skin of the pulp of a finger by mosaic plasty from the point of view of wound healing is a good method of treatment, but functionally it gives a poorly satisfactory result, since the area of \u200b\u200bsmall skin flaps is insensitive.
The cosmetic result is poor. This method is rarely used on the brush.
b - creation of a volar skin flap according to Marcus

Disadvantages of this way consist in the fact that the skin flap is strongly wrinkled, pigmented over time, and, finally, its temperature, pain and tactile sensitivity decreases for a long time or finally. In the engraftment of a dermatome (epidermal flap), one can be more confident than in the engraftment of a Krause flap.

Free transplant of an epidermal flap is one of the most acceptable plastic methods. It is described by Blair, Brown and Byers, behind them and Paget, and simultaneously with them, but independently of them, by the Hungarian explorer Ketteshi. In Hungary this method was introduced into wide practice by I. Zoltan. It is used with great success "to replace a skin defect in such cases when the subcutaneous fat is preserved or there is no need to replace it (Zoltan)."

Replacement of skin defects the palmar surface of the hand and fingertip is most successfully performed by using the own skin of the hand in the form of a displaced or pedicle flap. Of course, the own skin of the hand, having a special structure, surpasses the qualities of any other, being very strong and extremely sensitive. The density of the sensitive nerve endings contributes to an almost complete restoration of the sensitive function within several months.

Also fast recovers and the function of the sweat glands, since their number in the skin of the hand is three times greater than in the skin of the abdominal wall (Horn). This is very important when grabbing small items (for example, a sheet of paper, paper money). During plastic surgery, a very important fact is the presence of a rich vascularization of the transplanted skin, otherwise there is a danger of ischemia and infection. When the patient's own skin is transplanted, the patient does not need inpatient treatment or crossed immobilization (fixation to the other hand, to the abdominal wall). The latter can lead to the formation of contractures.

When loss of soft tissue of the fingertip to replace the defect, the own skin of the hand can be used according to the methods described below.

Clapp plastic is a modification of the Zamter method of covering an amputation stump. Currently, this method is rejected by surgeons, since after it a small defect remains. It is also unsuitable for replacing large defects.

Marcus way consists in shortening the bone and forming a volar skin flap in such a way that a small triangular segment is excised from the skin on both sides. If there are indications for shortening, this method is applied successfully.


In connection with the separation of the tip of the index finger, plastic was performed according to Trankiyi-Lili.
The result of the operation is excellent not only cosmetically, but also in terms of function

Plastic according to Trankiai - Lily - according to Kosh's experience, it gives excellent results when closing skin defects. A triangular skin flap is cut out on the volar surface of the finger, the tip of which is cut off almost to the bone. Then it shifts upward, and its base is sewn over the nail bed or the nail itself. This method gives less good results with a large defect in the flesh of the finger than when covering the fingertip with skin.

Clinic Lehi In 1945, a plastic method was proposed for the treatment of loss of the fingertip. The main method is to move the skin flap. Like Lengemann, we have obtained good results with this method.

Moving the finger's own skin has led to favorable results in the practice of Euler, Ehalt, Henzl, Hessendörfer, Lengemann, Reis, Bofinger and Stucke.


Plasty with a skin flap on the legtaken from the skin of the hand or distant sites, Iselen and Bunnell are used primarily in the restoration of a large defect in the soft tissues of the distal phalanx of the thumb and index fingers.

Tenar flap taken from the skin of the eminence of the thumb, while the proximal border of the flap should not interfere with flexion of the thumb. The skin defect remaining in the thenar area is replaced with a free skin graft.


Use of a thenar flap to close a fingertip defect. The tip of the third toe had an extensive defect in the skin and soft tissues (a-b).
The place of the leg skin flap in the thenar area is covered by free skin grafting from the forearm (c).
The injured finger is conveniently located after the leg flap is sewn to it (d), the plaster cast does not significantly limit the movement of healthy fingers (e)

Palmar flap suitable for replacing thumb defects. The base of the flap can be positioned in any direction; you should only spare the subcutaneous digital nerves.

Cross finger flap can be used to replace defects not only in the tip of the thumb and other fingers, but also for defects in the volar surface of the middle and main phalanges. This method is advisable to apply only to young people (Horn). The method of obtaining such flaps is shown in the diagram of Bofinger and Curtis, and the diagram of its structure is shown in the figure of Curtis.

Cross skin flap application indicated in cases where there is a need for replacement and skin and subcutaneous tissue. Good mobilization of the pedunculated skin flap is achieved by the detachment of obliquely passing fascia bundles, since the skin of the finger is laterally attached to the peritenon of the extensor tendon and to the periosteum (see Curtis's drawing). The results of plastic surgery performed with a cross-cut skin flap in the cases we operated on turned out to be excellent both in terms of function and cosmetics. Therefore, this method is indicated in all cases of skin and subcutaneous tissue replacement, especially in the presence of type B fingertip damage.

The sensitivity of the transplanted skin does not match the sensitivity of the displaced skin flap.

Apply a cross-cut skin flap from the thumb to close the thumb defect. The photographs show this method of plastics.
During the operation, the defect at the site of the pedunculated skin flap, taken from the lateral edge of the index finger, was immediately closed by free skin grafting.
The last photo shows that the index finger is in contact with the stump of the thumb, which has sufficient soft tissue thickness

Replacement of the defect using the skin of the less important damaged finger. The use of this method is allowed only if there is no possibility of restoration of this finger. In any case, with the simultaneous presence of a skin defect and destruction of the finger, the latter is removed only after the replacement of the defect, since the remnants of the skin of such a finger can be used by skeletonization.

Cross skin flap it is taken from the forearm when several fingers are damaged at the same time. Such a flap is suitable not only for replacing a fingertip defect, but also, for example, in the presence of a skin defect over the sheath of the tendon.


Finger cross skin flap surgery:
a) the flap is taken from the dorsal surface of an intact finger, its base lies proximally,
b) the base of the flap is located distally,
c) a flap to replace a defect in the pulp of a finger, the base is located laterally

Pediatric skin flaptaken from the abdominal wall, with the usual technique for plastics, is used reluctantly. Its flaws are described by Erzi.

Plasty with a stem flap on one leg in our literature was first described by Koshem in 1952. It is mainly used for exposing the thumb and forefinger.


a-b - a) Cross section of the main phalanx. Beams of fascia are visible, fixing the skin to the extensor tendon and periosteum,
b) Elongation of the skin flap used for the formation of a cross finger flap, after cutting these fascial bundles (according to Curtis)
c-d - Scheme of the formation of a pedunculate flap on one leg

Without soft tissue of the finger on a large area and along the entire circumference of the finger, as a rule, there are no conditions for free skin grafting. However, if skin grafting is performed without subcutaneous fat, the results obtained are usually not very satisfactory. Replacement of the defect with a displaced flap in such cases is not feasible, since there is not enough skin in the circumference. Thus, two options remain: shortening the toe or using a pedicle flap. Thumb shortening is not recommended, but in cases of damage to the remaining fingers, the patient's profession must be taken into account. In such cases, the use of a simple pedicle flap (bridge or wing shape) or a finger transplant under the abdominal skin is no longer satisfactory. A simple pediatric skin flap does not completely cover the circular defect. The disadvantages of this method are described by Erzi, Zoltan and Janos. The disadvantage of the method of transplanting a finger under the skin of the abdomen is that its release takes too long and, in addition, the desired end result can only be achieved by repeated plastic surgeries.

When replacing extensive circular defects of the soft tissues of the finger in four cases, we have successfully applied a pedunculated pedicle flap. After this operation, short-term immobilization of the forearm is required.

We have applied following operation technique: after the usual preparation of the finger wound for surgery, the size and shape of the skin defect is determined with a piece of gauze. Then this piece of gauze is placed on the abdominal wall and the edges are marked on the skin, taking into account the contraction of the prepared skin, then the skin is incised on three sides. At further stages, the formation of a pedunculate flap occurs according to the method of filatov's pedicle flap, proposed by Erzi and Zoltan. The only difference is that a triangular section of skin is cut out at the free edge of the skin defect on the abdominal wall to ensure uniform contraction of the edges of the defect. The skin in the area of \u200b\u200bthe critical area that occurs at the point of convergence of the two lines of sutures is not separated from the underlying tissues in order to maintain blood supply. To prevent tension on the abdominal skin, a loosening suture should be used, for example, over a bone button. A cutaneous tube prepared in this way is quite suitable for replacing a defect in a bare finger. Suturing the free edge of the flap and the edge of the skin wound of the finger is not difficult even in cases where the edges of the defect are uneven. Below are two cases from our practice.


1. S. M., 18-year-old worker... The left thumb hit the cogwheel. The damage pattern is shown in figure a. After plastic surgery (b), the skin flap was excised on the 18th day. The patient was discharged after a three-week hospital stay. She started work three months after the injury. The state of the thumb in this period is shown in the photographs in and d. Currently, he has no complaints, works in the same place.

2. B.I., a 36-year-old worker... The thumb of the right hand is compressed by iron blocks. In addition to the skin defect shown in Fig. a, exposing the distal phalanx bone and part of the flexor tendon, there was also an open fracture of the base of the nail phalanx (b). Four weeks after plastic surgery (c) the finger is separated from the abdominal wall. Full recovery of working capacity began on the 16th week after the moment of injury (d).

With this operations to establish the length of the flap, it is necessary to take into account the fact that with this modified method, in contrast to Filatov's original pedicle flap, the transplanted skin receives a full blood supply from only one side. Therefore, the length of the flap should not exceed twice its width. In addition, the blood supply to the flap gradually decreases from the side of the finger.

To evaluate our results compared with resultsobtained by other authors. It is safe to say that our results were more favorable. So, for example, on page 41 of Kroemer's monograph (see the list of references), an injury identical to our first case is described, the restoration of which was carried out with a pedicle flap taken from the abdominal wall. The reconstructed finger turned out to be much thicker and more deformed than in our case.

Described above skin grafting methods can be used not only to repair damage to the pulp and fingertip, but also to replace skin defects in other parts of the hand. Skin grafting for open fractures of the phalanges and metacarpal bones is required in 25-35% of cases. With regard to the primary replacement of skin defects, the favorable results of plastic surgery with displaced skin grafts deserve attention.

If the hands, fingers have lost their grace and correct shape due to illness, have birth defects, it will help out plastic surgery... Exist different types operations with the help of which it will be possible to return them to an acceptable appearance. Surgeons often manage to almost completely restore the function of the fingers.

Read in this article

Problems Solved by Plastic Surgery of Hands and Fingers

Surgery may be needed in the following cases:

  • With stenosing tendovaginitis... Pathology leads to the fact that the fingers or one of them are constantly in a bent position. It disrupts not only the appearance, but also the performance of the hand, and also leads to the appearance of pain, edema.
  • With rheumatoid arthritis. Autoimmune disease proceeds with joint inflammation. They are deformed, giving the fingers an unattractive look, soft tissues swell. Pathological changes cause pain in the hands, it is impossible to work with them, to hold anything. The disease can bend the fingers, leaving them in an unnatural position.
  • With Dupuytren's contracture... Pathology is a thickening of the subcutaneous fascia in the palm area. From this, the hand and fingers are bent, as the tendons are pulled over. Under the skin, during a severe stage of the disease, dense areas form that prevent the palm from being straightened.
  • Finger missing due to injury or birth... Modern surgery is able to restore it from the patient's own tissues or using prostheses.
  • With congenital anomalies... Sometimes a child is born with fused fingers. This is called syndactyly. More often it affects the area of \u200b\u200bthe middle and ring fingers, they are sometimes connected not only by skin and soft tissues, but also by bone. Polydactyly or having an extra toe is less common. It usually consists of soft tissue, sometimes bone is present, but no joints are present.

These defects are operated on in childhood, which allows to solve the problem with the maximum return of hand functions.

The cosmetic procedure biorevitalization of hands will restore the beauty of the skin. What drugs are used for her? How is hyaluronic acid carried out? What are the contraindications?