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With severe deformities of the foot, which leads to the appearance of bumps on the legs, the patient is recommended to undergo a surgical operation to excise them (exostectomy). And, despite the fact that modern medicine has about 150 methods of surgical treatment of this pathology, there is still a lot of controversy around the effectiveness of surgical treatment of hallux valgus deformity of the thumb.
If the metatarsal bone separates from other bones at an angle of more than 18 ° C, and the thumb is bent by more than 35 ° C, then surgical intervention is necessary.
With gout, surgery is prescribed for its atypical form, when the disease is accompanied by an accumulation of intra-articular effusion. In this case, puncture evacuation of pathological contents is required.
Preparing for an operation
Before proceeding with the procedure for removing the bumps, the doctor must examine the patient. Be sure to appoint him an x-ray of the foot in different projections. More accurate information can be obtained using the CT or MRI method.
Tests to be taken by the patient:
Blood for glucose level, blood for evaluation of the coagulation system, blood for biochemical and general analysis.
Urine on the general analysis.
Blood for HIV and hepatitis.
Be sure the patient will need to undergo an ECG or provide a doctor with a fluorography.
Indications for operation
To determine whether the patient needs surgery to remove the bumps on the leg, you need to carefully examine it. Surgical intervention is carried out only when the disease has reached the final stage.
Indications for surgery to remove bumps on the leg:
The valgus position of the hindfoot exceeds 20 °C.
The patient’s legs hurt both at rest and while walking.
The joints are very tight.
Calluses constantly form on the foot.
The joints are inflamed, it is not possible to cope with the inflammation with conservative methods.
Sometimes the operation is performed solely for aesthetic reasons, since the bumps on the legs are a cosmetic defect. The smaller the angle of deviation and tissue deformation, the easier the operation will be.
Results after the operation
The prognosis after the operation to remove the bumps on the legs may be as follows:
The patient will be in pain. Already on the second day after the procedure, it will be possible to refuse the use of anesthetics.
The mobility of the toes is normalized. However, the full range of motion will be restored only after the completion of the rehabilitation period.
The cosmetic defect will be corrected.
The leg will look attractive, the person will get rid of psychological discomfort, will be able to wear open shoes.
When should cones not be removed?
The operation to remove bumps on the legs may not be performed for everyone.
There are the following contraindications to its implementation:
Thrombosis complicated by inflammation of the venous wall.
Violation of blood clotting.
Diabetes.
Obesity.
Heart failure.
Disorders of the innervation of the foot.
If there are no contraindications, then the patient is prepared for surgery.
Types of operations to remove bumps on the legs
Access to bone tissue can be obtained both openly and through the skin. During an open operation, the patient’s leg is cut with a scalpel, exposing the area of work. In addition to a scalpel, a laser beam can be used as a cutting tool.
With percutaneous access, all manipulations are carried out through small punctures. Modern medicine has many technologies to get rid of bumps on the legs. There are more than 200 of them.
However, the most commonly used ones are:
Lump resection on the lateral surface of the head of the first metatarsal bone and the phalanx of the finger. The procedure is carried out on an outpatient basis, it is not necessary to hospitalize the patient. The patient’s leg is treated with iodine, after which Novocaine is injected into the incision area. As a rule, local anesthesia is sufficient. The doctor makes an incision, about 5 cm in size, separating the soft tissue from the bone. The cone itself is knocked down using a chisel, and its surface is polished. The wound is fixed with threads, and a roller of dense material is inserted between the 1st and 2nd fingers of the patient. A splint is placed on the limb.
Osteotomy of the first metatarsal or, as it is also called, the Hohmann operation. This will remove only part of the bone. Anesthesia is shown local, with the formulation of an injection of Novocaine. The doctor cuts soft tissues along the first phalanx of the finger, after which he removes the mucous bag located in the area of the bump. The next step in the operation is cutting off the tendon. With the help of a chisel, the doctor beats off the wedge-shaped part of the bone to align the joint. The bones are fixed with a wire or plate, and the bump itself is cut off. The tissues are sutured with threads, and a cast is applied to the leg. The patient will need to wear it for 21 days. This operation is associated with a lower risk of complications compared with resection of the bump.
McBride operation with muscle truncation. This procedure can be carried out if the deformation is minor. Anesthesia is required only local. The doctor performs a skin incision from the side of the sole. Then the doctor separates the adductor muscle of the first finger, notching it and shortening it. The next step is to suture the muscle to the first metatarsal bone. The tissues are fixed with surgical threads, a plaster splint is put on the leg. You will need to wear it for 3 weeks.
Vredenu-Mayo operation involves an osteotomy of the 1st metatarsal bone or the first phalanx of the finger. It is most often performed on elderly patients who have severe joint deformity. The procedure is performed under local anesthesia. The incision is made in the form of an arc. With the help of a bone spoon, the doctor dislocates the bone, which is to be shortened, after which it is cut down, and the edges are polished. After performing all the manipulations, the tissues are sutured, and a splint is placed on the limb. The advantage of this operation is that relapses rarely occur after it. However, at the same time, impressive volumes of bone are removed, which can lead to a violation of the supporting functions of the foot.
Reconstructive surgery according to the CITO method. In this case, the patient is implanted with an implant, which is made from the tendons of the person himself. The procedure is performed under local anesthesia. An implant is placed in the site of removal of the sphenoid process of the bone, the bones are fixed with knitting needles, which are subsequently removed. In parallel, the doctor shortens the tendon, which will have to fix the bone in the desired position. The surgeon puts stitches in the incision area. The time of wearing a plaster after the operation is 30-45 days.
Percutaneous minimally invasive osteotomy
The operation is performed either under local anesthesia or with the help of epidural anesthesia. In the latter case, an anesthetic is injected into the spine.
The doctor, using a drill, makes a hole in the metatarsal bone, working with the tool at low speeds. The hole diameter is 2 mm. A needle is inserted into it. On the other hand, another hole is drilled, into which a knitting needle of a smaller diameter is also inserted. This allows you to change the position of the bone. In the future, the spokes are removed, and the screw is left in order to fix the bones. If necessary, the bones can be shortened with a drill.
If the patient has large bumps, then the hole can be expanded up to 1 cm. However, this situation is rare. Since the operation is minimally invasive, it is possible to refuse suturing. The patient is shown to wear an antiseptic bandage for 2 days.
The advantages of such an operation are obvious:
The scars after it will be hardly noticeable.
The rehabilitation period is shortened.
The risk of thrombosis is minimal.
Using a laser to remove bumps on the legs
If the incision is made with a laser rather than a scalpel, then the recovery period can be shortened. Within a few hours after its completion, a person can be discharged. You can begin to actively move your finger after 3 weeks.
The operation, performed using a laser, allows you to save the patient from pain in the rehabilitation period. The procedure itself is practically bloodless, since the vessels will immediately be cauterized. The use of a laser eliminates the need for suturing.
Recovery after surgery
The recovery period depends on the extent of the intervention. If only the bones of the metatarsus were removed, then the joint is immobilized for 4 weeks. When large areas are removed, the cast will need to be worn longer – up to 10 weeks. At this time, it is necessary to minimize the load on the limb, so the patient is shown bed rest.
After the plaster is removed, the person will need to adhere to the following medical recommendations:
Wear Baruk’s shoes. It has a wide base in the toe area and allows you to remove the load from the first toe.
If a person is haunted by pain, then he should take drugs from the NSAID group, for example, Nise.
The wound must be properly looked after, timely changing dressings with antiseptic compounds.
Starting from the 20th day after the intervention, the patient is shown to perform gymnastics for the toes. Exercises are selected individually. They allow preventing the formation of joint contractures and avoid limiting its mobility in the future.
What is the likelihood of recurrence after the operation? Statistics say that the danger threatens the patient in 30% of all cases. In addition, you should know that immediately after the operation, a person cannot be fully able-bodied. For several months in a row, he should limit any load on the foot. Typically, a patient needs two to six months to recover. The joint itself will be able to fully function only after a year.
Possible complications
Any surgical intervention is associated with the risk of complications, including:
Decreased sensation in the foot. Most often, it is restored after the nerve fibers regenerate. This happens 8-10 months after the intervention. However, if the nerves have been severely injured, the deterioration in sensitivity may persist throughout life.
Long tightening of the wound, which is especially important for the elderly. Provoke the development of inflammation can enter the soft tissues of the infection. Therefore, it is necessary to take care of postoperative sutures correctly.
Pain during movement of the toes. A similar complication develops when the fixing structures of the bone were not positioned correctly. This will require a second operation.
Necrosis of the bone can be observed when it is significantly damaged, or when an infection is introduced into the wound.
Reappearance of cones. Relapse most often occurs when minimally invasive surgery is performed.
Contractures of the metatarsophalangeal joint. Deterioration of joint mobility is observed when the patient does not follow medical recommendations.
In the early postoperative period, swelling of the foot may be observed. This is normal. Physiotherapeutic procedures, for example, UHF therapy, amplipulse therapy, etc., help to reduce tissue swelling and pain. With their help, the patient will be able to recover faster.
Cons of surgery to remove bumps on the leg
Before deciding on surgery, you need to take into account that after it is carried out, a person will lose his ability to work for 1-2 months. In the rehabilitation period, he will be able to move only with the help of crutches.
You also need to be prepared for pain after the procedure. Analgesics can cope with them. Therefore, the decision on the need for surgical excision of the bumps on the legs should be weighed. Discuss other treatments with your doctor.