Schede operation for Hallux Valgus

The term “halus valgus” in medicine refers to a disease associated with deformation of the bones of the foot. In this case, the big toe acquires a stably curved position in relation to the direction of the other fingers, and the pathology is progressive in nature and over time the condition of the foot may worsen. How dangerous is such a curvature? In addition to the fact that a person with a pathology constantly feels discomfort, everyday shoes cause inconvenience to him, gradually the pain in the area of ​​​​the joint of the big toe acquires a continuous intense character and constantly poisons his life.

Pathology of Halus Valgus: what is it and why does it develop

Halus Valgus is a pathological change in the condition of the big toe, during which it is deformed at the level of the metatarsophalangeal joint, bending and bending. The joint forms the so-called “bone”, which bulges outward. In addition to the curvature itself, the disease is accompanied by arthrosis of the first metatarsophalangeal joint.

Women are about 10 times more likely to develop this problem than men – doctors attribute this fact to a weaker ligamentous apparatus of the foot, as well as to wearing high-heeled shoes.

The reason for the formation of the disease is the lack of development of connective tissue. The usual manifestation of such a pathology is the development of transverse flat feet, due to which there is a violation of the normal distribution of loads on the foot, varicose veins are formed, increased mobility of the articular elements, and excessive extensibility of the ligaments.

What factors can contribute to the appearance of curvature? The hereditary factor, that is, the presence of the disease in close relatives, for example, mothers or grandmothers, can cause the development of halus valgus. In addition, high heels, uncomfortable and tight shoes, congenital deformities, polio also negatively affect foot function.

The mechanism for the appearance of hallux valgus looks like this: when the ligaments are not strong enough, and the muscles that abduct and adduct the thumb are unevenly loaded, the joint becomes unstable, and the imbalance of muscle tension is exacerbated.

Due to the fact that the inner surface of the joint is in contact with the inside of the shoe, a bone growth gradually forms on it, and the deformation increases. In addition, the head of the first metatarsal bone is displaced, and the zones of the heads of the second and third metatarsal bones feel overload during walking.

Symptoms of valgus curvature of the big toe

The first thing that the affected person can pay attention to is pain. They appear when walking or running for a long time, after wearing shoes with heels, tight or narrow shoes. In the early stages, the sensations do not bother the person much, but over time they turn into severe burning and aching pain.

The intensity of pain is not always directly proportional to the magnitude of the curvature. Usually the pain in the first stage is more pronounced.

In addition, the change in the shape of the foot is visually clearly visible – it becomes flatter and wider. The thumb, as it were, is superimposed on the neighboring ones, forming an X-shaped combination with them. In the place of the metatarsophalangeal joint, a lump is formed – a bone growth.

With a visual examination, the diagnosis of pathology does not cause problems, since it is easy to determine by the following signs:

• spreading of the foot;
• deviation of the first finger at an angle to the rest;
• visible deformation;
• moderate or slight hyperemia in the joint area.

Degrees of development of pathology diagnosed by the attending physician

After conducting an external examination and assessing the condition of the affected person, the doctor determines how well the pathology is formed – the choice of the patient’s treatment regimen depends on this.

Physicians distinguish such degrees of Halus Valgus:

• the first, when the angle between the bones is less than 12 degrees, and the first finger is deviated from the rest by less than 25 degrees;
• second: in such affected persons, the angle between the bones is from 12 to 18 degrees, and the angle between the thumb and the rest of the fingers is 25-35 degrees;
• third: in this case, the angle between the bones is more than 18 degrees, and the deviation of the first finger is more than 35 degrees.

How to treat Halus Valgus: conservative and operative techniques

In the early stages, when the disease is just beginning to form, doctors prefer to prescribe conservative treatment. At the same time, it should be understood that a full correction of the deformity is possible only by the method of surgical intervention, however, it is possible to slow down the growth of the disease and reduce its unpleasant manifestations at the initial stage of occurrence without surgery.

To do this, it is necessary, first of all, to reduce the level of load on the foot. If the patient is overweight, he should pay attention to the need to reduce it.

The patient is assigned a special set of exercises, which is aimed at strengthening the ligamentous and muscular apparatus. Long walking, standing, performing heavy physical exercises should be reduced.

Further hallux valgus can be slowed down or prevented by wearing special orthopedic shoes. Special inserts between the first and second fingers help to achieve the same goal.

To relieve swelling and inflammation, you can use special cooling and anti-inflammatory ointments.

Surgery is the only way to get rid of hallux valgus, even if it has reached the last stage of development. During the operation, the doctor opens access to the affected joint, after which he performs manipulations to return it to its normal state.

Types of operations for halus valgus

There are more than 300 known algorithms and schemes for performing operations to reduce the affected joint surgically.

In general, they all fall into three groups:

• operations on soft tissues;
• operations on the bones;
• combined types of operations.

Shede operation: indications and contraindications

One of the methods of getting rid of the curvature of the big toe affected is the Shede operation. In what cases is such an intervention indicated? Indications for the appointment of a surgical operation according to Shede are:

• the presence of Halus Valgus;
• the age of the patient is from 20 to 40 years;
• diagnosed the second stage of the development of the disease;
• the presence of pain;
• severe inflammation and tissue damage.

If conservative treatment (wearing orthopedic shoes and insoles, reducing stress and exercise therapy) does not bring results, at this stage of the development of the disease, the patient is assigned a resection of the protruding part of the head of the first metatarsal bone. The reason for the appointment of the operation may be the desire of the patient to get rid of a cosmetic defect, which, among other things, can really spoil the appearance of the foot.

Among the contraindications for surgery:

• the presence of systemic pathologies of the cardiovascular system;
• the general serious condition of the patient;
• skin lesions at the site of the operation;
• the presence of infectious diseases and acute inflammatory processes;
• blood diseases, blood clotting disorders.

How the Sheda operation is performed: preparation for intervention and correction of halus valgus

As part of the preparatory measures, the patient is placed in a hospital of a medical institution. An operation of this nature is practically not performed in an outpatient clinic.

Before the scheduled operation, the patient needs to pass some tests, including a coagulogram, general blood and urine tests. In addition, the patient is sent for x-rays, if necessary – for computed or magnetic resonance imaging.

During the week before the operation, the patient needs to do hygienic foot baths. On the evening before the operation, the skin of the fingers and the distal part of the foot is lubricated with an iodine solution, and an aseptic dressing is applied on top.

In the process, anesthesia is necessarily used – novocaine anesthesia is administered intraosseously, by puncture of the calcaneus. After the anesthetic takes effect, the doctor gets to work.

An oval oblong incision about 5 centimeters long is made along the head of the first metatarsal bone on the back of the foot. The surgeon mobilizes the skin flap downward and dissects the mucosal sac. Additionally, a flap is cut out from the capsule of the metatarsophalangeal joint, its base is located in the region of the proximal phalanx of the finger. Then it is turned away in the distal direction. The process uses a flat chisel. The outwardly protruding part of the head of the first metatarsal bone is longitudinally knocked down or resected with this instrument. The remaining sharp edges are knocked off and rounded with a chisel or Luer tongs. The flap removed from the joint capsule is placed in place, then it is sutured with special sutures to the surrounding tissues, while it is in some tension, and the first finger should be positioned evenly.

The laid flap of the capsule in this case performs the function of the lateral ligament of the joint – this avoids the recurrence of the curvature after the operation. Hypercorrection of the first finger is also achieved by placing a dense cotton roll in the interdigital space – it is glued with glue. Next, the skin wound is sutured.

The postoperative period is associated with complete immobilization of the leg – for this, a wooden or metal splint is applied along the inner edge of the foot and toe, which is fixed with plaster bandages.

It should be noted that the presence of progressive arthrosis in elderly patients is usually almost impossible to correct by performing a Schede operation – other techniques are used for this, for example, corrective osteotomy according to Hohmann.

Often, the Shede technique is performed in conjunction with the Brandeis operation. The Brandes operation is a resection of the proximal part of the main phalanx of the first finger. A plaster splint is applied to the foot, and then, during the period of postoperative rehabilitation, a finger is pulled by the nail phalanx for two weeks.

Postoperative rehabilitation and possible complications

For the full recovery of the patient after the Shede operation, he is prescribed bed rest. The load on the operated leg should be eliminated as much as possible, however, light exercises for the development of the foot will not interfere from the first day – already on the next day after the operation, you can start moving your fingers.

Short walking is allowed on the third day, while the doctor prescribes the wearing of special devices – orthoses, as well as the use of crutches or walkers. The hospital stay lasts up to 14 days.

Until the surgeon removes the sutures, it is forbidden to wet the wound and the bandage, and to carry out water procedures, it is necessary to wrap the affected area with a polyethylene bandage.

Walking without orthoses and special devices is allowed no earlier than after six weeks.

The total recovery period can last up to six months – all this time, swelling in the foot and ankle joint area may remain.

As procedures to speed up postoperative recovery, the attending physician may prescribe electrophoresis, shock wave therapy, physiotherapy exercises and massages. At night, the patient is recommended to wear a corrective splint.

Two to three months after the operation, the attending physician may recommend therapeutic swimming, as well as exercise on a stationary bike.

Tight, uncomfortable shoes, high heels, active physical activity and heavy sports activities – all this should be forgotten after the operation, otherwise the effect of it will be short-lived, and after a few years the problem will return.

How safe is Schede surgery for Halus Valgus? Like any surgical intervention, this operation can cause the development of some complications, for example, infection of tissues, the formation of deep vein thrombosis, limitation of the functional ability of the finger joint, numbness and swelling, disruption of the nerve ligament, aseptic necrosis of the head of the metatarsus.

Reviews and forecasts after the operation

The development of complications is quite rare. Usually patients, regardless of age, tolerate the operation well. Another advantage of this type of intervention is the absence of the need to apply a tourniquet and use metal structures: firstly, the Schede operation can be performed on patients with venous or arterial insufficiency, and secondly, in the future it will not be necessary to repeat the surgical intervention again to extract the established metal structures. elements.

Nevertheless, physicians are very ambiguous about the Sheda operation, as well as their combinations with the Brandes intervention. Although it refers to simple bone interventions, some surgeons consider it “crippling”. Due to the fact that in the process a part of the bone apparatus is removed, as a result, the function of foot rolling is disrupted, while the big toe is shortened. The ability of the joint to move becomes more limited. Due to the fact that only bone resection is performed during the Shede operation, and the ligamentous-muscular apparatus remains practically unaffected, over time, the pathology can develop again, especially if the previously concomitant factors have not disappeared anywhere.

As for the reviews of the operated people, they note a long recovery process, especially in older patients. Within a few months after the intervention, significant swelling of the lower extremities is observed, and even after the end of the postoperative recovery, patients feel some pain in the joint. If you return to your previous lifestyle and old shoes, after a while you can notice the gradual formation of a “bone” in the same place.

The pathological condition of the foot, caused by a curvature of the joint of the big toe, is called Halus Valgus. The disease is often formed in women both at a young and in adulthood. It can cause a lot of inconvenience to a person: pain, fatigue, swelling, inflammation, deformity of the foot, inability to wear normal shoes.

It is unlikely that such a disease directly threatens a person’s life, however, constant pain and a twisted finger clearly require treatment.

Among conservative and surgical methods, operations to correct valgus curvature of the finger joint are considered more effective. In total, there are about 300 types of operations that can affect the bone part, ligaments, muscles, individually or together.

A simple operation that allows you to get rid of the “bumps” on the joint is the Shede operation. In the process, the surgeon, using a special chisel, cuts off the protruding part of the head of the first metatarsal bone, thereby removing the bone growth that comes into contact with the shoe and causes pain to the affected person.

This type of operation cannot be considered unambiguously effective for getting rid of Halus Valgus, since the factors themselves that provoke the development of curvature remain in place, in addition, the operation practically does not affect the muscles and ligaments, due to which improper load distribution can again cause pathology .