Foot Lump Removal Surgery
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 issue of the effectiveness of surgical treatment of hallux valgus.
If the metatarsal bone moves away from other bones at an angle of more than 18 ° C, and the thumb is curved by more than 35 ° C, then surgical intervention is indispensable.
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.
Content:
- Preparing for surgery
- Indications for surgery
- Results after surgery
- When can't you remove buds?
- Types of surgery to remove bumps on the legs
- Recovery after surgery
- Possible complications
- Cons of surgery to remove bumps on the leg
Preparing for surgery
Before starting the procedure for removing bumps, the doctor must examine the patient. Be sure to prescribe an X-ray of the foot in different projections. More accurate information can be obtained using the CT or MRI method.
The tests that need to be passed to the patient:
- Blood for glucose level, blood for assessment of the coagulation system, blood for biochemical and general analysis.
- Urine for general analysis.
- Blood for HIV and hepatitis.
The patient will definitely need to undergo an ECG or provide a doctor with fluorography.
Indications for surgery
To determine whether a patient needs an operation to remove bumps on his leg, he needs to be carefully examined. Surgical intervention is performed only when the disease has reached its final stage.
Indications for surgery to remove bumps on the leg:
- The valgus position of the hindfoot is greater than 20 ° C.
- The patient's legs hurt both at rest and while walking.
- The joints are very tight.
- Calluses are constantly forming on the leg.
- 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, as the bumps on the legs are a cosmetic defect. The smaller the angle of deflection and tissue deformation, the easier the operation will be.
Results after surgery
The prognosis after the operation to remove bumps on the legs may be as follows:
- The patient's pain will stop. Already on the second day after the procedure, it will be possible to stop using 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 and will be able to wear open shoes.
When can't you remove buds?
The operation to remove bumps on the legs may not be performed for every person.
There are the following contraindications to its implementation:
- Thrombosis, complicated by inflammation of the venous wall.
- Blood clotting disorder.
- Diabetes.
- Obesity.
- Heart failure.
- Innervation disorders of the foot.
If there are no contraindications, then the patient is prepared for surgery.
Types of surgery to remove bumps on the legs
Access to the bone tissue can be obtained both through the open route and through the skin. During open surgery, 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 a percutaneous approach, all manipulations are performed through small punctures. Modern medicine has many technologies to get rid of bumps on the legs. There are over 200 of them.
However, the most commonly used ones are:
- Resection of the cone on the lateral surface of the head of the first metatarsal bone and phalanx of the toe. The procedure is performed 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 area of the incision. Local anesthesia is usually sufficient. The doctor makes an approximately 5 cm incision to separate 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 made of dense material is inserted between the 1st and 2nd fingers of the patient. A splint is applied to the limb.
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Osteotomy of the first metatarsal bone or, as it is also called, Hohmann's operation. This will remove only part of the bone. Local anesthesia is indicated, with the setting of an injection of Novocaine. The doctor cuts the soft tissue along the first phalanx of the finger, and then removes the mucous bag located in the area of the lump. The next step in the operation is the excision of 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 wire or a plate, and the lump itself is cut off. The fabrics are sewn up using threads, and plaster is applied to the leg. The patient will need to wear it for 21 days. This surgery is associated with a lower risk of complications compared to resection of the lump.
- Operation according to McBride with muscle truncation. This procedure can be performed if the deformation is minor. Only local anesthesia is required. The doctor makes a skin incision on the sole side. Then the doctor separates the adductor muscle of the first toe, incising 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.
- The Vreden-Mayo operation involves osteotomy of the 1st metatarsal bone or the first phalanx of the toe. It is most often performed in elderly patients with severe joint deformity. The procedure is performed under local anesthesia. The incision is made in the shape 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 off and the edges are polished. After completing all the manipulations, the tissues are sutured, and a splint is applied to the limb. The advantage of this operation is that relapses rarely occur after it. However, this removes impressive volumes of bone, which can lead to a violation of the support functions of the foot.
- Reconstructive surgery using 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 bone process, the bones are fixed with wires, which are subsequently removed. In parallel, the doctor shortens the tendon, which will have to fix the bone in the desired position. In the area of the incision, the surgeon sutures. The time of wearing the plaster after the operation is 30-45 days.
Percutaneous minimally invasive osteotomy
The operation is performed either under local anesthesia or with 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 instrument at low speeds. The hole diameter is 2 mm. A knitting needle is inserted into it. On the other hand, another hole is drilled, into which a needle of a smaller diameter is also inserted. This allows the bone to be repositioned. In the future, the needles are removed, and the screw is left in order to fix the bones. If necessary, the bones can be shortened using a bur.
If the patient has large bumps, then the hole can be expanded 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:
- Scars after it will be hardly noticeable.
- The rehabilitation period is shortened.
- The likelihood of thrombosis is minimal.
Using a laser to remove bumps on the legs
If the incision is performed using a laser, rather than using a scalpel, then this can shorten the recovery period. Within a few hours after its completion, a person can be discharged. You can start moving your finger actively after 3 weeks.
The operation, performed with the use of a laser, allows the patient to relieve pain during 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 volume of the intervention performed. If only the metatarsal bones have been removed, 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 take stress off the first toe.
- If a person is in pain, then he should take drugs from the NSAID group, for example, Nise.
- The wound must be properly looked after by timely changing the 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 on an individual basis. They allow preventing the formation of joint contractures and avoiding limitation of its mobility in the future.
What is the likelihood of recurrence after the operation? Statistics say that the patient is in danger in 30% of all cases. In addition, you should know that immediately after the operation, a person cannot be fully able to work. For several months in a row, he must limit any load on the foot. It usually takes a patient 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:
- Deterioration of the sensitivity of the foot. Most often, it is restored after the nerve fibers are regenerated. This happens 8-10 months after the intervention. However, if the nerves have been severely injured, then the deterioration in sensitivity can persist throughout life.
- Long-term wound healing, which is especially important for the elderly. The development of inflammation can be provoked by infection in the soft tissues. Therefore, you need to take care of the postoperative sutures correctly.
- Soreness when moving the toes. A similar complication develops when the fixing structures of the bone were incorrectly positioned. This will require a second operation.
- Bone necrosis can be observed when it is significantly damaged, or when an infection is introduced into the wound.
- Re-emergence of bumps. Relapse most often occurs when minimally invasive surgery is performed.
- Metatarsophalangeal joint contractures. Deterioration of joint mobility is observed when the patient does not follow medical recommendations.
In the early postoperative period, there may be swelling of the foot. 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 their ability to work for 1-2 months. During the rehabilitation period, he will be able to walk only with the help of crutches.
You also need to be prepared for painful sensations after the procedure. Analgesics allow you to cope with them. Therefore, the decision on the need for surgical excision of the bumps on the legs should be considered. You need to discuss other treatments with your doctor.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
