Percutaneous foot surgery. Foot surgery. Methods of intervention

Relevance. The need for correction of forefoot deformities is determined both by the high incidence of this group of pathologies and by the growing demands of modern patients for quality of life. According to various authors, about 40% of young women at one time or another in their lives suffer from problems caused by the structural features of their feet. In the age group over 60 years, foot deformities of varying nature and severity occur in approximately 60% of women. Orthopedists have been involved in the surgical treatment of forefoot deformities for centuries. Hundreds of techniques have been proposed, many of which are currently in use. For the same form and degree of deformity, surgeons may use significantly different methods of intervention. The orthopedist’s choice of surgical technique can be influenced by various factors: the doctor’s technical and theoretical training, belonging to a particular school, the traditions of the medical institution, the technical equipment of the hospital, etc. This ambiguity of choice indicates, among other things, the absence of a unified approach to solving the problems of forefoot deformities. This is also evidenced by the large number of unsatisfactory outcomes of operations.

A characteristic trend in modern surgery is the desire to reduce the trauma of surgical interventions. Percutaneous foot surgery is a branch of orthopedics that best meets the principles of minimal invasiveness.

The purpose of the study is to improve the results of surgical treatment of static forefoot deformities by introducing and modernizing percutaneous reconstructive operations.

Material and methods.

The foundations of percutaneous foot surgery were laid in the 60s of the last century. At first we talked about removing heel spurs using a drill and small cutters. Later, percutaneous techniques were developed to perform operations for static foot deformities (primarily metatarsalgia). The theoretical foundations of percutaneous surgery are based, among other things, on the principles expressed in the 60-70s by several authors that with correctly performed distal osteotomies of the lateral metatarsal bones, their fragments can not be fixed. In this case, the heads of the metatarsal bones find their “ideal” position under the influence of early load. In the late 80s and early 90s, American podiatrist Stephen Isham developed a detailed technique for percutaneous surgery for hallux valgus, tailor's disease and other foot pathological conditions. Today, Stephen Isham is recognized as the founder of percutaneous foot surgery.

Percutaneous foot surgeries are performed through small (up to 1 cm) incisions or punctures of the skin. To perform a standard operation, the following tools are required:

narrow scalpels of the Beaver type, which have a triangular sharpening and allow access to the bones, creating space for working with cutters, as well as performing teno-, ligamento-, and capsulotomies;
low-speed pencil-type microdrill, which makes it possible to work at speeds of up to 4000 rpm, which avoids bone burns;
micro-mills for performing exostosectomies, corrective osteotomies (there are several types of micro-mills, differing in length, diameter, shape, cutting surface design);
rasps and spoons for removing bone chips and smoothing bone filings;
electron-optical converter of the C-arc type (ideally a mini C-arm).

Here is an approximate list of pathological conditions of the forefoot, in the treatment of which percutaneous techniques can be used:

hallux valgus deformity of 1 toe (hallux valgus);
hammertoe deformity;
metatarsalgia;
Morton's disease;
varus deformity of the 5th toe (quintus varus supraadductus);
tailors' disease;
Hallux interfalangeus hyperextensus;
Hallux valgus interfalangeus;
clinodactyly;
interdigital exostoses.

As in traditional surgery, during percutaneous operations there is a certain set of surgical actions, one or another combination of which makes it possible to solve the assigned problems. In this case, the approach to treatment should be differentiated and determined not only by the type and severity of the deformity, but also by the patient’s complaints, his wishes, age, quality of bone tissue, condition of soft tissues, etc.

Percutaneous surgical intervention for hallux valgus of 1 finger in a significant percentage of cases may consist of the following stages:

Exostosis of the head of the 1st metatarsal bone: exostosis is removed by exposing it to the lateral surface of the cutter. The bone chips, crushed to a pulpy state, are removed by squeezing through the wound opening, as well as using a rasp or spoon.
The second stage is distal wedge-shaped osteotomy of the 1st metatarsal bone according to Reverdin-Isham. This stage is not permanent. It is performed through the same access as exostostectomy in cases where shortening of the 1st metatarsal bone is necessary, as well as in the presence of a lateral inclination of its distal articular surface. The size of the wedge removed can be adjusted by the shape and size of the cutter.
The next permanent stage of surgical intervention is the lateral release of the 1st metatarsophalangeal joint. It consists of cutting off the adductor tendon from the base of the main phalanx of the 1st finger, as well as partial lateral capsulotomy.
Osteotomy of the base of the main phalanx of the 1st finger. Akin was first described many decades ago. It is performed through a skin puncture on the dorsal inner surface of the base of 1 finger. Preservation of the outer cortex during sawing with a milling cutter significantly increases the stability of the phalanx fragments after osteotomy. At the same time, in some cases a complete osteotomy is performed. For example, if necessary, eliminate the pronation of 1 finger or achieve its shortening. If there is an external deviation due to deformation of the main phalanx itself, the osteotomy is shifted to the middle third or can be performed at the level of the distal third of the phalanx with Hallux valgus interfalangeus.

The need for intervention on the lateral rays during surgery for hallux valgus is determined by the specific clinical and radiological picture. Even in the absence of clinical manifestations in the form of hammertoes or hyperkeratoses under the heads of the lateral metatarsal bones, in cases where radiographs show a violation of the formula of the metatarsal bones in the form of a significant predominance of the lengths of the lateral metatarsal bones, subcapital osteotomy of one, two or more may be required to prevent the development of transitional metatarsalgia three metatarsal bones.

Percutaneous operations for Hallux valgus are most effective for mild and moderate degrees of deformity (according to our observations, up to an angle of 14-15º between the 1st and 2nd metatarsal bones).

Deformations 5 rays. In our work, we most often encounter tailor disease. There are 3 main types of structure (or position) of the 5th metatarsal bone that contribute to the development of tailor's disease:

5th metatarsal bone with an enlarged lateral part of the head;
5th metatarsal bone in a position of excessive outward deviation;
5th metatarsal with increased lateral bending of the diaphysis, leading to lateral deviation of the head.

The choice of the type of percutaneous surgical intervention for tailor's disease is determined by the structure of the 5th metatarsal bone, as well as the presence and degree of inward deviation of the 5th toe:

Exostosectomy: The skin is punctured on the plantar-lateral surface of the foot just proximal to the head of the 5th metatarsal bone. A scalpel is used to create a space for work, after which the protruding part of the head is removed with a milling cutter. With the first of the above-described options for the structure of the 5th metatarsal bone, exostosis may be sufficient to achieve the desired effect.
Distal linear osteotomy of the 5th metatarsal bone. It is performed with the aim of medially displacement of its head. The osteotomy line should run obliquely in the direction from distal-lateral to proximal-medial. After completion of the osteotomy, the head is displaced by finger pressure.

Varus and adductovarus deformities of the 5th finger. Percutaneous surgical intervention may consist of tenotomy of the extensor of the 5th finger and medial capsulotomy of the 5th metatarsophalangeal joint, as well as osteotomy of the base of the main phalanx.

Metatarsalgia is a collective concept that is not a definition of a specific pathology. There can be many causes of pain in the forefoot, however, within the framework of this work, we are interested in metatarsalgia caused by the structure or location of the metatarsal bones.

There are 2 main types of mechanical central metatarsalgias:

associated with the low location of the heads of one or more central metatarsal bones relative to the others - static metatarsalgia.
associated with a greater length of one or more metatarsal bones relative to the others - pushing (or propulsive) metatarsalgia.

Both conditions lead to increased pressure on the central metatarsal heads, which may manifest as pain or hyperkeratoses. If metatarsalgia is not accompanied by deformity of the fingers, surgical treatment, as a rule, consists of performing percutaneous subcapital osteotomies of the central metatarsal bones. Osteotomies are performed through dorsal punctures of the skin at the level of the corresponding metatarsophalangeal joints. The number and order of bones to be crossed are determined as follows: if hyperkeratosis is located under the head of the 2nd metatarsal bone, 2-3 metatarsals are crossed. In all other cases, osteotomy of the 2nd, 3rd and 4th metatarsal bones is performed. It is after subcapital osteotomies of the central metatarsal bones that full early load on the foot is important to achieve the best result, allowing the heads of the metatarsal bones to “find” their optimal position.

Deformities of the middle fingers can be combined with valgus deviation of 1 finger or be an independent pathology. Clinically, the problem is no less important than hallux valgus. In practice, we often have to deal with a situation where it is the appearance or progression of the deformity of the middle fingers that forces the patient to undergo surgery in the presence of a long-term severe valgus deformity of 1 finger. Most often we encounter a group of deformities of the middle fingers in the sagittal plane, traditionally united in the literature under the name “hammer finger”. Within the framework of this general concept of the involvement of various joints in the process, the following are distinguished:

hammertoe deformity;
swan-neck or claw-shaped deformity;
hammertoe deformity.

Percutaneous operations for hammertoes can be performed on soft and bone tissues.

Operations on soft tissues:

Extensor extension tenotomy. The most common manipulation for hammertoe deformity, performed in almost any form and stage. The exception is the hammertoe deformity. The tendons are divided through a dorsal puncture of the skin at the level of the metatarsophalangeal joints, where there are intertendon stretches that prevent significant migration of the proximal ends of the tendons. Some time after the operation, reinsertion of the ends of the transected tendons occurs.
Dorsal capsulotomy of the metatarsophalangeal joints. As a rule, the need for it arises in the presence of a dislocated finger, although eliminating the dislocation to the rear of the main phalanx should not necessarily be the goal of surgical intervention. Typically, pain in the area of the metatarsophalangeal joint appears during the development of displacement and lasts 1.5-2 months. Most often, the patient comes for surgery with no pain caused by a dislocation in the metatarsophalangeal joint, that is, with complaints of pain under the head of the corresponding metatarsal bone or at the top of the deformity of the finger in the projection of the head of the main phalanx.
Flexor tenotomy. Ideally, extensor tenotomy should be performed in all cases in order to maintain tendon-muscular balance and prevent the progression of flexion contracture of the fingers. However, a differentiated approach is necessary and possible in this matter. For example, in the case of mild or moderate hammertoe or claw deformity in the absence of a fixed contracture of the interphalangeal joints, it is sufficient to perform only tenotomy of the extensors.

Bone surgeries:

Osteotomy of the main phalanx. It is performed with a cutter at the level of the proximal or middle third of the phalanx through a plantar puncture of the skin. Allows you to both change the phalanx axis and shorten it.
Osteotomy of the middle phalanx. It can be performed through both plantar and lateral approaches. The main indications are a fixed deformity of the finger or the need for significant shortening.

In this work we do not dwell on more rare deformities of the forefoot. The methods used to eliminate them are similar to those described above.

The consolidation process after percutaneous osteotomies has its own characteristics. Quite often, radiological signs of fusion appear later than after traditional operations. In the vast majority of cases this does not manifest itself clinically. The X-ray picture at certain stages can be described as a false joint, or even as a defect. In this case, consolidation occurs in almost 100% of cases.

A few words about anesthesia and the postoperative period. Most often, foot operations are performed under general anesthesia at the level of the ankle joint. For anesthesia, we use a mixture of 1-2% lidocaine solution with naropine or marcaine (in equal parts). Lidocaine begins to act faster. The effect of marcaine or naropin develops more slowly, but lasts up to 8-10 hours after surgery. During this time, the patient begins to walk in postoperative shoes with full weight bearing on the feet.

For single foot surgery, patients are typically discharged on the day of surgery. In case of intervention on both feet - immediately after surgery or the next day.

The first outpatient examination takes place 7 days after surgery. In this case, the sutures are removed (if they were applied), and the fixing bandage is changed. Then the dressing is changed twice more with an interval of 1 week. 4 weeks after the operation, the patient independently removes the bandage and begins active physical therapy exercises. Then walking in rehabilitation shoes stops.

Results.

The results of 102 percutaneous surgical interventions on the forefoot were analyzed over a period of 6 to 24 months. Surgeries on one foot were performed on 26 patients, on two - 38. A total of 64 patients were operated on, of which 6 were men. The average age of the patients was 48 years (from 19 to 83). Treatment results were assessed using the Kitaoka scale, according to which 84% of good and excellent results were obtained, and 15% of satisfactory results. There is only one unsatisfactory result, noted at the stage of mastering the method and due to a technical error. In addition to the Kitaoka scale, all feet were photographed before surgery, at the first dressing, and 3 and 6 months after surgery. This made it possible to objectively evaluate the aesthetic result of the operation, the dynamics of swelling reduction, and note the disappearance or persistence of hyperkeratoses. After operations for complex foot deformities, complete disappearance of edema was usually observed by two months. After operations on the first ray only, swelling often did not develop at all in the postoperative period. The need for taking analgesics in the postoperative period was determined by the sensitivity threshold of each patient, but, as a rule, did not exceed 1-2 times taking 400 mg of ibuprofen or a similar dose of another non-steroidal anti-inflammatory drug during the first 3-5 days after surgery. Many patients did not resort to taking pain medications. One superficial and one deep suppuration were noted after surgery on both feet in a 19-year-old patient who seriously violated the regimen in the first week after surgery. Superficial suppuration was stopped by conservative measures, deep - by sanitizing surgery. The good result of reconstructive operations was not lost. After surgery on one foot, return to normal daily activities was possible in most cases within 1-2 weeks; after operations on two feet for hallux valgus - after 2-3 weeks; after operations on both feet for complex deformities - 3-6 weeks after the interventions.

Conclusions.

Based on the analysis of the results obtained, the following advantages and disadvantages of the method of percutaneous surgery of the forefoot can be identified:

less pain;
short rehabilitation periods;
aesthetic benefits (spot scars only);.
lower cost of treatment;
no need for internal fixators;
no need for plaster immobilization or orthotics;
lower risk of complications;
the possibility of repeated (if necessary) operations in the future (including open methods).

The disadvantages of the method include the impossibility of correcting severe varus deformity of the 1st metatarsal bone (more than 15-18º) without the use of internal fixators, as well as some other components of the deformity (for example, the position of the sesamoid bones).

In conclusion, it should be noted that percutaneous foot surgery is a technically complex intervention. The learning curve, according to various authors, ranges from 30 to 50 operations. The number of complications and unsatisfactory results associated with the training period can be reduced by working on casts and cadaveric material, as well as by combining traditional and percutaneous techniques with a gradual increase in the number and complexity of the percutaneous components of the operation.

Percutaneous foot surgery in Spain is a minimally invasive method used by the best Spain. Is to correct the altered position of bones and soft tissues feet through a minimal incision of 2-3 mm in length (instead of the large incision, usually 6 cm, made in classical open surgery).

What are the main foot deformities?

The most common foot deformity that may require percutaneous foot surgery are hallux valgus (bursitis of the big toe).

Horse foot – accompanied by persistent plantar flexion. Active dorsiflexion at an angle of 90 degrees or less is impossible or difficult. In severe cases foot cannot be returned to a normal position even by passive flexion.

Heel foot – characterized by persistent dorsiflexion. For severe deformities, the dorsal surface feet touches the front surface of the shin.

Hollow (rigid, supinated) foot – accompanied by an increase in the curvature of the longitudinal part of the arch. In severe cases, the patient relies only on the heads of the metatarsal bones and the calcaneal tubercle, while the middle sections feet do not come into contact with the surface.

Flat (soft, pronated) foot – characterized by flattening of the transverse or longitudinal part of the arch. With longitudinal flatfoot, the foot rests on the surface not with the outer edge, as is normal, but with the entire sole. Transverse flatfoot is accompanied by expansion of the anterior sections and an increase in the distance between the heads of the metatarsal bones.

In practice, when foot treatment in Spain, a combination of several types of deformation is observed feet. Along with the condition of the bones, joints, tendons and ligaments, the magnitude and type of deformation can be influenced by pathological changes in the overlying parts, especially the ankle joint.

What are the benefits of percutaneous foot surgery in Spain?

The operation is performed under local anesthesia.
The ability to walk is restored immediately after surgery. The patient enters and leaves the operating room independently.
No hospitalization period. The operation is performed on an outpatient basis.
Reduced postoperative pain due to the fact that soft tissues are injured to a minimal extent. In 95% of cases, patients do not take painkillers.
There is no need to use nails and screws to fix bones.
Plaster is not required in the postoperative period; only a gauze bandage and special shoes are used.
This method allows you to return to work immediately after surgery.
Due to the small incision, the risk of complications is reduced and a relatively smaller scar remains.
Material benefits: hospital stay is only a few hours.

Percutaneous surgery for foot treatment in Spain - Medical Service BCN organizes treatment in Spain, selects the best clinics and specialists, and accompanies you to your appointment.

In the literature you can find a description of more than 400 methods of surgical treatment of hallux valgus. In the past, podiatrists combated hallux valgus by surgically removing the articular heads, which resulted in severe impairment of foot function. Therefore, today doctors prefer to perform less traumatic operations.

Fact! What is hallux valgus? Initially, Hallux Valgus causes only the big toe to become bent. As a result, a person increases the load on the heads of the 2-4 metatarsal bones, which leads to hammertoe deformity of the II-V fingers. Timely surgical treatment helps to avoid this unpleasant phenomenon.

Types of foot surgeries

Operations performed for hallux valgus deformity can be divided into minimally invasive and reconstructive. The former are less traumatic, but are effective only for exostoses and initial deformation. Minimally invasive surgical interventions are performed through two or three punctures measuring 3-4 mm.

Scar after intervention.

Reconstructive interventions help to cope with severe hallux valgus deformity, accompanied by changes in the position of the bones of the foot. Such operations are more invasive and involve more trauma. They are performed through a 2-4 cm long incision on the medial surface of the foot. During surgery, the doctor restores the normal position of the metatarsal bones and fixes the first metatarsocuneiform joint in the correct position.

Table 1. Types of operations.

Minimally invasive intervention.

Curious! During minimally invasive operations, the surgeon uses micro-instruments that allow complex manipulations of the ligaments and joint capsule. If necessary, he files the bones using micro-mills, which vaguely resemble dental instruments.

Name of surgical techniques

In the initial stages of the disease, doctors try to perform minimally invasive operations. After them, the patient recovers quickly and returns to his normal lifestyle within 3-4 weeks. With advanced hallux valgus deformity, the need for more complex surgical interventions arises.

Let's see which of them are most often used in modern orthopedics.

Operation McBride

The most popular among all surgical interventions on the soft tissues of the foot. Its essence is to move the tendon m. adductor halluces on the head of the first metatarsal bone. This allows you to bring the metatarsal bones closer together and restore the normal muscle-tendon balance of the foot.

Unfortunately, the abductor pollicis muscle is unable to withstand constant stress. This is why the relapse rate after McBride surgery is quite high. If a person does not eliminate the effect of provoking factors, he will soon develop Hallux Valgus again. Wearing orthopedic shoes, avoiding heels and heavy physical work helps to avoid this.

Fact! In case of pronounced deformities, the McBride operation is supplemented with SCARF osteotomy of the first metatarsal bone.

SERI

Refers to minimally invasive operations. During surgery, patients undergo a transverse osteotomy through a 1 cm long skin incision. After this, the distal bone fragment is shifted in the lateral direction and fixed using a special pin.

CHEVRON

During the operation, the surgeon performs V-shaped osteotomy. He saws down the first metatarsal bone in the area of the head, and connects the bone fragments using special titanium screws. Since the fixation is very strong, the patient does not need plaster immobilization in the postoperative period.

Note that Chevron osteotomy is effective only for minor deformities of the first toe. Nowadays, it is used less and less in orthopedics. Instead, most doctors perform a Scarf osteotomy.

SCARF

The Scarf Z-shaped osteotomy is the gold standard for the treatment of hallux valgus. It allows you to set the head of the metatarsal bone at the desired angle. During surgery, doctors also remove deformation of the joint capsule and change the direction of some tendons.

When Scarf surgery is not enough, surgeons perform a proximal wedge osteotomy or arthrodesis.

Important! In most patients with hallux valgus, doctors detect callus (exostosis). The growth is localized on the medial surface of the head of the first metatarsal bone. As a rule, it is removed during all operations, including minimally invasive ones.

Do not confuse cutting down a bone spur with an osteotomy. These are two completely different manipulations. The goal of the first is to remove a cosmetic defect, the second is to restore the normal functional state of the foot. Remember that callus removal (Schede procedure) will not cure you of Hallux Valgus.

Arthrodesis for hallux valgus deformity

Arthrodesis is the complete immobilization of the metatarsal-wedge joint by connecting the bones that form it. The operation is performed on persons with transverse-spread deformity and Hallux Valgus with hypermobility of the first metatarsocuneiform joint.

Test to detect pathological mobility:

hold the II-V metatarsal bones with the fingers of one hand;
with the other hand, take the first metatarsal bone and try to move it in the dorsal-plantar direction;
look how much you managed to move it;
displacement of the bone by more than one sagittal dimension of the thumb indicates the presence of hypermobility .

Fact! Arthrodesis is the most traumatic operation, involving complete removal of the metatarsocuneiform joint. It is done only as a last resort when other methods are ineffective.

Surgery for hammertoe deformity

As is known, in the later stages of Hallux Valgus it is combined with hammertoe deformity of the II-V fingers. It looks unattractive and negatively affects the functions of the foot. To correct it, a number of surgical interventions are used.

These include:

Closed redressing. The essence of the technique is to forcibly correct the defect non-surgically. Unfortunately, redressal has little effect, and relapses often occur after it.
Tenotomy or tendon transposition. Operations are performed on the ligaments of the foot. Their skillful intersection or movement allows you to correct hammertoe deformity.
Bone resection. During surgery, doctors excise the base of the middle or head of the main phalanx. This allows you to get rid of excess bone mass and eliminate deformation.
Weil or Wilson osteotomies. They resemble Scarf and Chevron operations, but are performed on the II-V metatarsal bones. Surgeons cut them open and then fix the bone fragments with titanium screws.

Osteotomy is most effective in treating hammertoe deformity. This is what is performed in the most severe and advanced cases.

Recovery period

Patients are allowed to get out of bed the very next day after surgery. At first they are allowed to walk only in Baruk's shoes.

Baruk's shoes.

In the first days after surgery, patients are under the supervision of the attending physician. They are discharged from the hospital within 2-3 days. If a person was given non-absorbable sutures during the operation, they are removed after 10-14 days.

Regarding footwear, patients are required to wear orthotics for at least 3 months. You can wear heels only six months after surgery. However, their height should not exceed 6 cm.

Cost of foot surgery

The cost of surgical treatment depends on the degree of deformity, the type and complexity of the operation, the level of the medical institution and the qualifications of the specialists working there. Removal of exostosis in Moscow costs from 40,000 to 50,000 rubles. Prices for reconstructive operations start at 70,000 rubles. Please note that the price does not include preoperative examination, specialist consultations, consumables and rehabilitation.

If you want to have surgery abroad, pay attention to the Czech Republic. Treatment there will cost you in euros including rehabilitation. In Germany and Israel, the same operation will cost much more.

Curvature of the fingers, including hallux valgus and hallux varus, hammertoes and crossed toes
Painful lumps ("bones") on the legs, resulting from hallux valgus or Taylor deformity - respectively, curvature of the 1st or 5th metatarsophalangeal joint
Heel spur
Painful corns, calluses on and between the fingers
Arthrosis of the metatarsophalangeal joint
Fasciitis and ligamentitis
Morton's disease
Flat feet
Pain in the feet, as well as pain in the knees, hips, lower back, caused by flat feet, etc.

Treatment of hallux valgus

Surgical treatment of hallux valgus (literally translated as “outwardly deviated finger”) is one of the most popular procedures in orthopedics.

When the normal axis of the finger deviates outward as a result of wearing tight, uncomfortable shoes, arthritis, flat feet, hereditary and acquired causes, the first metatarsophalangeal joint begins to bulge, a lump is formed, which is often rubbed by shoes and becomes inflamed. Due to constant trauma when wearing shoes and walking, the defect tends to progress and does not go away on its own.

If this problem exists, orthopedists usually recommend wearing orthopedic shoes. However, the aesthetic defect, the extreme pain of the “bone,” as well as the simplicity and accessibility of the hallux valgus correction operation, are forcing more and more patients to seek help from surgeons.

Advantages of foot surgery at MEDSI:

Foot surgery is performed at the MEDSI medical center minimally invasively, through mini-accesses, using the most modern equipment and instruments. Implants, metal structures and endoprostheses are made of inert materials that do not cause allergic reactions or rejection by the body. Thanks to small incisions in the skin and minimal trauma to surrounding tissues, recovery after surgery occurs in a short time. After the operation, no additional casting is required; wearing orthopedic shoes or insoles is sufficient.

With the help of minimally invasive and cutting-edge surgical interventions on the feet, you can achieve:

Corrections for flat feet and its consequences
Correction of congenital and acquired (including post-traumatic) finger deformities
Correction of congenital and acquired (including post-traumatic) foot deformities

In recent decades, minimally invasive techniques have been increasingly developed in foot surgery. The main difference between this technique and traditional foot surgery is that it is less traumatic. All bone manipulations are performed through skin punctures, and in some cases percutaneous operations are as effective as traditional open surgery. The main advantage of this approach is a reduction in trauma, and, as a result, a significant reduction in patient recovery time. An orthopedic traumatologist, Doctor of Medical Sciences, talks about minimally invasive technology:

What place does minimally invasive foot surgery occupy in the practice of Russian specialists?

Today, a fairly large number of surgeons use standard modern techniques. Minimally invasive foot surgery, on the contrary, is an area of narrower specialization, which is associated both with the lack of necessary equipment in the arsenal of Russian medical institutions and the lack of a training system for podiatric surgeons. has not only the most qualified specialists in this field, but also the most complete technical base for carrying out such operations.

Recently, a new mini-X-ray installation for monitoring operations - an electron-optical converter (mini-EOC) - appeared in the operating unit. This is a very compact X-ray machine with a minimal dose of radiation. The radiation level is so low that surgeons work even without additional protection. Such a device is necessary because performing operations on small bones “blindly” or under a conventional X-ray machine is quite problematic. The ECSTO team consists of specialists who have undergone training in specialized clinics in Europe and have extensive experience in performing similar minimally invasive foot surgeries.

What is the reason for the critical attitude of some specialists to the method of minimally invasive surgery?

There are two reasons for this attitude. Firstly, as I said above, in the absence of appropriate equipment and training, it is impossible to obtain good results on enthusiasm alone. Secondly, unjustified attempts to expand the indications for such operations played a role. It is important to understand that minimally invasive surgery alone is not always enough. It can be used in full for non-advanced deformities in children and adolescents. Another area is the solution of a purely cosmetic part of foot problems or the elimination of one of the components of a complex pathology. Minimally invasive surgery can often be used as a complement to the main stages of the operation: some manipulations are carried out using standard skin incisions and bone cuts, and some additional interventions - on the small toes, lateral metatarsal bones, in the heel area - are carried out using minimally invasive surgery. As a result, the overall invasiveness of the intervention is reduced, the duration of the operation, the number and size of incisions is reduced, and the rehabilitation period is also shortened.

What foot pathologies do patients most often turn to ECSTO for, and which of them can be eliminated with minimally invasive surgery?

These are various types of foot deformities, almost always acquired as a result of hereditary predisposition, as well as due to wearing “wrong” shoes - with very high heels, with narrow triangular toes, or shoes with completely flat soles. Patients, as a rule, go to the doctor at the last moment, when it is no longer possible to wear even normal shoes, and in such a situation it is not always possible to solve the problem with one minimally invasive operation. If you come to a specialist on time and early, it is quite possible to get by with minimally invasive techniques.

It is worth adding that minimally invasive surgery involves intervention not only on bones, but also on soft tissues - tendons, ligaments, joint capsules. We often deal with pathology not of bones, but of the tendon-muscular system, when for some reason the muscles pull too hard, the tendons become strained, and the toes are displaced. In such a situation, sometimes it is sufficient only to lengthen the tendons through small punctures of the skin.

What is the likelihood of relapse of foot disease after minimally invasive surgical treatment?

If the patient fully complies with the early postoperative regimen and subsequently follows the doctor’s recommendations, then recurrence of the deformity is excluded. In the case of only minimally invasive surgery, the patient usually leaves the clinic on the day of surgery, since he has no severe pain, no significant swelling, or postoperative bleeding. If minimally invasive surgery is used in combination with standard intervention, you will need to spend a day in the hospital.

Is it safe to say that percutaneous surgery is the preferred treatment for foot deformities in ECSTO?

This method is preferred if appropriate indications exist. The larger the incision the surgeon makes, the more the soft tissue is injured, the more pronounced the pain and postoperative swelling. Subsequently, the process of scarring may begin, accompanied by the formation of adhesions and the appearance of various associated problems: contractures of the fingers (decreased range of motion), sensory disturbances, difficulty in circulation, trophic disorders, etc. Accordingly, the smaller the injury, the lower the likelihood of such phenomena occurring. It is also important (especially for women) that after the operation, 2-3 stitches of 3-4 mm each remain on the skin of the feet instead of the usual seven to ten centimeters. In addition, such interventions are especially indicated for active patients who cannot afford forced inactivity for several months.

It is important for potential patients to understand that in Russia, specialists in the field of minimally invasive foot surgery can be counted on the fingers of one hand, and there are hundreds of surgeons willing to operate using this technique. When it comes to health, don't tempt fate. It is better to turn to specialists who demonstrate good results.