RU2481078C2 - Method of treating adductus valgus foot deformity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics and is intended for treatment of adductus valgus foot deformity. Derotation of first cuneiform bone in medial direction in elimination of adduction of anterior part of foot is performed by medial displacement of first metatarsal bone base with adaptation of anterior part of first cuneiform bone due to economic resection. Transplantation of anterior tibial muscle into first intercuneiformis space and installation of implant for stabilisation of subtalar joint are carried out.

EFFECT: method ensures simultaneous correction of valgus position of posterior part of foot and adduction of its anterior part.

2 dwg

Description

The invention relates to medicine, namely to orthopedics.

Bringing the forefoot refers to the most common pathology of the musculoskeletal system in children and adolescents. In 25-30% of cases, it is combined with the valgus position of the hindfoot. This combined version of the pathology of the foot is usually designated as valgus-reduced deformation of the foot. In the English-language medical literature, the term "scewfoot" is used to describe such a deformation.

There is a method of treating anterior foot adduction in children, which consists in mobilizing the scaphoid, first sphenoid-metatarsal and interclinical joints, as well as cutting off abnormally walking tendon bundles of the anterior tibial muscle (Ghali NN; Abberton MJ and Silk FF The management of metatarsus adductus et supinatus. J. Bone and Joimit Surg., 66-B (3): 376-380. 1984). The disadvantages of the above method with combined valgus-reduced deformity of the foot are the preservation of the deforming muscle traction of the anterior tibial muscle, as well as the impossibility of influencing the position of the hindfoot.

There is also a method of treating hallux valgus deformity of the foot, which consists in stabilizing the subtalar joint by introducing a stabilizing implant in the sinus region of the tarsus, limiting mobility in the subtalar joint (utility model patent RU 94443 U1).

The objective of the proposed method is to simultaneously correct the valgus position of the hindfoot and bring it to the front.

The technical result of the problem is achieved by the fact that the first sphenoid bone is rotated in the medial direction with the forefoot adduction removed by medially displacing the base of the first metatarsal bone, adapting the anterior spine of the first sphenoid bone due to economical resection, transplantation of the anterior tibial muscle into the first interclavicular space and installation of an implant to stabilize the subtalar joint.

The operation is as follows.

From the incision along the medial edge of the dorsal surface of the foot 5 cm long, the capsule and ligaments of the first sphenoid-metatarsal, first interclinical, interdigital and navicular-sphenoid joints are separated and dissected along the dorsal and medial surfaces. The tendon of the anterior tibial muscle is cut off from the site of attachment. The base of the first metatarsal bone is displaced in the medial direction. After this, the first sphenoid bone also moves medially due to derotation, and its anterior section adapts to the base of the first metatarsal bone due to economical resection. The reached position is fixed by an axial spoke. The tendon of the anterior tibial muscle is fixed by transossal sutures in the first interclinical space. Soft tissue in the projection of the tarsal sinus is dissected from a 2-cm incision along the outer surface of the foot. In the supination position of the foot between the talus and calcaneus, a guide needle is carried out in the outer-inner direction along the tarsal canal. An implant with a variable diameter is implanted in the tarsal sinus along the guide needle to stabilize the hindfoot with the middle position of the calcaneus. The guide needle is removed and the wound is sutured in layers.

Clinical example.

Patient A., 7 years old. Congenital valgus-reduced deformity of the foot. On the radiographs of the feet before the operation (Figure 1), the angle of the talacaneal divergence in direct projection is 45 °, which reflects the severe degree of hallux valgus deformity of the hindfoot. The angle of adduction of the forefoot is 40 °, which also corresponds to the severe degree of reduced deformation of the forefoot. For the purpose of simultaneous correction, an operative measure was performed, including mobilization and derotation of the first sphenoid bone, transplantation of the anterior tibial muscle into the first interclavicular space, and installation of a subtalar implant. On radiographs after the operation (Figure 2), the angle of the talacaneal divergence in direct projection is 20 °, which corresponds to the normal value, the angle of reduction of the forefoot is 11 °, which also corresponds to the norm. Thus, a complete correction of the deformation components is achieved. The shape of the foot is correct. The patient uses ordinary shoes.

Claims (1)

A method of treating valgus-reduced deformity of the foot, characterized in that the first sphenoid bone is rotated in the medial direction when the anterior foot is removed by medial displacement of the base of the first metatarsal bone, adapting the front of the first sphenoid bone due to economical resection, transplantation of the anterior tibial muscle in the first interclinical space and the installation of an implant to stabilize the subtalar joint.

Images