Mounts

Hallux valgus-site (mont of the foot) is part of the static disorder antepiciorului. Mounts are prominent metatarsal head (bone at the base of the thumb), moving inward to the medial leg. It's not a bone / cartilage or the recently opened an expansion in the bone or joint, as is still considered.
MYTHS ABOUT delicateWe talk about the existence of 10 frames myths, myths that must be combated through a correct:1. Monte is a goatee, a bone excrescence2. Tight shoes and high heels cause mounted3. Local applications of iodine concentrate, celandine, cabbage, etc. can handle fitted4. Monte can be treated with "the hallux-valgus orthosis"5. Any mounting should be operated more quickly6. Any orthopedic surgeon can operate correctly fitted performance7. The surgery is painful8. Postoperative immobilization is inevitable9. Monte recur after surgery10. Smoking does not influence treatment success
CAUSES delicateThe causes are not known, but no predisposing factors and risk factors:1. Factors favoring- Selected morfotipuri foot (constitutional types), the private relationships of bone size, favors static disorder;- Female preponderance of this deformation (95%) can be explained by typical ligament laxity, hormonal conditioned (thus exacerbated during puberty, pregnancy and menopause) antepiciorului ligaments relax and give in, favoring movement and prominent first metatarsal.- Type inflammatory diseases rheumatoid arthritis and destabilizes the entire foot-producing hallux valgus include a rapidly evolving;- Antepiciorului trauma, they have thinning bones, ligaments and structures have changed between them;- Failure by the second finger amputation (particularly traumatic and surgical) is a well known factor, which is why the second toe amputation should be avoided.2. Risk Factors- Uncomfortable shoes, high heels and tight, unlike those held so far, does not generate hallux valgus, but it's worse on the already existing;- Family history stands out, daughters 'inheriting' the mother's foot over 50% of cases;- Flat feet (pes Planus) can promote to some extent the appearance of deformation by mechanical stretching a relative range.- Obesity or rapid weight loss through its own mechanisms of action may encourage the emergence of strain.
Physio-pathological MECHANISMIt can be described briefly in several stages:- A joint-sesamoido-falangiana metatarso is a complex but unstable equilibrium, with the weak link metatarso-falangian medial ligament, which gives the action of stimuli gradually. Initial stimulus is more difficult to distinguish, the more there are two major types of hallux-valgus: the congenital, which occurs in the teenage years and acquired, which occurs in adulthood, peri-menopause.- It produces a complex movement local:1. Metatarsal moves medially (in varus) and turns up, his head protruding under the skin and is a typical strain.2. Toe (thumb) is leaning towards the other fingers, revolves around (and nail by guiding inside leg) and pushes the other fingers, forcing them to "ride" through lack of space required for each.3. Extrinsic muscle tendons is set up as a "rope" as opposed hallux return to normal ligaments and muscles and the intrinsic strain is perenizeaza withdrawal.
NATURAL EVOLUTION AND COMPLICATIONSPhysio-pathological changes described produce functional impairment (support) of radius 1 and, therefore, metatarso-phalange joint side strain, with progressive appearance:1. metatarsalgii (with plantar hyperkeratosis, "horny")2. Digital crowns (fingers "in the hammer")3. Tailor's bunion deformity ("mounted tailor"), which constitutes the final picture of complex deformation called "triangular foot."4. may occur secondary "corns", ingrown nails, bursitis or wounds that can become infected.
REASONS FOR CONSULTATIONS- Progressive deformation and footwear antepiciorului by the prominent metatarsal head in hallux valgus and movement, aesthetics "disgraceful" the leg;- Major pain at rest or during exercise (walking); frames- Associated deformities: Digital crowns, "the tailor fitted" (tailor's bunion), metatarsalgii. Often only one of these symptoms may be cause for concern and therefore the consultation;- Hyperkeratosis ("woof") is a symptom of static disorder and a fine indicator of hiperpresiunilor planting;- Inflammation of the skin near the 'Monti' bursitis and even going up to serious infections caused by driver conflict with the shoes.
DOCTORS RECOMMENDED FOR CONSULTATION AND TREATMENT OF FOOT delicate- The only truly recommendable is physician orthopedic surgeon, preferably one with specific experience in a large antepiciorului surgery.- Physician and rheumatologist at physio-therapist spa palliative procedures can be applied in order to reduce pain and increase walking perimeter. Warning, cortisone infiltrations are completely prohibited in the antepiciorului!- Your GP may prescribe a symptomatic treatment and anti-inflammatory painkiller waiting for specialist medical consultation.
DIAGNOSISIt is predominantly clinical, based on:- Medical history: history of occurrence of symptoms, type of footwear used, factors that aggravate the pain, patient activity, previous treatments, etc..- Thorough physical examination not only antepiciorul study, but also the entire locomotor system, resting, pregnancy and went- Examination of footwear.
 INVESTIGATIONS- Radiography is useful:1. to eliminate other diagnoses, which would require emergency treatment;2. preoperative surgical procedure for choosing optimal;3. Warning! To be relevant, radiography technique requires a very demanding and precise execution.- Rarely can be given a CT-scanner, especially for studying oasoase precise structures and especially the relations between them.- Blood tests can diagnose biological microcrystalline arthropathy (gout), rheumatoid arthritis, local infections, all of which can simulate the pain of hallux-valgus;- The local point of a collection of fluid can differentiate an inflammation of an infection.
 DIFFERENTIAL DIAGNOSIS- Gout (microcrystalline arthropathy) can simulate the "Monte" due prominence, but the pain is acute onset of brutal, inflammatory type, and missing movement metatarsal. It is a general disease (metabolic type), and the treatment is medical and not surgical.- Rheumatoid foot, that foot deformity in rheumatoid arthritis, has a perfect look-like hallux valgus site, but has a much more rapid evolution and benefits of treatment profoundly different.- Osteoarthritis (hallux rigidus) shows the clinical and radiological features and specific treatment other than the mounts.
 FOOT EVOLUTION MONTI- Leads to worsening slow, progressive and inevitable, but the pace varies depending on the two main forms:1. congenital or juvenile type, appeared as a teenager, moves more slowly and become symptomatic (pain) to 40 years old;2. static type, which occurs around the age of menopause, has in turn accelerated evolution to form a complex deformation of the entire leg.- Can be stopped by applying curative surgery.- Can be slowed by respecting local therapeutic measures, providing acceptable comfort everyday life and professional activities.
 PREVENTION- There are no specific prophylaxis, the worsening evolution not being prevented.- Exercise can not stop disease progression, in turn, applied irrationally, can worsen.
 TREATMENTTreatment must restore patient confidence, by rebuilding a harmonious aesthetic and functional leg, pain free and able to handle daily activities or leisure.
 TREATMENT "NATURIST"Deserves special attention because of a mythology and an extremely popular literature.- Those who propagate such treatment assumes absolutely false that "Monte" is a kind of wart or excrescence osteo-cartilage, which is trying to remove all kinds of applications by local iodine concentrated salt diluted in water, comfrey , celandine, lemon, potatoes, raw fish, dissolved aspirin, garlic, etc. steep.- These substances are not only totally unnecessary, but often extremely dangerous, causing local infections, burns extremely serious, which can cripple foot.- The only substance allowed the local grease neutral in order to protect the skin from irritating the mechanical action of footwear.
 Conservative treatment (nonsurgical)
Assume:- Adaptation of physical activity, professional sports, local to reduce suffering. Avoid prolonged standing (standing), and aggressive sports (jogging, foot-ball) will be replaced with milder (swimming, cycling).- Adapting footwear is the capital and major requirement is comfort. There is no miracle recipe in this respect, the fact is that we have lowered the bar "chic" to an appropriate size and model, its demands to avoid conflict and ensure a comfortable walk, painless.- Orthoses (sustinatoarele) plantar foot statics correction (inserts) can be useful, provided to be properly executed (purely hand made and custom). By harmonizing the plantar pressures may improve metatarsalgiile-associated hallux valgus but does not change the evolution of deformation.- Cosmetic-type palliative measures: special protective bandages and digital separators may allow local shoes foot by avoiding conflict.- "The hallux-valgus orthoses", day or night should be avoided completely. Acting symptomatic, not causal, like most surgical procedures practiced in Romania, have a devastating effect on the joint, causing rapid degeneration of arthrosis.- NSAIDs and pain medicines can reduce pain and inflammation, but should be consumed with discernment and short term, given the aggressiveness of gastric potential medical complications or interference.- Local infiltration cortisone must be banned completely from the entire leg (popular, "foot"). Consequences of their improper use can be devastating tendon or ligament tears, followed by destruction of the foot architecture and serious infections.- Antibiotics are useless in 99% of cases, addressing a swelling caused by shoes that are too tight and not an infection, as mistakenly believed.- Treatment of inflammation (bursitis) requires local very wise, given their extreme frequency, and especially to avoid their superinfection. There is one good treatment, namely a much larger shoes, to completely avoid contact with prominent.
 SURGICAL TREATMENTSurgery Overview- It is only able to correct deformity, to relieve pain and allow cvasinormala shoes, and practicing the profession of sports or leisure.- Assume a reasonable expectation horizon: foot surgery can not play a leg "new" but tries to restore lost architectural harmony with the passing years.- Tratementul surgery is never urgent! He can be delayed for decades, especially if there is functional disorders (pain) or discomfort when walking.- Not urgent treatment should be on time to avoid the appearance of strains that require hard treatable and irreversible operations such as blocking of joints.- Time operator will be chosen by the patient in collaboration with the surgeon, after an exhaustive information on techniques and possible complications.- Intervention should be avoided in children and during pregnancy.Asolut There is no indication of surgical correction at age bone growth, regardless of the size of deformation.- Corrective interventions have a spectacular aesthetic result, but this is not an aesthetic surgery, but a purely functional, as determined by pain and difficulty walking. Patient's desire to have a harmonious body, with valences aesthetic criterion should not rely on functional orthopedic type.- The presence of a highly experienced surgeon is the capital antepiciorului surgery: the one who routinely perform these operations successfully and can minimize the rate of complications.- Surgical procedures require a powerful processor block, dedicated to modern equipment, dedicated osteosynthesis material, the presence of well-trained anesthesiologists. There is a "small surgery, but a surgical performance and extremely demanding, in order to minimize complications and recurrence rate.
 Principles of surgical treatment- Surgery should recreate a support body and quasi-normal walking, with harmonious architecture, free from pain and able to respond to requests daily or occasional basis.- Must be reasonable expectations of patients: grade deformation condition largely the result of surgery, and sometimes sacrifices are necessary for certain functional. No other leg does not look like the surgeon can not always do a leg of the model.- Harmonisation of the two seemingly contrary interests, in fact complementary: the patient wants to wear stylish shoes again, and the surgeon really wants to restore normal biomechanics, leading to a normal gait and long-lasting results.
 The objectives of surgical treatment- Removal of deformation does not mean simply cutting the protuberant bone: this process is damaging and censurable unfortunately widespread in Romania and cause huge degree of dissatisfaction of patients and surgery negative reputation of "frames". This technique has a high relapse and is absolutely unacceptable from every point of view, illogical.- The challenge of any major intervention is going early to avoid major complications of immobilization. Avoid operations that require prolonged immobilization plaster casts, walking with crutches or simply immobilization in bed. Immobilization is strictly forbidden!- There is now enough reliable operative techniques allow progress since the first day after surgery, the rapid resumption of professional activities and sports footwear and port "elegant."
There is a laser surgery for frames?- It is not yet firmly stated that nowhere in the world invented a hysterectomy.- Monte is not a type of skin formation, which could be removed with laser.- Origin Monte is deeper, progressive movement consisting of a normal bone that protrudes under the skin. To correct this situation, the bone must be restored to its original place by cutting its full, which can not be achieved with the laser.- It is true that recent years have witnessed a development of percutaneous techniques (minimum of 2 mm incisions), but still using the knife and cutting principles (osteotomy) of the first metatarsal using special cutters. These techniques can be applied only in certain cases requires both early and specific instruments, and a very long period of improvement.Surgical techniques- There are multiple surgical techniques and their development is exponential in the last 15 years. Each technique has advantages and risks, leaving the surgeon's task to apply them depending on local conditions and especially to his experience. Currently 2-3 longer applies modern interventions of the more than 250 described.
- Any intervention principle axis is restoring a normal range of the leg, axle is deformed by moving the big toe (thumb) and the corresponding metatarsal. For this purpose metatarsal should not necessarily cut and moved into place originally, normalizing device-sesamoido-falangian metatarso in order to cvasinormale biomechanics.
- Surgical techniques Major Requirements:1. to keep as much of the capital of bone joints by avoiding mutilation or amputation amputation proximal phalanx base metatarsal head;2. be kept simple, reliable and reproducible;3. Fixing performance (fixation), often made by using titanium screws, specially tailored;4. allow an easy restart of the procedure in case of relapse or failure correction.5. to generate a minimal surgical scar on the principle of mini-invasive.
 - Maneuvers are multiple operators, depending on the nature and severity of deformation, and is based on:1. Selective cutting of muscles or ligaments, and joints in order to maintain reaxarii decomprimarii;2. metatarsal osteotomies: distal metafizare, basal or combined with osteotomy of the proximal phalanx;3. antepiciorului global surgery, when complex deformities, addressing both the hallux and first metatarsal, lateral metatarsals and lateral fingers.
 Pain Control- Total absence of pain is essential and desirable.- Control of pain is crucial evidence being nefarious reputation antepiciorului surgery, accompanied by significant pain. This surgical anesthetic procedures require the application of modern, effective for a period of 36-48 hours (critical period pain). It is also the only reason this character can not have surgery "outpatient", "one-day-surgery."- The only anesthetic is effective locally, the sensory nerve perineural block, which allows long-term pain relief and especially allowing early resumption of walking. Type of spinal anesthesia (anesthesia, peri-or epidural) are proscribed and can not allow early mobilization and walking advand reputation and frequent postoperative complications.- Pain of morphine are justified as an indication and use. Pain relief is justified and algodistrofic avoidance syndrome, often redoubtable complication attributable to pain.- After the first 48-72 hours are sufficient analgesic paracetamol's class.
 Contra surgery- Diabetic foot is a major but not an absolute contraindication, there are cases that can be operated by percutaneous procedures, mini-invasive.- Peripheral arteriopathy ("arteritis") should be evaluated by the vascular surgeon, inter-disciplinary team.- Peripheral venous insufficiency (varicose veins) should be thoroughly evaluated by the vascular surgeon.- Smokers have a relative contraindication, because of the major complications of skin, bone or recovery. A moderate smoker (less than 20 cigarettes / day) will be operated only after an abstinence of at least 3-6 months, depending on the clinical examination of the foot.- The patient must understand that this surgery is not an emergency, or necessity. Intervention can and should be avoided in particular conditions, which may even endanger his life. There is always a conservative solution, with the adjustment of orthopedic shoes or making one, special.
 ComplicationsAny surgery can be followed by complications or failures, most can be prevented by careful patient selection, indications operators, application and follow proper procedure careful evolution. There specficate better treatment protocols for each of these complications:- Failure is maintaining the deformation correction after surgery, attributable to the surgeon, is generally well tolerated and can be corrected;- Hyper-correction (correcting exaggerated)-called hallux varus, is a redoubtable complication and difficult to tolerate, yet benefiting correction techniques;- Relapse is the initial deformation reproduction, possibly increased severity, contrary to myths spread, relapse is not caused by footwear port "elegant but is the result of surgical procedures obsolete, mutilated joint and, unfortunately, extremely popular in Romania, is a major problem the psychological, the patient refused surgery disappointed with a new operation. "- Transfer Metatarsalgia occurs after treatment poorly and requires to resume, a surgical-type "global";- Infection is a complication inherent in any surgical procedure. The strict internal rules of sterility, and use minimal-invasive procedures can reduce infection rates;- Algodistrofia, joint stiffness and venous thrombosis are complications due to immobilization and insufficient analgesia, sometimes due to particular land vascular (varicose veins);- Hallux major shortening, deformity sesamoidelor cook-up and retraction, necrosis metatarsal head and rapidly progressive arthritis, neconsolidarea and secondary displacement are the result of an improper technique or "DIY" insufuciente technical means.
 Postoperative recovery-It is relatively simple and is based on a strong doctor-patient relationship, relationship based on cooperation.- The first two weeks after surgery requiring a proper rest, to avoid inflammatory syndrome.- Walking can be resumed from the first day after surgery, most often using a special therapeutic shoes.- Control consultations are needed for surgical wound surveillance, monitoring and periodic radiographs and gait recovery.- It is not necessary kineto-therapist, the patient was instructed to mobilize the necessary joint recovery.- Professional and sporting activities can be resumed after 3-8 weeks, depending on the nature and intensity of physical application.
RESULTS OF SURGICAL TREATMENT- In the hands of a highly experienced professional, modern procedures bring spectacular results, both aesthetically and functionally: foot regains form and function, can be received by a shoe "elegant."- The results are stable over time: modern techniques have a recidivism rate of about 2-5%, compared to the "classical", reputed for recurrence of 50-60%.- The satisfaction of patients is quite exceptional, the proof is their request for the operation of the other leg or relatives and close friends.- Relapse may be related to decompensation of rheumatoid arthritis, sudden weight gain, the existence of extremely complex deformities, foot-flat, etc..- This surgery is evolving, always defending the original procedure, the abandonment of the existing multi-disciplinary approach.