Information
In "percutaneous surgery," the surgical operation is performed through mini incisions about 5 mm in size. Many conditions affecting various joints are currently treated using a minimally invasive approach, but this is particularly true for the entire pathology of the forefoot: hallux valgus, pain in the area of the metatarsal bones, and hammer toe. Special instrumentation is required, effective and specifically designed for percutaneous surgical operations. The goal of the intervention is to restore the anatomy, and consequently also the morphology, in a way that brings it as close as possible to its theoretically normal appearance. The aesthetic effect is simply a consequence of this restoration and should not become the main goal, since orthopedic surgical intervention is functional, not aesthetic. For this purpose, surgical fractures (osteotomies) are performed, aimed at reducing the distance between the first two metatarsal bones, that is, the metatarsal angle, which is normally around 12 degrees, but which increases significantly in hallux valgus, reaching very high values of 20-25 degrees or more in the most severe cases.
There are various types of corrections
The choice is made according to the type of correction that needs to be performed and based on the surgeon's preference. In rare cases, the percutaneous technique is not possible, and it becomes necessary to resort to more traditional techniques, but again minimally invasive ones (i.e., mini incisions not exceeding 3-4 cm).
The surgery is performed under spinal or locoregional anesthesia. Hospitalization is very short, and the patient can walk immediately afterward.
Advantages of percutaneous surgery
Reduced postoperative pain, comparatively faster healing, very fast execution of the operation, with extremely short surgical times (about 10 minutes for one limb when the case is not complex, about 15-20 minutes for one limb in a very complex case).
Possible complications
Inflammation, phlebitis, swelling lasting several months, which usually resolve with appropriate postoperative therapy. More specifically: swelling (edema) and reduced sensitivity, as well as a slight loss of the ability to move the toes, in the case of hammer toe correction, cause significant concern among patients, who must be informed that this is an extremely common occurrence for the first 3-4 months and that it will gradually pass.
IMPORTANT: Percutaneous surgery gives excellent results in 97-98% of cases. There are no real failures with this surgery, but in 2-3% of cases there may be minor residual imperfections, discomfort, or more serious complications - these can usually be easily corrected, either with medication or with a simple "touch-up" procedure under local anesthesia.
Hospital stay
After the surgical intervention, the stay at VITA Hospital is three days. Dr. Pintore personally visits each patient the day after the surgery and gives instructions for the period until the next meeting with him - one month after the surgery. The follow-up visit after the surgery is free of charge for the patient.
Postoperative period
The patient will be able to walk immediately, with the help of a special shoe (e.g., the so-called Barouk shoe or similar), which is used until the bandage is removed (about 45 days).
The surgical correction performed will be fixed with the help of a metal pin (Kirschner wire), which is left in place for a period of 30 days.
Follow-up
As a patient of VITA Hospital, after the surgery you will continue to be cared for by the specialists in the orthopedics and traumatology department. You will be notified in a timely manner of the date and time of the postoperative consultation with Dr. Pintore.
Follow-up examinations are carried out in the following sequence:
- 7 days after the surgery: dressing change (VITA Hospital)
- 15 days after the surgery: stitch removal (VITA Hospital)
- 30 days after the surgery: removal of the Kirschner wire (not painful) and dressing change (VITA Hospital), Dr. Pintore
- 60 days after the surgery: clinical examination (VITA Hospital), Dr. Pintore
For patients who live far from Sofia, the number of follow-up examinations may be reduced, with the dressing changes and stitch removal entrusted to the patient's personal physician, on the seventh and fifteenth days after the surgery, respectively.
Recovery
The recovery period is an individual process, depending on the degree of foot deformity, the patient's age, any accompanying conditions (if present), and weight. It is recommended that you allow for at least one month of rest or, at the very least, a lighter weight-bearing regimen, systematically alternating with keeping the leg in a horizontal position.
IMPORTANT!
Not all patients will be able to wear normal shoes by the second month after the surgery due to frequent swelling, and this should not be a cause for concern, nor should you be worried about the blue coloring of the foot in the days after the surgical intervention, which is due to the hematoma rising toward the surface.
Driving is usually difficult for a period of about 45-60 days after the surgery. Returning to work depends on the type of activity you do: within a few weeks in the case of sedentary work, up to a few months in the case of employment requiring physical effort. Sports that do not require running and jumping can be resumed from the second month after the surgery. For sports activities requiring running and jumping, the interval will be longer, around 3-6 months.
In addition to anti-inflammatory therapy, antibiotic prophylaxis for thromboembolism is also important, i.e. when you are not walking, take care to keep the limb elevated, in order to prevent lymphostasis, stimulate venous circulation, and reduce swelling.
It is a good idea, while at rest, to independently and immediately perform passive mobility exercises for the toes.
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