Silver surgery

Silver surgery is used for the treatment of foot valgus. The valgus deformity is more common in women. The main clinical features are excessive toe deviation of the toes in the plane of the metatarsophalangeal joint (outer angle >15°), and the first metatarsal varus (the angle between the first and second metatarsal > 10 °), the first metatarsal bone formed osteophytes and bursitis, severe deformity, the second toe is sometimes squeezed to the dorsal side of the toe to form a hammer toe, the dorsal joint of the interphalangeal joint to form a hernia. If the symptoms are severe, you can wear shoes and walk because of the pain. The cause of valgus deformity is related to many factors, which are closely related to the wearing of pointed shoes and high heels. For those with mild symptoms, you can change the habit of wearing shoes, do not wear narrow pointed shoes and high heels, so that the toe and the first metatarsal head can be prevented from being squeezed and rubbed, and the symptoms can be alleviated. If the deformity and pain are heavier, surgery can be performed. There are many surgical methods, including soft tissue surgery, bone surgery and soft tissue combined with bone surgery. Appropriate surgical methods can be selected according to the situation. Treating diseases: foot valgus Indication Silver surgery is not very serious for the valgus deformity. The external angle of the foot is between 20° and 35°. The angle between the first and second metatarsal is <15°. There is no degenerative arthritis in the metatarsophalangeal joint. And the walker. Contraindications Recently, there was an acute inflammatory attack of bursitis; the metatarsophalangeal joint of the toes had a change in degenerative arthritis; the foot valgus or the first metatarsal varus deformity was too severe. Preoperative preparation Including skin preparation, bone knife, osteophytes and other orthopedic basic equipment. Surgical procedure 1. Make a straight incision on the medial aspect of the first metatarsophalangeal joint or an arcuate incision to the dorsal aspect. Starting from the midpoint of the proximal toe of the toe, extend backwards and stop at the middle third of the first metatarsal shaft. 2. Make a U-shaped incision of the medial joint capsule to form a joint capsule attached to the proximal phalanx. The tip of the flap is 1.3 to 1.6 cm proximal to the metatarsophalangeal joint, and a longitudinal incision extending proximally is connected. The joint capsule is turned to the distal side to reveal the metatarsophalangeal joint and the medial epiphysis of the humeral head. Be careful not to damage the attachment of the proximal part of the joint capsule at the humeral neck. 3. Excision of the medial epiphysis of the humeral head: a sharp bone knife is used to make a score on the proximal edge of the epiphysis, and then the prominent epiphysis is removed from the distal side. The rough surface of the bone can be smoothed with the bone. 4. Incision of the lateral joint capsule and the removal of the occipital muscle: pulling the toe to the distal side to widen the gap between the metatarsophalangeal joint, and using a sharp knife to cut the lateral joint capsule through the joint and cut the adductor muscle. 5. Overlapping the medial joint capsule to correct the foot valgus deformity, keeping the metatarsal toe in the neutral position, and pushing the U-shaped flap of the medial joint capsule proximally and tightening with the proximal part. 6. Suture the incision in layers. complication 1. The foot valgus deformity is not corrected or recurred. The main reason may be that the adductor muscle combined with sacral cutting or the lateral joint capsule severing is insufficient, the foot valgus factor is not completely relieved; or the medial joint capsular flap is not securely overlapped. Or failed to fix in the correct position after surgery. 2. Foot varus deformity, the main cause may be the removal of the medial process of the medial humeral head, which causes the medial phalanx of the proximal phalanx to lose the fulcrum and the medial slant to cause the medial varus; The lateral sesamoid injury accidentally injures the lateral head of the short flexor, resulting in an imbalance of the intrinsic muscle strength of the toe; or fixation of the metatarsal to an excessive varus position after surgery. 3. Other complications may include claw-toe deformity, metatarsophalangeal joint movement disorder and over-extension of the toe.