Operative Orthopaedics
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Boutonniere deformity
Rupture or stretching of the central part of the finger extensor tendon results in the inability to actively extend the first joint of the finger to the hand. Over time, the lateral parts of the same tendon move downward and become active finger flexors. Deformity, if not treated, ends with complete stiffness of that joint. Such a deformity prevents daily activities such as washing and putting one's hand in one's pocket. Operative treatment reconstructs the ruptured tendon with the use of bioresorbable anchors that enable better rehabilitation of finger mobility.
Knocked knees
The deformity is most often congenital and often leads to joint damage due to the poor balance of body weight transfer on the joint bodies. Before severe damage to the cartilage, the deformity is painless.
On the other hand, arthrosis, a disease in which the cartilage disappears over time, leads to a change in the shape of the knee (more in O or more in X). Knee deformities caused by arthrosis are generally painful.
Both of the above-mentioned different causes of deformity can be corrected by so-called operations. corrective osteotomies, which correct and balance the transfer of body weight through joint bodies, as in a healthy normal knee. In the case of arthrosis, it is also possible to correct the axis so that more weight is transferred over the healthy part of the joint and thus protects the diseased part.
Ultimately, in case of complete cartilage damage, it is possible to replace the entire joint. Then, in addition to replacing the lack of cartilage with artificial materials, the previous O or X deformity is also corrected.
Bone deformities resulting from a poorly fused fracture
With conservative treatment with immobilization, the bone can heal at a certain angle and the deformity is more or less visible. Certain angles are tolerant regarding the function of the adjacent joints. Bone healing at a certain angle occurs less often after surgical treatment. Such a bone can be corrected by the so-called corrective osteotomy, and the straight position is maintained with the use of special plates and screws or special intramedullary nails (special nails that go through the middle canal of the long large bone), and additional stability is achieved with screws that are placed perpendicular to that nail and pass through it.
Hallux valgus - bunions
is a potentially painful or painful deformity of the foot that occurs due to congenital weakness of the so-called connective tissue in the ligaments and joint capsules of the foot. We also notice it in children, at younger and older ages. The deformity begins in the joint above the thumb joint, where it is not so visible. The consequent outward displacement of the big toe and the protrusion on the inside of the foot at the first joint of the big toe are visible. Corrective devices that can be purchased do not correct the deformity, on the contrary, they aggravate it because they push both the thumb and the bone above it in the direction of the initial appearance of the deformity. The only successful treatment is surgery. With an individual approach to each patient, and after a detailed examination and analysis of special X-rays, we will recommend the optimal type of surgery. There is a possibility that the deformity will return, but never to the same degree as before the operation. It is possible to perform an operation where there is no possibility of returning the deformity, but these operations are not recommended as the first, because in most cases the first succeeds. This operation is more demanding with more metal implanted parts and with sacrificing the mobility of one joint (the joint becomes stiff during the operation). The stay in the hospital is one day, and you walk with a walking shoe with support only on the heel. Crutches are only for balance. After 1 to 1.5 months, the bones and soft tissues heal in the corrected position and you can walk in ready-to-wear shoes normally.
In the event of a recurrence of the deformity after the previous surgical treatment, a reoperation is approached, which is usually more complex with the use of more implants needed to stabilize the bone.
Digitus V varus, inward displacement of the little toes, bunnionette, Taylors bunnion
as with hallux valgus, the big toe moves outwards, in this deformity the little toe is strongly moved towards the inner part of the foot, the foot is wider and there are pressures on the outside and/or bottom of the foot, walking is painful and difficult as well as wearing ready-made shoes. Depending on the type of deformity, which is assessed by standing X-ray, the position is corrected by surgery. It is possible to use mini or micro screws that remain in the bone and do not interfere with the movement of the tendons and do not have to be removed.
Right condition before, left after surgery
Wide foot
is a combination of the two deformities described above
Brachymetatarsia
Deformity of the foot in which, due to the shortening of the metatarsal bone, the toe looks significantly shorter. The 4th metatarsal bone is most often affected, but others can also be affected. In the beginning, it is a cosmetic defect, while later in life due to improper loading of the feet when walking, pain begins. With surgical treatment, it is possible to lengthen the shorter bone and possibly shorten the surrounding bones in order to achieve a better cosmetic result. In the case of very large deformities, a definitive solution can only be achieved in the second operation, after the bones and soft tissues (ligaments, tendons, blood vessels and nerves) have adapted to the new length after the first operation.
Hallux rigidus
there is a painful restriction of the ability to move the thumb more upwards due to the formation of a bony protrusion and arthrosis. Conservatively, it is possible to place an elastic band ( plastic or metal) under the orthopedic insole, which partially limits the full upward movement of the thumb. In severe cases, the bone protrusion is removed by surgery. In case of complete disappearance of cartilage from the joint (arthrosis), it is possible to install a partial or total endoprosthesis.
Hammer toes
are a combination of deformities in the first and second joint of the toe. Above that second joint, there are pressures, redness and pain. The tendons on the top and bottom of the toe are tense. The toe is pinched. The deformity is often associated with a lowered transverse arch of the foot. By surgery on bones and soft tissues (tendons, ligaments, joint capsule), it is possible to straighten the toe. Depending on the degree, it is possible to keep the movements in the joints. In the case of arthrosis, the toe is straightened, but the joint is stiffened by surgery. In principle, it does not interfere when walking.
Too long toes
it is possible to shorten such toes, usually with the consequent stiffness of the most distant joint on the toe, without functional impairment.
Extra toes or parts of a toe - polydactyly
Accessory toes or parts of toe are most often operated on already in early childhood. However, some patients opt for surgery after the end of growth. After analyzing the X-ray image, it is necessary to see if it is only an excess of soft tissues or if the bone is fully developed. During surgical treatment, it is important to take into account the condition of the adjacent joints as well as the tip of the toe with the nail.
Accessory navicular bone
next to the so-called navicular bone on the inside of the foot in some people there is a additional bone. It can be connected to the navicular or have a true joint with it. For some people, such a bump on the inside of the foot causes pressure and pain. The operation removes the excess bone and in this way the complaints are solved.
Ingrown nail
the nails on the hands are cut semicircularly, and on the feet straight. In the case of a semicircular cut, the side edges of the nail can get stuck in the skin, causing a sore that soon becomes infected. The body protects itself by creating the so-called granulation tissue that is composed of inflammatory cells, capillaries and bacteria. Many different operations are described. What I would absolutely not recommend is removing the entire nail. First, such an operation does not solve the problem permanently, because when the nail grows back, problems appear again, and secondly, the nail takes a long time to grow. A more gentle procedure that removes 1 mm of the so-called of the matrix (the part from which the nail grows) and the same amount of nail, with the removal of inflamated tissue completely and by placing two stitches that will bring the edges of the wound closer, the problems are completely solved. Stiches can be removed in 14 days.
Haglund's heel
even though all heels in people are similar, they are not the same. Some people have a square upper end of the heel bone as opposed to a rounded one. The Achilles tendon attaches in the lower third of the heel bone. In people with a square end of the heel bone, the sharp edge of the bone protrudes and scrapes the tendon. This creates inflammation and pain and there is possibility for tendon rupture. On the skin of the back of the heel, there are visible bumps, redness and soreness on pressure. Women who wear high heels usually do not have any problems because in this position the tendon moves away from the bone. Most often, patients with complaints are men, especially athletes. It is possible to remove the bony protrusion through a mini incision or arthroscopically. In the case of severe damage to the tendon, it is necessary to examine the tendon using a mini-open approach, remove the diseased parts, and strengthen the tendon with particularly strong stitches that are attached to the heel bone with special anchors. They can be made of metal (titanium) or of bioresorbable materials (they dissolve over time).
Calluses on the bottom of the foot
they are most often caused by the lowering of the transverse arch of the foot. Then the heads of bones of the front part of the foot can be easily palpated. The bearing during walking goes through these bones and the subcutaneous tissue becomes thinner and the skin thickens. This can be painful. If wearing orthopedic insoles with a metatarsal pad, that should raise the arch and relieve pressure to the bones, should not alleviate pain, we will recommend surgial treatment. Most often, the problem is the second metatarsal bone, which in some cases is also the longest, and all the bodyweight goes over it while walking. During surgery, this bone is shortened to the level of the others and/or raised, and the transverse arch is reconstructed again.