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Kotsi. Can I treat it conservatively?

What is the big toe or knuckle?

This is the most common deformity of the foot, in which the big toe deviates outwards and turns around its axis, while the head of the 1st metatarsus protrudes inwards (knuckle) resulting in its friction on the shoe. The condition is more common in women. There is an inherited predisposition, while the aggravating factor is the narrow shoes on the front with high heels, which force the big toe to be angled towards the 2nd toe.

What are the symptoms of this condition?

There is obvious deformity of the limb and mild pain. However, the intensity of the pain is not always proportional to the deformity. In the area of ​​the lump on the lateral surface of the toe in the big toe, friction is created when in contact with the shoe, resulting in painful irritation of the area.

If the big toe deviates continuously, it can be found under the adjacent 2nd finger or pressed so that it also tilts in turn, resulting in greater deformation. Pain may also occur on the anterior surface of the sole, below the heads of the metatarsals, due to the lack of contact of the big toe with the ground when walking.

How is it diagnosed?

The diagnosis is always made by a specialized orthopedist after a good and detailed clinical examination. The doctor will then refer the patient for an X-ray.

How is it treated and when do we choose the surgery?

Unfortunately the big toe correction is ONLY corrected with surgery. Conservative treatment can not reverse the progression of the disease and eliminate the knuckle, but it can stop further progression. Includes soft and wide shoes that do not press on the foot, as well as the use of silicone separators between the first and second toe. Special orthotics soothe the lower part of the foot and can help relieve symptoms.

The decision for surgery depends on the severity of the symptoms (pain, inability to walk and walk), the age, the general condition, the expectations of the patient and finally on the failure of conservative treatment. The purpose of the operation is to correct the deformity, something that can only be achieved with corrective osteotomies, with minimally invasive surgical methods being the most modern treatments for the knuckle. Until now, the gills were treated with large and painful surgeries, and the postoperative recovery time was very long.

Transdermal surgery of the big toe is a revolutionary new method of treatment. With this new technique, the patient does not need to be admitted to the hospital. The operation is performed through 3 small holes that do not exceed 2-3 mm, with local anesthesia, lasts 20 minutes, without blood loss and of course leaves no postoperative scars. Through these holes, small tools are driven with which the corrective osteotomies are performed and the exostoses are removed. The patient walks without pain a few hours after the operation, without crutches, using a special shoe, which he wears for 4-6 weeks and can return to his activities much faster.

A pre-required parameter for the application of this technique is that it should be done ONLY by surgeons specialized in transdermal foot surgery and well acquainted with this surgical technique.

Do you need hospitalization for this operation?

The patient is discharged the same day and does not need to stay in the hospital for treatment. The anesthesia is always local (block), ie the patient does not need to receive general or dorsal anesthesia.

The complication rate of this operation is less than 1%, when it is performed by specially trained orthopedic surgeons in percutaneous foot surgery. The deformity does not recur if the surgical technique is properly selected and performed.