RU2612097C1 - Method for flat-valgus foot deformities treatment for children and adolescents - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves imposition of external fixation unit on the foot and lower leg, peroneal muscle group tendon and Achilles tendon lengthening, foot joints resection followed by distraction on the unit, with bringing down of calcaneus and forefoot. Semicircular supports of the unit are applied parallel to the plantar surface of the calcaneus and the metatarsal bones and perpendicular to the side surface of the forefoot in relation to the rear department. Talonavicular arthrodesis is created by taking out the scaphoid from the subluxation position, which is fixed by a longitudinal needle drawn through the first metatarsal, first wedge, and scaphoid bones to the normal correction position. Valgus deformity of the forefoot is eliminated by cuboid bone osteotomy in the middle third. Pronation and equinus installation of calcaneus is corrected by calcaneus body osteotomy made outside inwards, in a plane parallel to the talo-calcaneal joint space. The rear and front semicircular supports are connected in a closed elliptical frame, which is connected to the annular support, superimposed on the middle third of the tibia by means of rods and joints, control which forms a multiplanar reclaim of the calcaneus. Sphenoid-distraction regenerate of the cuboid bone is form by connecting rods between the front and rear of semicircular support.

EFFECT: method prevents development of shortened foot.

5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat children and adolescents with acquired flat-valgus deformities of the feet of various etiologies, or relapses of deformation, with congenital deformation when correcting the position of the talus.

This deformation of the foot is characterized by the absence of the arch of the foot, pronation and equinus position of the calcaneus, dorsal flexion of the forefoot and abduction, deflection in the joint of Shopar. Tension of the tendons of the fibula group, Achilles tendon is noted. The range of motion in the ankle joint, especially plantar flexion of the foot, is sharply limited.

Currently, various methods are used to treat flat valgus deformity of the feet. The greatest difficulties are noted in the treatment of flat-valgus deformity of the feet in children older than 12-14 years (adolescents). Deformation at this age is acquired in nature, and may be due to the treatment of congenital clubfoot, relapse of flat-valgus deformity with vertical standing of the talus, or, as a result of neurogenic diseases. In this case, the position of the talus in patients of this age group is close to normal (the talocental angle in the horizontal plane is 35-50 °, in the sagittal plane up to 40 °), although the main pathology is detected not only in the soft tissues, but also in the bone (heel -the tarsal angle in the horizontal plane 180-190 °, in the sagittal plane 150-180 °, and the pronation of the heel up to 170 °) [1].

A known method is wedge-shaped according to Perthes, or sickle-shaped according to Kuslik, resection of the inner edge of the deformed foot. This method consists in removing a bone wedge of various sizes, depending on the degree of deformation, from the inner edge of the feet, followed by matching the fragments of the foot and immobilizing them in a plaster cast [2].

The disadvantage of this method is the inability to eliminate pronation of the hindfoot, which further leads to a relapse of the deformation, in addition, to a significant lag in the growth of the foot.

There is also a method of surgical treatment of flat valgus deformities of the feet, which consists in removing the calcaneus from the equinus by knocking the bone wedge with the base downward from the calcaneus, dividing it into 2 wedges and forming the longitudinal arch of the foot by introducing these wedges with the base upward in the transverse osteotomy of the scaphoid and sphenoid bones. Fixing with knitting needles and plaster cast for 2.5-3 months. [3].

The disadvantages of this surgical method are the high invasiveness of the operation and the high likelihood of aseptic necrosis of wedge-shaped autografts, which, in turn, significantly reduces the effectiveness of treatment. Removing the bone wedge from the calcaneus in order to eliminate its pronation, leads to its significant shortening. The need for graft reconstruction significantly increases the duration of treatment.

The closest in its technical solution to the claimed method for the treatment of flat hallux valgus deformities is a method of treating congenital flat hallux valgus feet [4]. Its essence lies in the intervention on the tendon-ligamentous and musculoskeletal system. The tendons of the Achilles and peroneal muscle groups are lengthened, the subtalar and Chopar joints are resected, the Ilizarov apparatus is distracted in the Chopar joint, and the calcaneus and forefoot are reduced around the axial spoke through the talus. Fixation of the foot and the formation of the arch is carried out by removing the calcaneus from the equinus position, and converging the front and rear sections of the foot with a compression-distraction apparatus G.A. Ilizarova. However, this method is quite traumatic, because resection of subtalar and shopar joints leads to the development of shortening of the foot.

The aim of the invention is to reduce the morbidity and increase the efficiency of surgical treatment of flat-valgus deformity of the feet in children and adolescents.

The essence of the invention lies in the combination of essential features sufficient to achieve the desired technical result, which consists in correcting deformity of the foot, while reducing trauma and improving treatment outcomes in the form of preserving the growth zones of the cartilaginous integuments of the joints of the foot, which is the prevention of the development of aseptic necrosis of the talus.

A method of treating flat-valgus deformity of the foot in adolescents involves the imposition of an external fixation apparatus on the foot and lower leg, lengthening of the tendons of the peroneal muscle group and the Achilles tendon, resection of the joints of the foot, followed by distraction on the apparatus, with the calcaneus and forefoot. Semicircular supports of the apparatus are imposed parallel to the plantar surface of the calcaneus and metatarsal bones and perpendicular to the lateral surface of the calcaneus and the longitudinal axis of the metatarsal bones, taking into account the torsion of the forefoot in relation to the back. A talon-scaphoid arthrodesis is created by removing the scaphoid from the position of the subluxation, which is fixed with a longitudinal spoke drawn through the first metatarsal, first sphenoid, scaphoid and talus in the normocorrection position. Hallux valgus deformity of the forefoot is eliminated by osteotomy of the cuboid bone in the middle third. The pronational and equinus installation of the calcaneus is corrected by the osteotomy of the calcaneus body, performed from the inside-the inside, along the plane parallel to the joint gap of the calcaneal joint. The rear and front semicircular supports are connected into a closed ellipsoidal frame, which is connected to an annular support superimposed on the middle third of the lower leg by means of rods and hinges, the control of which forms a multi-plane calcaneus regeneration. The wedge-shaped distraction regeneration of the cuboid bone is formed by connecting rods between the anterior and posterior semicircular support.

The imposition of the semi-ring supports of the external fixation apparatus: the front - parallel to the plantar surface of the calcaneus and metatarsal bones, and the posterior - perpendicular to the lateral surface of the calcaneus and the longitudinal axis of the metatarsal bones - allows you to mount a closed ellipsoid frame from the parts of the Ilizarov apparatus, used universally for the treatment of various congenital and acquired deformities of the feet. With flat-valgus deformities, the foot acquires a twisted appearance, that is, the heel is in the pronation position, and the forefoot is in the light supination position, and the use of a closed ellipsoid frame makes it possible to simultaneously eliminate this foot deformation.

The creation of a scaphoid-scaphoid arthrodesis is necessary to keep the scaphoid in the position of normal correction, since with flat-valgus deformation of the foot, the scaphoid is in the position of subluxation.

Fixation with a longitudinal spoke conducted through the first metatarsal, first sphenoid, scaphoid and talus bone provides partial removal of the forefoot from the abduction position, thereby eliminating the valgus deformity of the forefoot, and setting the scaphoid in - the position of normal correction. In this case, the relationship between the first beam of the foot and the bones of the middle part of the foot is stabilized in the position of normal correction.

Elimination of valgus deformity of the forefoot is performed after osteotomy of the cuboid bone in the middle third by growing a distraction regenerate of a triangular shape from the side of the osteotomy, with an angle open to the outside of the foot.

Coronation of the pronational and equinus installation of the calcaneus is carried out by osteotomy of the body of the latter, performed externally-inside along a line running parallel to the joint gap of the talacaneal (subtalar) joint, with the formation of a multi-plane regenerate. This regenerate is formed in a wedge-shaped form, with an angle open posteriorly, which ensures the formation of the longitudinal arch of the foot, and outward - to remove the calcaneus from the position of pronation, its hallux valgus. Performing an osteotomy of the body of the calcaneus extra-articularly allows maintaining the talacaneal joint with osteogenic tissues, preserving the function of the growth zones of these bones, which ensures the growth of the latter, reduces the morbidity of surgical intervention and is a preventive measure for the development of aseptic necrosis of the talus.

Mounting the rear and front semicircular supports in a closed elliptical frame, connecting it with an annular support superimposed on the middle third of the lower leg by means of rods and hinges, provides all the manipulations for fixing the bones of the foot, and for growing regenerates.

The method is illustrated by the following illustrations:

In FIG. 1 depicts a foot from the outside, with the designation of anatomical formations, where 6 is the line of the osteotomy of the calcaneus, 10 is the cuboid bone.

In FIG. 2a is a schematic illustration of the foot, rear view, with knitting needles for fixing the calcaneus in the posterior semicircular support, where 6 is the line of the planned calcaneus osteotomy;

In FIG. 2b shows the formed distraction regenerate 15 of the calcaneus, with an angle open outwards, where: 8 are the spokes drawn through the distal fragment of the calcaneus, and 7 are the knitting needles with thrust pads drawn through the proximal fragment of the calcaneus;

In FIG. 3a, FIG. 3b - bones of the foot, top view;

In FIG. 3a - knitting needles 8, made through the calcaneus, and knitting needles 4, made through the forefoot, with the putative osteotomy line 10 of the cuboid bone, longitudinal knitting needle 5, made through the first metatarsal, first sphenoid, navicular and talus bones;

In FIG. 3b shows the formed distraction regenerate 14 of the cuboid bone;

In FIG. 4 schematically shows the bones of the foot from the outside, where 6 is the line of the alleged osteotomy of the calcaneus; 10 - line of the alleged osteotomy of the cuboid bone;

In FIG. 4a - knitting needles 4, made through the forefoot, knitting needles 8, made through the hindfoot, knitting needles 11, 12, through fragments of the cuboid bone, after its osteotomy;

In FIG. 4b - distraction regenerate 14 cuboid bone and distraction regenerate 15 - calcaneus; 2 - knitting needles held through the lower third of the leg;

FIG. 5 - layout of the apparatus for the treatment of flat-valgus deformity of the foot from the parts of the Ilizarov apparatus.

The method is as follows.

The base annular support 1 of the apparatus is superimposed on the lower third of the tibia on two knitting needles 2. The semicircular support of the apparatus 3 is applied to the forefoot and mounted on one or two knitting needles 4, drawn through the distal sections of the metatarsal bones perpendicular to their longitudinal axis (anterior semicircular support 3) . An external-lateral incision is made of the skin, soft tissues, enveloping the outer ankle, and the talacaneal and talar navicular joints are distinguished. By opening the talon-scaphoid joint, releasing the scaphoid with removal of the articular cartilage, it is removed from the position of the subluxation to the position of normal correction and fixed with a longitudinal spoke 5 held through the first metatarsal, first sphenoid, scaphoid and talus bones (Fig. 3a, Fig. 3b) . The tendons of the peroneal muscle group and the Achilles tendon are lengthened. After preliminary isolation of the talocental joint, reference points are set in the region of the posterior edge of the calcaneus, deviating about 1 cm from the posterior edge of the articular surface of the talocental joint, or 1 cm lower from the posterior process of the talus (processus posterior talu), see FIG. 1. A second landmark is set under the fibula block (trochlea fibilaris), see FIG. 1 at the lower edge of the calcaneus surface. A corticotomy is performed along line 6 formed by these landmarks in a plane parallel to the plane of the talacaneal joint (Fig. 1). The proximal fragment of the calcaneus is fixed with two knitting needles with thrust pads 7 at an angle of 45 °, with fixation to the articular surface of the talus (Fig. 2b). These spokes 7 are fixed in an annular support 1 mounted on the lower third of the lower leg with the help of distraction rods. Through the distal fragment of the calcaneus, one or two knitting needles 8 are parallel to the plantar surface and perpendicular to the lateral surface of the calcaneus and fixed in the posterior semicircular support 9 of the apparatus, taking into account the pathological deviation of the calcaneus. A transverse osteotomy of the cuboid bone 10 is performed (Fig. 1) with fixation of the distal fragment with the spoke 11 held perpendicular to the longitudinal axis of the foot (Fig. 4a, Fig. 4b) and fixed in the posterior semicircular support 9. The proximal fragment of the cuboid bone is fixed with the spoke 12 and fixed in the front semicircular support 3. The wound is sutured in layers. Rubber graduate. The front 3 and rear 9 semicircular foot supports are connected by threaded rods 13 on the remote brackets, while the longitudinal torsion of the foot is corrected. In the postoperative period, the valgus deformity of the foot is corrected by distraction along the external threaded rod of 13 semi-ring supports 3, 9 of the foot with the formation of distraction regenerate of 14 cuboid and 15 calcaneus. At the same time, pronation of the foot is eliminated by distraction along the external threaded rods 16 connecting the annular support 1 and the system of semicircular foot supports 3, 9 with the formation of the distraction calcaneal bone regenerate 15.

Information sources

1. Kh.Z. Gafarov. Treatment of children and adolescents with orthopedic diseases of the lower extremities. Kazan, 1995, Fig. 358. Tab. 25.

2. V.D. Chucklin. Orthopedics, 1956, p. 465-467.

3. Kh.Z. Gafarov. Treatment of children and adolescents with orthopedic diseases of the lower extremities. Kazan, 1995, p. 364-368.

4. RF patent No. 1825624, А61В 17/56, Bull. No. 25, 1993.

Claims (1)

A method of treating flat-valgus deformity of the foot in adolescents, including applying an external fixation apparatus to the foot and lower leg, lengthening the tendons of the peroneal muscle group and the Achilles tendon, resection of the joints of the foot with subsequent distraction on the apparatus, with the calcaneus and forefoot lowering, characterized in that the semicircular supports of the apparatus are imposed parallel to the plantar surface of the calcaneus and metatarsal bones and perpendicular to the lateral surface of the calcaneus and the longitudinal axis of the metatarsal bones with Taking into account the torsion of the forefoot in relation to the hindfoot, a talon-scaphoid arthrodesis is created by removing the scaphoid from the subluxation position, which is fixed with a longitudinal spoke drawn through the first metatarsal, first sphenoid, scaphoid and talus bones, in the normocorrection position, the valgus deformity of the anterior part is eliminated foot osteotomy of the cuboid bone in the middle third, and the pronational and equinus installation of the heel bone is corrected by the osteotomy of the body of the calcaneus, made outside on the plane parallel to the joint gap of the talacaneal joint, the posterior and anterior semicircular supports are connected into a closed ellipsoid frame, which is connected to an annular support superimposed on the middle third of the lower leg by means of rods and hinges that control the formation of a multiplane calcaneal bone regenerate, and the distraction regenerate of the cuboid bone is formed by connecting rods between the front and rear semicircular support.

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