Open operation using walk1 and walk5
After the foot correction surgery, medicated and bandaged the foot, the post-operative course begins. A period of convalescence during which a fundamental biological healing process must be carried out: the callus. In fact, once the metatarsal has been interrupted and moved to the desired position, it is kept in the correct position only by the particular interlocking geometry of the osteotomy, which gives it stability, especially under load (with the patient standing) and by a screw, which can be in titanium or in resorbable materials, such as polylactic acid or calcium triphosphate. The callus is still missing, which welds the two parts of the metatarsus interrupted, moved and added in a more effective and stable way. For the formation of a callus, which gives the correction a certain strength of cohesion, it takes at least twenty days for this reason EBi shoes are designed to leave the foot in a static position.

In these three weeks, the extravasated blood proteins first organize themselves into collagen fibers of fibrin and these, in turn, unite to form shoots of thick and tenacious connective tissue, which acts as a powerful glue between the two additional bone surfaces. . A fibrous bone caul is thus formed, not yet as robust as healthy bone, but sufficient to be able to walk in EBI shoes with Double Fit Insoles and to support and activate the big toe again.

The recommendations of the orthopedist given to the patient in the postoperative immediate are now clearer: a few hours after the operation, once the effects of the anesthesia have ended, it is already possible to place the foot on the ground and take a few steps with a elephant hoe walk, if necessary to go to the bathroom. The small screw that holds the correct metatarsal together and the particular geometry of the osteotomy, self-stabilizing, give the correction just obtained such stability as to allow the first steps even in the total absence of callus.

As a precaution, the patient is however made to wear a post-operative shoe that is designed in such a way as to keep the forefoot and therefore also the operated big toe off the ground. These are our EBI shoes, equipped with a sole that allows only the support of the heel and the sole and which in fact does not allow the big toe to give weight to the toe. A shrewdness that helps to walk without excessively stressing the operated part. The patient must therefore equip himself with this shoe by purchasing it at our site and must have his own number, it is not necessary to abound because the shoes have been designed for feet both after surgery and after about 20 days (following the doctor’s instructions), so order the normal number you wear, because the protective bandage is bulky and takes up a certain space, but the double fit system avoids the purchase of 2 shoes. Before putting on the shoe and taking the first steps, however, you must wait a few hours.

after the operation the foot is bandaged
When the patient leaves the operating room, he is stretched out and pushed by a nurse on a mobile bed and still has his foot and leg completely asleep from anesthesia.

The patient is accompanied to his room and transferred from the mobile gurney to his bed. The patient is perfectly alert, cooperative and Once the radiological evaluation has been completed, he does not feel any pain in the operated part, but he is still strictly forbidden to get out of bed, even just to go to the bathroom. In fact, anesthesia not only numbs and removes sensitivity to the part, but also blocks the motor commands to the leg and foot. Therefore, the patient, as long as he suffers the effects of anesthesia, is unable to feel the support of the foot on the ground, nor to command the foot to support himself and would risk a ruinous fall to the ground with the possibility of hitting and compromising the alignment of the big toe.

The duration of anesthesia depends very much on the amount of local anesthetic with which the nerve has been blocked, on the type of local anesthetic used (usually 10 cc of chirocaine or naropine are used) and on the individual metabolic capacity to dispose of the drug. Normally anesthesia lasts from a minimum of 4 hours to a maximum of 24 hours and is scheduled by the anesthetist, also based on the type of hospitalization performed. In fact, if a day surgery has been planned for the patient and is discharged the same day, the quantity of anesthetic administered will be more modest and the type of anesthetic used chosen from among the molecules that have a shorter duration of action, in order to allow the patient early autonomous mobility, to get on and off the car that will take him home.

On the contrary, in the case of ordinary hospitalization, lasting one or two days, the anesthetist will provide a long-lasting anesthesia, in order to leave the part asleep for as long as possible. Normally, even when the foot wakes up, there are no excruciating and unbearable pains, more commonly the patients I have operated on report a feeling of swelling and soreness, as if due to the presence of a large bruise. However, to cover any pain, a prophylaxis against pain is routinely performed by administering, into a vein, some pain-relieving drugs with an elastomer system.

Subsequently, once at home, the patient can take other painkillers as needed, but, in most cases, patients report well-being and that they have not had the need to resort to any painkiller treatment. In addition to painkillers, the discharge sheet that is given to each patient at the time of departure also specifies drugs for prophylaxis against vascular complications such as phlebitis and thrombophlebitis. These are low molecular weight heparins that have the function of making the blood more fluid and less coagulable.

in addition to drug prescriptions, also useful recommendations: keep the foot raised in an antideclive position, when walking is not essential and apply and intermittent cryotherapy. The first recommendation is to prevent the foot from swelling excessively. In fact, the operated part, already in conditions of rest, tends to swell due to edema and the accumulation of liquids exuded in the tissues and if in addition to this normal physiological phenomenon, the difficulty of venous circulation that the foot develops over the days is added. immediately following the surgery, this explains the recommendation to keep the foot raised at the height of the heart to favor the venous return from the periphery to the central circulation. The second recommendation concerns the application of ice on the operated part at intervals during the day: 20 minutes, 4-5 times a day, the recommended treatment to have a valid anti-edema and pain-relieving action, thus reducing the possible intake of pain-relieving drugs.

1st post-operative check-up with the specialist on the 15th day (do not dress, do not remove and do not wet the bandage) This last note means that it is not necessary to dress or check the part before two weeks after the operation in good agreement with the North American guidelines that consider the dressings of a sterile surgical wound a potential source of bacterial contamination. Only after two weeks, in fact, the patient goes to the orthopedist to remove the bandage to evaluate the results of the operation. On this occasion the patient does not have to fear any pain for the removal of the suture, because the stitches were given in a woven and absorbable material, which at the time of the visit fall without trauma, simply by dabbing the surgical wound, now healed, with a gauze pad. soaked in a common disinfectant. A patch or, depending on the case, a light bandage are applied to protect the part for a further week as well as the use of the EBI shoe is recommended until the twentieth day after surgery without the 1 + 2 insole.
AAfter twenty days, in fact, the patch and bandage can be removed and the foot normally washed with warm water and amuchina, to finally cleanse the foot. The EBI shoe is used with the addition of the insole 1, it is not necessary to purchase footwear of a larger number as in the past with the use of specific footwear only for use after the operation in the first about 20/30 days (following the doctor’s instructions), moreover if the foot is still swollen, EBI footwear with insole 1 can always be used, without insole 2 for both feet until the foot, which is still slightly swollen, is not deflated.
These shoes must be worn for about a month with insole 1, as long as the foot does not completely dry out of the post-operative edema, then we can insert the insole 2 and freely wear these shoes as long as desired.
Physiotherapy is not normally provided to promote the recovery of the function of the big toe and the normal gait pattern, as long as the recommendations of the specialist are followed: after the first twenty days after the operation, it is necessary to walk in EBI shoes and to articulate the step scheme giving full support to the operated big toe. In other words, the protective and analgesic attitude that induces the patient to avoid articulating the big toe and making him perform his work of levering and pushing in the final phase of the step must be absolutely avoided. Incorrect support in supination (support on the lateral part of the foot) with poor activation of the long flexor tendon of the big toe (the one that plantarly flexes the finger to give the push to step) is frequently observed in those who have been operated on for a few weeks. In these patients, if the step is not immediately corrected, the development of pain and edema from exertion on the lateral part of the ankle and a certain stiffness of the big toe for the development of joint adhesions are observed. Unfavorable effects on the regular post-operative course, which however can be easily canceled, by showing the patient some simple exercises for mobilizing the big toe and indicating the correct gait pattern, during the second check-up visit, which is generally fixed 30 days after the operation (following the doctor’s instructions). A third post-operative check-up is usually fixed three months after the operation with radiographs performed in two projections (dorso-plantar and lateral) under load (standing) to ascertain the healing of the foot, the recovery of correct walking and a physiological plantar support. The radiographs at this point not only show the transformation of the fibrous callus into real bone, but also the remodeling that the metatarsal has undergone following the new lines of force and load that have almost erased the traces of the previous surgery and osteotomy . If all the post-operative timing is not delayed and the patient respects all the recommendations of the orthopedist, the return to normal walking is expected after twenty days from the intervention, the driving of the car on the 25th day, the return to sedentary work activities after 30 days (following the doctor’s instructions) and heavy ones or with safety shoes after 45 days. Sport, on the other hand, is allowed in the gym and for activities that do not involve jumping and running after only 30 days, while for football, running and athletics it takes 3 months to wait for the metatarsal to recover the necessary strengthEBI shoe is used with the addition of the insole 1, it is not necessary to purchase footwear of a larger number as in the past with the use of specific footwear only for use after the operation in the first about 20/30 days (following the doctor’s instructions), moreover if the foot is still swollen, EBI footwear with insole 1 can always be used, without insole 2 for both feet until the foot, which is still slightly swollen, is not deflated.
These shoes must be worn for about a month with insole 1, as long as the foot does not completely dry out of the post-operative edema, then we can insert the insole 2 and freely wear these shoes as long as desired.
Physiotherapy is not normally provided to promote the recovery of the function of the big toe and the normal gait pattern, as long as the recommendations of the specialist are followed: after the first twenty days after the operation, it is necessary to walk in EBI shoes and to articulate the step scheme giving full support to the operated big toe. In other words, the protective and analgesic attitude that induces the patient to avoid articulating the big toe and making him perform his work of levering and pushing in the final phase of the step must be absolutely avoided. Incorrect supination support is frequently observed in those who have been operated on for a few weeks