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vraisemblablement des causes familiales. Certains développent cette déformation dès leur plus jeune âge. Il existe une prédisposition féminine.",{"type":186,"children":198},[199],{"text":200,"type":130},"Le plus souvent il s’agit de l’affaiblissement de la capsule articulaire qui ne peut plus lutter contre les contraintes sur le gros orteil. Ces contraintes sont permanentes à la marche et sont accentuées par le port de talon et surtout les chaussures à bouts pointus.",{"type":186,"children":202},[203],{"text":204,"type":130},"Progressivement l’avant pied s’élargi, le gros orteil repousse les orteils latéraux. Une exostose douloureuse survient et « frotte » contre l’empeigne de la chaussure.",{"type":186,"children":206},[207],{"text":208,"type":130},"Lorsque les douleurs sont entêtantes, il est temps d’opérer. Il s’agit du seul traitement efficace pour « redresser » le gros orteil. Cette déviation est irréversible et s’aggravera progressivement. ",{"type":132,"image":210,"children":250},{"ext":211,"url":212,"hash":213,"mime":214,"name":215,"size":216,"width":217,"height":218,"caption":142,"formats":219,"provider":176,"createdAt":249,"updatedAt":249,"previewUrl":142,"alternativeText":215,"provider_metadata":142},".png","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fpied_1_429cbfe2c5.png","pied_1_429cbfe2c5","image\u002Fpng","pied 1.png",104.4,1007,482,{"large":220,"small":227,"medium":234,"thumbnail":241},{"ext":211,"url":221,"hash":222,"mime":214,"name":223,"path":142,"size":224,"width":149,"height":225,"sizeInBytes":226},"\u002Fuploads\u002Flarge_pied_1_429cbfe2c5.png","large_pied_1_429cbfe2c5","large_pied 1.png",363.61,479,363614,{"ext":211,"url":228,"hash":229,"mime":214,"name":230,"path":142,"size":231,"width":157,"height":232,"sizeInBytes":233},"\u002Fuploads\u002Fsmall_pied_1_429cbfe2c5.png","small_pied_1_429cbfe2c5","small_pied 1.png",117.33,239,117325,{"ext":211,"url":235,"hash":236,"mime":214,"name":237,"path":142,"size":238,"width":165,"height":239,"sizeInBytes":240},"\u002Fuploads\u002Fmedium_pied_1_429cbfe2c5.png","medium_pied_1_429cbfe2c5","medium_pied 1.png",234.77,359,234770,{"ext":211,"url":242,"hash":243,"mime":214,"name":244,"path":142,"size":245,"width":246,"height":247,"sizeInBytes":248},"\u002Fuploads\u002Fthumbnail_pied_1_429cbfe2c5.png","thumbnail_pied_1_429cbfe2c5","thumbnail_pied 1.png",33.98,245,117,33978,"2024-08-07T17:13:47.392Z",[251],{"text":180,"type":130},{"type":126,"level":12,"children":253},[254],{"text":255,"type":130},"Interventions",{"type":186,"children":257},[258],{"text":259,"type":130},"ostéotomie SCARF",{"type":186,"children":261},[262],{"text":180,"type":130},{"type":186,"children":264},[265],{"text":266,"type":130},"L’intervention consiste de plus en plus souvent à corriger la déviation osseuse par une coupe osseuse sur le 1er métatarsien qui permet de « resserrer » l’avant pied et de se fait redresser le gros orteil. La correction est maintenue par 2 vis enfouie dans l’os qui sont habituellement laissé définitivement.",{"type":186,"children":268},[269],{"text":270,"type":130},"On réalise une désinsertion de certains tendons qui tractent le gros orteil et risque de pérenniser la déformation. Souvent il est associé un geste osseux sur le gros orteil. (On raccourcit souvent de manière millimétrique le gros orteil, se qui ne change en rien la « pointure »)",{"type":186,"children":272},[273],{"text":274,"type":130},"L’intervention la plus souvent réalisée s’appelle l’ostéotomie de SCARF dont le recul et les résultats en font une intervention tout à fait fiable.",{"type":132,"image":276,"children":293},{"ext":134,"url":277,"hash":278,"mime":137,"name":279,"size":280,"width":281,"height":282,"caption":142,"formats":283,"provider":176,"createdAt":291,"updatedAt":292,"previewUrl":142,"alternativeText":279,"provider_metadata":142},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fpied_2_e418957e02.jpg","pied_2_e418957e02","pied 2.jpg",14.85,241,380,{"thumbnail":284},{"ext":134,"url":285,"hash":286,"mime":137,"name":287,"path":142,"size":288,"width":289,"height":174,"sizeInBytes":290},"\u002Fuploads\u002Fthumbnail_pied_2_e418957e02.jpg","thumbnail_pied_2_e418957e02","thumbnail_pied 2.jpg",4.2,99,4196,"2024-08-07T17:13:46.876Z","2024-08-07T17:15:14.103Z",[294],{"text":180,"type":130},{"type":186,"children":296},[297],{"text":298,"type":130},"D’un point de vue pratique, l’hospitalisation est habituellement en ambulatoire .. L’intervention se déroule sous anesthésie loco régionale (la jambe est insensibilisée) Dans certains cas, il est possible d’effectuer une correction chirurgicale par une méthode percutanée. Cette technique qui évite de faire une cicatrice n’est réalisable que pour les déformations mineures",{"type":186,"children":300},[301],{"text":180,"type":130},{"type":186,"children":303},[304],{"text":180,"type":130},{"type":126,"level":12,"children":306},[307],{"text":308,"type":130},"Les suites opératoires",{"type":186,"children":310},[311],{"text":180,"type":130},{"type":186,"children":313},[314],{"text":315,"type":130},"Le lever est possible  1 à 2 h après l'intervention sous couvert d’une chaussure orthopédique qui permet d’appuyer sur le talon (dite chaussure de Barouk).",{"type":132,"image":317,"children":333},{"ext":134,"url":318,"hash":319,"mime":137,"name":320,"size":321,"width":322,"height":323,"caption":142,"formats":324,"provider":176,"createdAt":332,"updatedAt":332,"previewUrl":142,"alternativeText":320,"provider_metadata":142},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fpied_3_57c8f8c09c.jpg","pied_3_57c8f8c09c","pied 3.jpg",13.15,293,204,{"thumbnail":325},{"ext":134,"url":326,"hash":327,"mime":137,"name":328,"path":142,"size":329,"width":330,"height":174,"sizeInBytes":331},"\u002Fuploads\u002Fthumbnail_pied_3_57c8f8c09c.jpg","thumbnail_pied_3_57c8f8c09c","thumbnail_pied 3.jpg",7.7,224,7695,"2024-08-07T17:13:46.874Z",[334],{"text":180,"type":130},{"type":186,"children":336},[337],{"text":338,"type":130},"Le pansement sera refait 3 jours après tà la sortie. La chaussure est à garder durant 1 mois.",{"type":186,"children":340},[341],{"text":342,"type":130},"Il faut se limiter à de courts déplacements durant les premiers jours et maintenir le pied à l’horizontal en position assise pour éviter son gonflement.",{"type":186,"children":344},[345],{"text":346,"type":130},"Le pied peut rester gonflé durant 2 à 3 mois.",{"type":186,"children":348},[349],{"text":350,"type":130},"La conduite automobile est autorisée à  2 semaines.",{"type":186,"children":352},[353],{"text":354,"type":130},"La durée de l’arrêt de travail sera adaptée à la profession. On compte régulièrement 2 mois d’arrêt pour un travailleur utilisant les transports en commun .",{"type":186,"children":356},[357],{"text":358,"type":130},"Il est fondamental de faire une auto rééducation et de mobiliser les orteils",{"type":132,"image":360,"children":376},{"ext":134,"url":361,"hash":362,"mime":137,"name":363,"size":364,"width":365,"height":366,"caption":142,"formats":367,"provider":176,"createdAt":375,"updatedAt":375,"previewUrl":142,"alternativeText":363,"provider_metadata":142},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fpied_4_6482329c0d.jpg","pied_4_6482329c0d","pied 4.jpg",20.72,400,356,{"thumbnail":368},{"ext":134,"url":369,"hash":370,"mime":137,"name":371,"path":142,"size":372,"width":373,"height":174,"sizeInBytes":374},"\u002Fuploads\u002Fthumbnail_pied_4_6482329c0d.jpg","thumbnail_pied_4_6482329c0d","thumbnail_pied 4.jpg",5.95,175,5950,"2024-08-07T17:13:46.922Z",[377],{"text":180,"type":130},{"type":186,"children":379},[380],{"text":381,"type":130},"L’intervention est fiable et donne régulièrement de bons résultats Les complications sont rares.",{"type":186,"children":383},[384],{"text":385,"type":130},"Le risque infectieux est très limité, et justifie exceptionnellement une nouvelle intervention",{"type":186,"children":387},[388],{"text":389,"type":130},"La déformation peut réapparaître (récidive), mais justifie rarement une ré intervention",{"type":186,"children":391},[392],{"text":393,"type":130},"Il peut survenir également un algoneurodystrophie qui correspond à un gonflement du pied douloureux prolongé, mais systématiquement régressif.",{"type":186,"children":395},[396],{"text":397,"type":130},"Une correction exagérée peut engendrer une déformation dans le sens inverse ou Hallux varus (particulièrement avec les techniques chirurgicales plus anciennes ) ","2024-08-07T17:16:38.217Z","2024-10-18T23:15:21.625Z","2024-08-07T17:17:13.000Z",[402,405,414,418,421,425,429,433,437,441,450,453,457,460,464,468,472,478,482,485,488,492,495,499,505,509,513,517,521,525,529,535,539,543,547,551],{"type":126,"level":6,"children":403},[404],{"text":129,"type":130},{"type":132,"image":406,"children":412},{"ext":134,"url":135,"hash":136,"mime":137,"name":138,"size":139,"width":140,"height":141,"caption":142,"formats":407,"provider":176,"createdAt":177,"updatedAt":177,"previewUrl":142,"alternativeText":138,"provider_metadata":142},{"large":408,"small":409,"medium":410,"thumbnail":411},{"ext":134,"url":145,"hash":146,"mime":137,"name":147,"path":142,"size":148,"width":149,"height":150,"sizeInBytes":151},{"ext":134,"url":153,"hash":154,"mime":137,"name":155,"path":142,"size":156,"width":157,"height":158,"sizeInBytes":159},{"ext":134,"url":161,"hash":162,"mime":137,"name":163,"path":142,"size":164,"width":165,"height":166,"sizeInBytes":167},{"ext":134,"url":169,"hash":170,"mime":137,"name":171,"path":142,"size":172,"width":173,"height":174,"sizeInBytes":175},[413],{"text":180,"type":130},{"type":126,"level":12,"children":415},[416],{"text":417,"type":130},"What are you suffering from?",{"type":186,"children":419},[420],{"text":180,"type":130},{"type":186,"children":422},[423],{"text":424,"type":130},"This very common deformation corresponds to the deviation of the big toe.",{"type":186,"children":426},[427],{"text":428,"type":130},"There are likely family causes. Some people develop this deformity from a very young age. There is a female predisposition.",{"type":186,"children":430},[431],{"text":432,"type":130},"Most often it is a weakening of the joint capsule which can no longer combat the constraints on the big toe. These constraints are permanent when walking and are accentuated by wearing heels and especially shoes with pointed toes.",{"type":186,"children":434},[435],{"text":436,"type":130},"Gradually the forefoot widens, the big toe pushes the lateral toes. A painful exostosis occurs and “rubs” against the shoe upper.",{"type":186,"children":438},[439],{"text":440,"type":130},"When the pain is stubborn, it is time to operate. This is the only effective treatment for “straightening” the big toe. This deviation is irreversible and will gradually worsen.",{"type":132,"image":442,"children":448},{"ext":211,"url":212,"hash":213,"mime":214,"name":215,"size":216,"width":217,"height":218,"caption":142,"formats":443,"provider":176,"createdAt":249,"updatedAt":249,"previewUrl":142,"alternativeText":215,"provider_metadata":142},{"large":444,"small":445,"medium":446,"thumbnail":447},{"ext":211,"url":221,"hash":222,"mime":214,"name":223,"path":142,"size":224,"width":149,"height":225,"sizeInBytes":226},{"ext":211,"url":228,"hash":229,"mime":214,"name":230,"path":142,"size":231,"width":157,"height":232,"sizeInBytes":233},{"ext":211,"url":235,"hash":236,"mime":214,"name":237,"path":142,"size":238,"width":165,"height":239,"sizeInBytes":240},{"ext":211,"url":242,"hash":243,"mime":214,"name":244,"path":142,"size":245,"width":246,"height":247,"sizeInBytes":248},[449],{"text":180,"type":130},{"type":126,"level":12,"children":451},[452],{"text":255,"type":130},{"type":186,"children":454},[455],{"text":456,"type":130},"SCARF osteotomy",{"type":186,"children":458},[459],{"text":180,"type":130},{"type":186,"children":461},[462],{"text":463,"type":130},"The intervention more and more often consists of correcting the bony deviation by a bone cut on the 1st metatarsal which allows the forefoot to be “tightened” and the big toe to be straightened. The correction is maintained by 2 screws buried in the bone which are usually left permanently.",{"type":186,"children":465},[466],{"text":467,"type":130},"Certain tendons which pull the big toe are removed and risk perpetuating the deformation. Often a bony gesture is associated with the big toe. (We often shorten the big toe by a millimeter, which does not change the “size”)",{"type":186,"children":469},[470],{"text":471,"type":130},"The procedure most often performed is called the SCARF osteotomy, the hindsight and results of which make it a completely reliable procedure.",{"type":132,"image":473,"children":476},{"ext":134,"url":277,"hash":278,"mime":137,"name":279,"size":280,"width":281,"height":282,"caption":142,"formats":474,"provider":176,"createdAt":291,"updatedAt":292,"previewUrl":142,"alternativeText":279,"provider_metadata":142},{"thumbnail":475},{"ext":134,"url":285,"hash":286,"mime":137,"name":287,"path":142,"size":288,"width":289,"height":174,"sizeInBytes":290},[477],{"text":180,"type":130},{"type":186,"children":479},[480],{"text":481,"type":130},"From a practical point of view, hospitalization is usually on an outpatient basis. The procedure takes place under regional anesthesia (the leg is numbed). In certain cases, it is possible to carry out surgical correction by a percutaneous method. This technique, which avoids making a scar, is only possible for minor deformities.",{"type":186,"children":483},[484],{"text":180,"type":130},{"type":186,"children":486},[487],{"text":180,"type":130},{"type":126,"level":12,"children":489},[490],{"text":491,"type":130},"The surgical aftermath",{"type":186,"children":493},[494],{"text":180,"type":130},{"type":186,"children":496},[497],{"text":498,"type":130},"Getting up is possible 1 to 2 hours after the procedure under cover of an orthopedic shoe which allows pressure on the heel (called Barouk shoe).",{"type":132,"image":500,"children":503},{"ext":134,"url":318,"hash":319,"mime":137,"name":320,"size":321,"width":322,"height":323,"caption":142,"formats":501,"provider":176,"createdAt":332,"updatedAt":332,"previewUrl":142,"alternativeText":320,"provider_metadata":142},{"thumbnail":502},{"ext":134,"url":326,"hash":327,"mime":137,"name":328,"path":142,"size":329,"width":330,"height":174,"sizeInBytes":331},[504],{"text":180,"type":130},{"type":186,"children":506},[507],{"text":508,"type":130},"The dressing will be redone 3 days later upon discharge. The shoe should be kept for 1 month.",{"type":186,"children":510},[511],{"text":512,"type":130},"You should limit yourself to short movements during the first days and keep your foot horizontal when seated to prevent swelling.",{"type":186,"children":514},[515],{"text":516,"type":130},"The foot may remain swollen for 2 to 3 months.",{"type":186,"children":518},[519],{"text":520,"type":130},"Driving is permitted for 2 weeks.",{"type":186,"children":522},[523],{"text":524,"type":130},"The duration of the work stoppage will be adapted to the profession. There are regularly 2 months of downtime for a worker using public transport.",{"type":186,"children":526},[527],{"text":528,"type":130},"It is essential to do self-rehabilitation and mobilize the toes",{"type":132,"image":530,"children":533},{"ext":134,"url":361,"hash":362,"mime":137,"name":363,"size":364,"width":365,"height":366,"caption":142,"formats":531,"provider":176,"createdAt":375,"updatedAt":375,"previewUrl":142,"alternativeText":363,"provider_metadata":142},{"thumbnail":532},{"ext":134,"url":369,"hash":370,"mime":137,"name":371,"path":142,"size":372,"width":373,"height":174,"sizeInBytes":374},[534],{"text":180,"type":130},{"type":186,"children":536},[537],{"text":538,"type":130},"The procedure is reliable and regularly produces good results. 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