Path of Medicine With a System

Where was the first metatarsophalangeal joint? It was actually quite simple: the point where the big toe was connected to the foot was where this joint was. On the hand, the thumb’s functions were the most numerous and most important. It was the same for the big toe of the foot as this joint was a highly active one.

People who injured the first metatarsophalangeal joint were either fat or professional sports athletes. People who were fat would cause the joint to suffer too much pressure from the weight, while athletes would typically suffer sports-related injuries. However, there was also one group of normal people who weren’t overweight that would often injure this joint: women who really liked to wear high heels, especially the really tall high heels. Although such high heels would make them seem tall and beautiful, the tall high heels were really good at destroying the metatarsophalangeal joints.

This was because wearing high heels would increase the pressure on the metatarsophalangeal joints and keep them extended in an unnatural position for long periods of time. The ligament between the metatarsals would become loose, the transverse arch would collapse, and the metatarsals would sink. The plantar digital nerve was also located here, so too much pressure on this nerve could easily cause a neuroma as time went on. Additionally, since the heel was too tall, not only would it cause the transverse arch’s collapse and the metatarsals to sink, it would also pressure the arteria digitorum pedis artery located next to the plantar digital nerve, which could cause arterial occlusion, leading to lack of blood, lack of oxygen, and fibrosis in the plantar digital nerve.

This was no exaggeration at all. The first metatarsophalangeal joint was a highly important joint in the foot that would be quite difficult to treat after it was injured. Moreover, injuring this joint was actually a slow process occurring over time. A sudden injury could still be treated with surgery, but a long-term injury would first damage and destroy the vascular bed and nerves in the feet before the bone would be damaged. Basically, when a woman started feeling pain from wearing high heels too much, she would have already severely damaged her joints and the nearby soft tissue and bone.

If this problem was noticed and treated too late, then she would have permanent fiery pain in her toes for the rest of her life, along with a strong numbness on the bottom of her feet. It would be easy to imagine how uncomfortable this would feel. Even if this problem was discovered and treated early, it would still be highly troublesome.

There were two treatment methods: surgical and non-surgical.

The non-surgical method was to have the woman wear flat shoes and place something under her big toe to help it stretch as straight as possible. Just imagine how difficult it would be to forcefully straighten a bone which had become curved already. Not only would this be difficult, it would also be incredibly painful. Why would a woman feel pain if she wore high heels for an entire day? That was because her joints were beginning to distort from too much pressure for the whole day. Thus, if you love your woman, please take off her high heels!

The black basketball player was hospitalized. He was more than two meters tall, and weighed well over 100 kilograms. Normal hospital beds would be far too small for him. There wasn’t enough time to custom order a larger bed for him, so he could only do his best to fit on the small hospital bed. Two large chairs were added to the end of the bed so that the black basketball player could actually stretch himself flat on the bed.

The black basketball player had undergone many very detailed checkups already quite recently, so there was no need to undergo additional checkups. The surgery was scheduled immediately as that was what Mrs. Wang wanted. To her and the rich basketball team owner, time was money—the faster the black basketball player recovered, the earlier he would be able to start playing again.

The metatarsophalangeal joints were quite small joints in the human body. However, if these joints were injured, regular orthopedic surgeries would only be able to alleviate the symptoms and decrease the pain. Restoring them to normal condition would be asking for far too much. Many basketball players would be forced to retire after injuring these joints.

“We’ll use a dorsal incision and start repairing after the incision. Prepare for the surgery now. Old Chen, inform the patient about the procedure and obtain his signature of consent for everything.” Zhang Fan immediately made a surgical plan.

Chen Qifa seemed rather cute as he exclaimed, “I, I don’t know any English!”

“Haha, Mrs. Wang knows English, so you can just tell her and have her translate for you!”

“Right, right, right, I forgot about that!” Chen Qifa immediately went to go find Mrs. Wang. The black basketball player really didn’t want to have surgery at such a trifling-seeming hospital, but he had no choice. He was already past peak performance age. It was already quite good for him that there was still someone willing to pay for his basketball skills, so he had to obey whatever the team owner said.

The surgery began. The anesthesiologist added extra anesthesia due to the black basketball player’s weight. “Doctor Zhang, he’s really thick and heavy, so I didn’t dare to give too much extra anesthesia. That’s why the anesthesia might not be very effective. If things really don’t work, you can add some extra local anesthesia.” The anesthesiologist had never treated someone so large before, so he was feeling unconfident.

“Okay!” Zhang Fan glanced at the black basketball player’s body, which really was so large and thick. He was also so black that he would seem invisible if the lights were turned off and he kept his eyes and mouth closed.

“Doctor Zhang, do you think he’s also black underneath his skin?” Li Liang commented while grabbing onto the black basketball player’s large toes.

“Probably not. The epidermis is likely black, but everything under the epidermis is the same as us.” This was also Zhang Fan’s first time to perform surgery for a black person.

“Begin! The anesthesia is ready,” said the anesthesiologist.

Li Liang began the disinfection and draping. Zhang Fan and Li Liang then began the surgery after everything was ready, while Song Bing acted as the operating room nurse. Zhang Fan sighed as he looked at the black man’s distorted toes. Although it seemed really cool to be a professional sports player, ordinary people wouldn’t understand the hardships that they went through.

Although the black man wasn’t a first-rate basketball player, his toes had become rather distorted due to his heavy training and exercise routine in combination with his heavy weight. Even though each of his toes was really large and thick, they seemed like they were an old man’s toes as they were really curved.

“Look here. His second and third toes have obviously been fractured several times. There’s already been compensation thickening,” Zhang Fan told Li Liang after observing the patient’s toes.

“It’s not easy for basketball players to make money.” Li Liang separated the big toe, which had been rather difficult to do with how thick it was—it was about as thick as a two-year-old child’s wrist.

“Nobody has it easy. Who actually has it easy in life?” interjected the anesthesiologist.

The surgery began as Zhang Fan used a small scalpel to gently open up the skin. This scalpel was incredibly sharp. In the early days, scalpels would be reused many times, but modern-day scalpels were single-use only. Although the modern scalpels were really sharp, they had low durability as they would become dull after being used to cut through skin just a few times.

“For this surgery, it’s really important to decrease damage to the blood supply system. His injury has already damaged a large portion of the vascular bed. In order to allow him to continue vigorously exercising in the future, it will be necessary to preserve what’s left of the blood supply system,” Zhang Fan explained while gently avoiding the dorsal artery and using the scalpel handle to separate the flexor hallucis brevis.

In surgery, not all exposed areas would require a scalpel. For instance, the skin required a scalpel to be as sharp as possible, but in the muscle layers, the surgeon would usually use either their fingers or the scalpel handle for separation. Muscles would be even more important for professional athletes. It would indeed be possible for muscles to recover after being cut with a sharp object, but that would form scar tissue which would permanently affect power output and stamina afterwards.

This was why functional joint surgeries for professional athletes were so hard to perform. If a normal person had such a joint injury, the surgeon would only need to restore functionality, correct the distortion, and eliminate the patient’s pain since that person wouldn’t need to push themselves to the very limit with vigorous exercise. As for some unimportant blood vessels? The surgeon would ligate whatever was possible without needing to pay special attention to the joint capsule. It would be alright to let things heal with scar tissue.

However, if a surgeon gave a professional athlete the same treatment, although this would indeed remove their pain, it would also end their career as a professional athlete. This was why many professional teams would have their personal team orthopedic joints surgeons. Top-level orthopedic joints surgeons would be capable of damaging the body minimally while helping the joint recover.

While Zhang Fan had only opened up Level 1 microsurgery courses in his System, which only taught him slightly more than half of the different types of microsurgery, Zhang Fan was far too much of a grinder who had already practiced the available surgery types countless times in his System already. He already had a 3-D mental image of the metatarsophalangeal joints mapped out in his mind.

Zhang Fan slowly separated the inflamed metatarsal tissue with his forceps and rinsed with saline solution. This surgery wasn’t particularly dangerous, but had a very high requirement for the surgeon’s knowledge of joints and precise movements.

In surgery, movements needed to be as few as possible. For instance, when in the joint capsule, a curette could only be used once to clean out the inflamed tissue as a second time would cause even more damage. This would be a complete test of a surgeon’s overall ability in how well they could manage their movements.

Zhang Fan began the repairs after cleaning out the inflamed tissue. Such exquisite repairs would be impossible for ordinary doctors, along with being unnecessary. However, this would be really necessary for the professional athletes. In America, there were less than 20 top-level orthopedic joint surgeons. Moreover, the doctor’s getting slightly older would make it impossible for them to perform such a surgery anymore, so the surgery fee was also really expensive.

“Doctor Zhang, why are you moving diagonally for this repair?” Li Liang didn’t understand, since the physiological position shouldn’t have been diagonal. However, Zhang Fan didn’t respond, as this was the most critical moment of the surgery which would determine its success or failure.

Zhang Fan held his breath as he did his very best to steady his hands while gently repairing. He made four movements in succession before he finally heaved a long sigh of relief! He had finally managed to repair the distorted and scarred muscle.

More than three hours had passed since the start of the surgery. This was how precision surgeries were; they really took a lot of time.

Zhang Fan waited for his breathing to calm down before he told Li Liang, “The diagonal movements are a consideration for his weight and job, that will make things more solid.”

“Oh!” Li Liang was still rather confused even with Zhang Fan’s explanation as he hadn’t performed enough surgeries to understand this.

“Electric drill, Kirshner wires,” Zhang Fan told the medical equipment nurse. Meanwhile, Song Bing was incredibly bored. This entire surgery had been performed under the microscope, so he couldn’t see anything at all. Zhang Fan opened up small holes with the electric drill and used the Kirshner wires to solidly affix the joint.

“Create a cast. The cast must be maintained for four weeks. Even one day less won’t do,” Zhang Fan informed Li Liang and Song Bing.

“Alright!” The surgery thus ended. Mrs. Wang and the black basketball player’s black friends had almost fallen asleep waiting outside the operating room! When Zhang Fan and the others spent a great deal of effort to somehow push the black basketball player out of the operating room, his black friends surrounded him happily and kept chatting in English. Even though Zhang Fan had learned English for quite a while, he still couldn’t understand what they said!

“Doctor Zhang, thank you for your hard work.” Mrs. Wang was looking expectantly at Zhang Fan.

He knew what she meant as he removed his surgical mask and smiled. “The damage was rather severe, but it’s all been repaired successfully. The rest will depend on his own body’s recovery. We’ll know more after four weeks. He should be able to start playing basketball again in the future.” Zhang Fan hadn’t dared to guarantee anything before the surgery, but things were different now that the surgery was over.

He was simply that confident in himself because of all the hard work and sweat that he had put in through his System!