Hallux Valgus Correction

Hallux Valgus Correction characteristics

A popular term "hallux" is defined as a foot defect, the medical name of which is "hallux valgus". The disadvantage is that the head of the first metatarsal bone moves towards the inside of the foot, while the toe is moved towards the reverse, i.e. towards the outer edge of the foot.
Sometimes the deformed toe can even be placed under the other toes of the foot. This problem is, contrary to appearances, quite frequent, because according to statistics around the world, there may be up to 35% of all people suffering from this disadvantage. Crooked palpitation is a deformity whose incidence increases with the age of patients - the highest prevalence of this defect is observed in the elderly, however, it may also appear in relatively young patients.
Hallux valgus is affected by factors that patients have absolutely no influence on, as well as those whose presence depends directly on patients. The first of these can include, for example, gender - women more often face this disadvantage because their soft tissues (compared to male representatives) are characterized by greater flexibility and have an increased tendency to appear in their deformations. Another other unmodifiable factor associated with the appearance of hallux valgus is genetic strain - the defect has a tendency to occur in the family.
In the case of modifiable risk factors of hallux valgus, the most important should be wearing the wrong footwear. This applies above all (and perhaps even only) women - high heels and those that have a narrow front, definitely favour the appearance of this disadvantage. This is due to the fact that in the case of this type of footwear is set in a non-physiological position. Wearing such shoes can thus lead to permanent setting of the foot in the wrong way, which can result in the occurrence of deformation in the form of hallux valgus.
Crooked mumps, as mentioned earlier, occur in both young and old patients. Both groups of patients can be recommended for conservative treatment as the first method of treatment, however, it should be emphasized that only in young patients it is possible to regress deformations by this way. This is due to the fact that correction of the defect by conservative treatment is possible as long as the foot tissue has not completed development processes. It is in this situation that special insoles or corrective footwear can allow the current deformations to reverse. In older patients, these conservative techniques, along with the use of pharmacological treatment (e.g. anti-inflammatory drugs and painkillers) and physical therapy aim to relieve hallux-related symptoms and not to reshape deformity.
It has already been mentioned that conservative treatment is usually the first method of treatment that is implemented in patients who have a crooked toe. However, such a procedure may, after some time, cease to bring any results, and the defect may simply get worse over time. In such a situation, patients can be offered more invasive, but at the same time bringing much better treatment results - speech about surgical correction of hallux valgus (hallux).

Hallux Valgus Correction benefits

Corrective treatment of hallux valgus is the only (excluding patients at an early age) method that allows to obtain a permanent correction of foot defects existing in patients. Thanks to the surgery, it is possible to correct the appearance of the foot as well as to relieve the associated hallucinations. Patients after hallux valgus surgery may stop struggling to walk, and it is possible that their problems with the selection of footwear will disappear.

Indications for the procedure

Hallux valgus correction is indicated primarily in those patients in whom the use of conservative therapy is not effective and patients suffer from the presence of this foot defect. The symptoms of hallux valgus can be:
• difficulty while walking,
• regular pain in the foot,
• foot deformities (leading to the fact that it is difficult for the patient to choose shoes where he will not experience pressure on the fingers),
• inflammation within foot structures,
• significant thickening of the epidermis (especially in the area of ​​the sole of the foot, occurring as a result of prolonged pressure - the patient with hallux valgus, to relieve the forefoot, can set the foot mainly on the heel during walking).

It should be noted that correction of hallux valgus is not performed for purely aesthetic reasons. After all, this is an operation that (just like any other surgery) carries some, although in the discussed case, a small risk. Treatments are performed primarily when the crooked pal itself leads to various types of ailments that cannot be alleviated by other, less invasive methods of treatment.

Contraindications for the procedure

The prognosis after the procedure primarily affects whether the patient's circulation within the lower limb functions properly and whether the blood flows through these areas without disturbances. Any conditions that impair blood flow in this part of the body could increase the risk of post-operative complications, as well as worsen the effect of the surgery (due to, for example, slowing the healing rate of the operated bones). The main contraindications for hallux valgus correction are therefore:
• peripheral artery disease,
• diabetic foot,
• peripheral polyneuropathy.

This is a rare situation, although the operation may also be contraindicated in those patients in whom (due to their different disease burden) it is not possible to introduce these patients into anaesthesia.
Careful treatment is required in patients suffering from rheumatoid arthritis and those with degenerative changes in joints of a different ethology - this may affect the choice of hallux valgus surgery.

Before the surgery

A consultation takes place before correction of the hallux valgus. Its aim is first of all to assess the degree of deformation existing in a patient - on this basis, it is possible to plan what method the procedure will be used. The X-ray of the foot is helpful in determining the treatment plan - such a patient may already have with him during the consultation, if the patient does not have one, the examination is usually ordered before the procedure.
It is very important that the patient with whom the hallux valgus correction is to be performed is in a good general state of health. Sometimes it may turn out that before the operation can be performed, it will first be necessary to stabilize the patient's condition (e.g. alignment of the carbohydrate metabolism in a patient with diabetes or normalizing the level of thyroid hormones in a patient with hypothyroidism). The patient is not always aware of any disturbances, which is why before the surgery he may be asked to perform basic tests, such as blood laboratory tests, general urine tests, ECG and chest X-ray.
During the consultation, the patient is asked not only about their medical conditions, but also about what medications he is taking regularly. This question is important both because the formulations used by the patient may affect the choice of anaesthesia, and because it may be necessary to discontinue some of the drugs for a short time before surgery. The second of these may relate primarily to agents that reduce blood clotting - their withdrawal may be necessary in order to reduce the risk of bleeding during and after surgery.

Type of anaesthesia

Hallux valgus correction is performed under spinal or local anaesthesia - the choice of anaesthesia method depends on both the technique that the operation will be performed and the general state of health of the patient.

How does the procedure work?

The course of hallux valgus correction varies and depends on the surgical method chosen. Regardless of the technique, before any intervention is taken, patients are first anesthetized - the purpose of this procedure is to make the patient to be as comfortable as possible.
The following are applicable in the surgical treatment:
• osteotomy treatments, consisting of cutting the metatarsal bone, eventual removal of unnecessary bone fragments and subsequent stabilization of the bones in the correct position (special plates and orthopaedic screws may be used for this purpose),
• stiffening of the big toe,
• manoeuvres taking place within the metatarsophalangeal joint (referred to as plastic surgery of this joint),
• correction of the tendons and ligaments of the foot (mainly used in patients whose crooked mump has existed for many years, which led to the occurrence of fixed defects within these elements of the foot).

The entire correction treatment of hallux valgus usually takes about an hour. After its completion, a dressing is put on the foot - in the past gypsum was put on the operated area, nowadays it is less and less used.

Time and course of convalescence

Hospital stay after correction of hallux valgus usually takes a day, however, this time can be extended. After the surgery, the patient has to save his foot, so he should take care of someone to bring him home before he arrives at the hospital. Walking is possible even one day after the surgery, however, it should be remembered that during this time supporting is possible only on the heel. Patients can help with the use of special orthopaedic footwear.
When it comes to the seams created during the surgery, sometimes it is not necessary to remove them - this is the case when their soluble forms are used. In situations where other forms of stitches are used, they are usually removed within 7-14 days after surgery.
Correction of hallux valgus is an operation after which it is necessary to take leave at work. The time of such leave depends on the profession being performed by the patient - in the case of people who do light work, it may be possible to return to it after about three weeks after the surgery, if the patient's professional duties are related to, for example, taking a position standing for a long time, you may find it necessary to rest for 6, sometimes even 8 weeks. For the anticipated length of absence at work it is best to ask the doctor carrying out the procedure.

Effects after surgery

The result of hallux valgus correction is usually visible immediately after surgery. However, the appearance of the foot may be disturbed in the short period after surgery due to the existence of a swelling of the foot that persists for several days after the procedure. The wound itself usually heals after two weeks, and bone adhesion takes about 4-6 weeks. After this time, it is possible to see the final results of hallux operations.
In scientific studies, in which the patients' satisfaction with the operation of hallux valgus has been assessed, it turned out that even 85% of the operated patients were satisfied with the results, while the remaining 10% were satisfied.

Recommendations after the procedure

After corrective surgery of the hallux valgus, saving the operated foot is the most important. You can walk quite fast, because even after an hour after the surgery, however, you should do it while supporting yourself not with your entire foot, but with your heel. Patients can be instructed to use orthopaedic crutches or special orthopaedic footwear. The main limitations are valid for 4-6 weeks, which is the time when healing of the operated bones gradually occurs. After this period, the patient may start wearing ordinary shoes, however, it should be emphasized that shoes should be as comfortable as possible and that it would be best if they were with a wide sole.
On the foot after the treatment there is a dressing. Before a patient leaves the hospital, the doctor makes recommendations as to how often the dressing should be changed - this should usually be done on a daily basis. For about 7 days (until the wound is dry) the patient should avoid soaking of the operated foot.
Patients also receive the recommendation to lift the limb as much as possible from the operated level above. This is mainly aimed at preventing the appearance of oedema within the corrected foot.
After the procedure, patients may experience various pain levels for several days. To exercise them, it may be advisable to use over-the-counter painkillers.

How long do the effects last after the treatment last?

The hallux valgus correction effect is permanent. However, it should be emphasized that can convert - such a risk exists when the patient will still have factors that increase the risk of this condition, such as the very frequent wearing of high heels.

How to avoid complications after the procedure?

In order to avoid the complications of the hallux valgus correction, patients should first and foremost follow the instructions given for postoperative procedures. Raising the limb will reduce the risk of oedema, while proper care of the wound and changes in the dressing as recommended will result in minimal risk of infection. Walking after surgery reduces the risk of life-threatening complications such as pulmonary embolism and deep veins thrombosis of the lower limbs.
Patients are also made aware that if they had any significant discomforts (such as severe redness of the skin in the area undergoing surgery, significant pain which persists despite the use of drugs or high fever), they should urgently report to the doctor. Strong ailments may suggest, for example, the development of infection, but if the treatment of such a condition is quickly implemented, then the risk of more serious complications (such as, for example, bone union disorders) will be significantly reduced.

Possible complications after the procedure

As with any other surgery, also after the correction of hallux valgus various complications may appear. Potential complications of the discussed operation may be:
• disorders of union of operated bones,
• formation of a hematoma in the operated area,
• significant swelling of the operated foot,
• nerve damage within the foot,
• necrosis of operated tissues,
• limitation of joint mobility,
• infection of operated tissues.
Complications not specific to hallux valgus correction but also possible to occur are deep veins thrombosis of the lower limbs and pulmonary embolism.

Recommended additional treatments after the procedure

Patients who have undergone hallux valgus correction, may be required to use the services of a physiotherapist. Early implementation of exercises can make the patient get faster within the rate and maximize the effects of surgery.

Author: Tomasz Nęcki, MD
Literature:
Nikolaus Wulker, Falk Mittag, The Treatment of Hallux Valgus, Dtsch Arztebl Int. 2012 Dec; 109 (49): 857-868; Orthopedics and traumatology, Handbook for medical students, T.S. Gaździk, ed. PZWL, 295-296; Gi Won Choi et al., Sex-Related Differences in Outcomes after Hallux Valgus Surgery, Yonsei Med J. 2015 Mar 1; 56 (2): 466-473
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