Hallux Valgus Surgery

What is hallux valgus?

Definition and Causes

The hallux valgus, also known as a bunion, is a deformity of the big toe characterized by instability of the metatarsophalangeal joint of the big toe (MTP1) and a separation between the first and second metatarsals called metatarsus varus. This deformity can be congenital or juvenile in patients with a genetic predisposition. The deformity can also be acquired, in which case it is promoted by wearing unsuitable footwear. The morphology of the hindfoot should be taken into account, as a flat valgus foot can encourage the appearance or worsening of a hallux valgus.

Symptoms and Complications

The main symptoms of hallux valgus include :

• A prominent bump on the inner side of the foot at the level of the head of the first metatarsal of the big toe
• Pain and redness around the MTP1 joint called bursitis
• Pain radiating into the big toe and even towards the ankle associated with irritation or compression of the dorsomedial cutaneous sensory nerve
• Difficulty walking and wearing shoes

If hallux valgus is not treated, it can lead to complications such as :

• Deformity of other toes such as claw or hammer toe deformities
• Increased pressure in the plantar pads leading to metatarsalgia, Morton's neuroma, and injuries to the plantar plates
• A breakdown of the forefoot structure

In the most disabling cases, hallux valgus surgery may be necessary to correct the deformity.

Diagnosis of hallux valgus

The diagnosis of hallux valgus begins with a medical consultation with a specialized doctor, such as a podiatrist or an orthopedic surgeon. During this consultation, the doctor assesses your gait, the overall morphology of your lower limbs, the axis of the hindfoot, the morphology of the forefoot, the deformation of your big toe, and any associated lesions related to your hallux valgus.

Medical consultation

The doctor conducts a clinical examination, which includes taking a medical history and performing a physical exam.

The medical history helps to determine the age of onset of the deformity in order to establish whether it is congenital, juvenile, acquired, or even post-traumatic. It allows your surgeon to understand your lifestyle, your professional activity, your sports activities, your footwear habits, your degree of pain or functional discomfort, as well as your expectations regarding the results of any potential surgical intervention. It also helps to identify your medical and surgical history.

The physical exam is performed first while walking and then while lying on an examination table.

Additional tests

Additional tests are always necessary to confirm the diagnosis and accurately assess the deformity. Among these tests are:

• Weight-bearing X-rays of the ankles: routinely performed during the first consultation, these X-rays allow analysis of the ankle's morphology, especially the hindfoot.
• Weight-bearing X-rays of the foot: these allow assessment of the deformity by measuring the intermetatarsal angle, the metatarsophalangeal angle, the alignment of the sesamoids, the orientation of the articular surface of the first metatarsal (DMAA), and the precise length of the first metatarsal.
• Ultrasound is used to measure the size of the plantar nerve in cases of associated Morton’s neuroma.
• MRI is not performed in routine practice.

Non-surgical treatment of hallux valgus

Orthoses and Adapted Shoes

The non-surgical treatment of hallux valgus mainly consists of using orthoses and adapted shoes to reduce pain. Orthoses are medical devices that help maintain or modify the position of the foot, while adapted shoes are designed to provide extra support and comfort.

Medications and Podiatry Care

Anti-inflammatory medications, such as NSAIDs (non-steroidal anti-inflammatory drugs), may be prescribed to relieve pain and inflammation. Podiatry sessions may also be recommended to care for your feet and to maintain mobility and strength in your toes. These non-surgical treatments are generally preferred when the deformity causes only minor disability.

Hallux valgus surgery

The hallux valgus surgery is a surgical procedure aimed at correcting the deformity of the big toe. Here are some important points to consider :

Indications and contraindications

• Indications : persistent pain, difficulty walking, difficulty wearing shoes.
• Contraindications : severe vascular and neurological problems, ongoing infection.

Surgical techniques

• Osteotomies : Osteotomies are systematically performed on the first metatarsal, and sometimes on the first phalanx of the big toe. Tissue release and retension maneuvers are not sufficient.
• Arthroplasties : Arthroplasties are performed on the lateral toes to correct a  claw toe for example.
• Arthrodesis : Arthrodesis consists of fusing the metatarsophalangeal joint to stabilize the big toe. It is used for old, stiff deformities, with significant cartilage damage and joint deformities.

Recovery and postoperative rehabilitation

It is important to allow sufficient time for recovery and rehabilitation to achieve a good functional outcome.

The first few weeks are characterized by :

• Rest and elevation of the foot to reduce swelling.
• Wearing a specific shoe to protect the foot and promote healing.

Rehabilitation with a physiotherapist can be started 3 to 6 weeks after the procedure to regain optimal mobility.

In summary, hallux valgus surgery helps relieve pain and improve patients' quality of life. It is important to consult a specialist to determine the appropriate treatment for your foot and, if surgery is needed, it is in your best interest to follow postoperative instructions carefully.

The Foot Clinic: expertise and care

The Foot Clinic specializes in treating foot problems, including hallux valgus surgery. It offers comprehensive care thanks to:

Specialized medical team

• Doctors who are experts in foot surgery
• Physiotherapist specialized in postoperative rehabilitation
• Osteopaths to correct muscular compensations after ankle or foot surgery
• Podiatrist for overall follow-up of foot problems

Cutting-edge technologies and equipment

• Use of innovative surgical techniques

Personalized support

• Pre- and postoperative follow-up tailored to each patient
• Rehabilitation advice and care for optimal recovery

Thanks to these elements, the Foot Clinic offers comprehensive care to effectively treat hallux valgus problems and ensure optimal recovery.

Testimonials and Results

Patient Testimonials

Many patients who have undergone a hallux valgus surgery report a significant improvement in their quality of life. They notice reduced pain and better mobility.

Success Statistics

According to studies, hallux valgus surgery has a high success rate, with over 90% of patients satisfied. Nevertheless, it is important to choose a specialized surgeon and strictly follow postoperative instructions to achieve the best possible results.