Surgical Correction Guide for Hallux Valgus

1-When to correct your hallux valgus?

There is no obligation to undergo surgical correction of hallux valgus (bunion) unless it has lost its support strength and begins to be associated with other toe pathologies, and metatarsalgia (pain and/or burning sensations under the forefoot). Some hallux valgus cases are very deformed but completely painless. It is generally not recommended to operate on a foot that does not hurt.

Surgical correction of hallux valgus is a functional procedure, its objective is to improve your pain while preserving the mobility of the big toe, called "hallux." The decision to have surgery is yours and depends on your level of disability. Regardless of your age, gender, and activity level, the goal of this procedure will be to improve your quality of life.

The procedure will help relieve pain in your joint, improve your functional performance, and put an end to pain treatments. In some cases, it may also relieve you if you have pain in other joints of the foot and/or ankle.

You will be the main actor in your recovery; we will be by your side to guide you. Following the advice you are given will help minimize the risk of complications, which are always possible after a surgical procedure.

2-How to correct your hallux valgus?

There are a multitude of surgical techniques for the correction of a hallux valgus.

We do not use the percutaneous technique for the correction of hallux valgus due to the risk of stiffness and lack of correction (malunion); however, it can be advantageously used on the lateral rays and toes in the case of associated corrections.

We use a minimally invasive technique involving a osteotomy of the first metatarsal, either Scarf or Kramer type, for its powerful corrective action, combined with a chevron osteotomy of the first phalanx and reconstruction of the soft tissues.

The osteotomy of the first metatarsal is fixed with an osteo-suture or with titanium hardware. Osteopenia (loss of bone density) of the metatarsal head may be seen on preoperative x-rays, which allows for anticipation of a stronger intraoperative fixation with screwed hardware to prevent secondary displacement that could compromise the result.

The osteotomy of the phalanx is generally not fixed; the dressing will hold the phalangeal correction, which can be adjusted if necessary with mini strapping.

These techniques allow for good bone reconstruction and provide between 95% and 98% good and excellent results without compromising the possibility of revision surgery in the future if it should become necessary.

3-Your consultation with the surgeon

Following an interview (where risk factors for scarring complications will be investigated: diabetes, smoking, obesity, corticosteroid use, etc.), a clinical and radiological examination of your foot, the surgeon will tell you, based on your disability, whether correcting your hallux valgus can improve your quality of life. The consultation with the surgeon is an important moment to ensure that your expectations align with what surgery can offer you.

4-Your consultation with the anesthetist

The consultation with the anesthetist aims to understand your medical history and personalize your medico-surgical care. The anesthetist will choose the most suitable anesthesia and analgesia techniques for you. They will tell you which treatments to continue and which should be stopped before the procedure. As a rule, care is outpatient and the anesthesia is regional, meaning anesthesia of the foot and ankle. Sedation is offered for your comfort during the procedure. This is the time to ask your questions about pain management. There are several treatments and techniques that can be combined to handle the temporary discomforts of the operation. An infectious screening assessment may be prescribed depending on your medical history: this will involve searching for and eradicating infectious sites in the teeth, urinary tract, gynecological areas, etc.

5-Surgical technique used

The correction of hallux valgus requires entering the hallux joint; the anatomical path to access it is called the surgical approach. We typically use a minimally invasive medial approach so as to fully release the joint if necessary, avoid the risk of adhesion of the hallux extensor, and to achieve a satisfactory cosmetic result.

The skin incision will measure between 3 and 5 cm depending on your body type, but also on tissue rigidity. The procedure is performed in the supine position (lying on your back).

This procedure is painless in 80% of cases; in 20% of cases, level 1 painkillers (paracetamol) and anti-inflammatories are sufficient to relieve any pain.

At the end of the procedure, you will have a postoperative dressing to keep for 3 weeks along with the postoperative shoe, on which you can start walking flat from the very first day.

Depending on intraoperative conditions, technical adjustments may be made.

During the procedure, and with your prior consent, we may take photos that will be used for scientific purposes (presentations, conferences, publications).

6-Your preparation before the procedure

If you are overweight, losing weight, even just a few kilograms, will always be beneficial for your joints. Imagine that when you walk, the equivalent of 5 times your body weight goes through your ankle. We recommend that you consult a dietitian or a nutritionist doctor to guide and monitor you.

If you are a smoker, take this opportunity to quit smoking. Tobacco significantly increases the risk of infectious complications, healing complications, and vascular thrombosis (phlebitis). Stopping smoking 6 weeks before and 6 weeks after a surgical procedure reduces the rate of post-operative complications.

Your surgeon will show you self-rehabilitation exercises to help maintain the muscles of the lower limb before and after the procedure.

7-Your stay at the Saint George clinic

You will be admitted as an outpatient for the surgical correction of your hallux valgus at the Saint George clinic. Our goal is to help you quickly regain your independence.

You must fast for 6 hours before the time of the procedure (no solid food, no liquids, no smoking).

It is perfectly normal to feel a bit anxious before your operation. If you are very anxious, you must let us know, and we will offer you treatment to help you relax before the operation.

The operation will last between forty minutes and one hour, and you will leave the operating room with your postoperative dressing.

After the procedure, you will be monitored in the recovery room until you are fully awake, in case sedation was used during the procedure.

Upon your return to the room, you will be offered a snack and then a meal. Eating reduces nausea, improves the return of bowel movements, and gives you the energy needed for healing. Your diet should then be balanced, without increasing your intake of dairy products. Your surgeon will give you advice on precautions to take regarding certain positions of your operated limb.

This is not a race, but it is in your best interest to get moving from the very first days after the procedure, with the help of crutches. Remaining immobile for fear of pain eventually makes every movement painful. Moreover, the regular walking recommended to you helps blood circulation and minimizes the risk of thromboembolic complications.

The physiotherapist and your surgeon will advise you on what to do and avoid before your discharge home on the same day.

8- The return home

Returning home may take place the same day or after a 24-hour hospital stay in some cases.
The postoperative dressing will be removed at the office during the 3-week postoperative appointment.

An anticoagulant treatment will be prescribed for 1 to 3 weeks to prevent the risk of phlebitis.

9-Resumption of activities

Driving may be resumed after the 6^th week for a right foot, or immediately if you had surgery on your left foot and have an automatic car. Your surgeon will give you the green light.

Sports can be resumed under certain conditions, starting from 45 days.

You may experience functional improvement for up to 1 to 2 years after the procedure, which is when the final result of your metatarsophalangeal hallux implant will be determined.

Finally, you will be able to lead a normal life and will be monitored by your surgeon. The schedule of check-ups during the first year will be provided by your surgeon.