How does percutaneous surgery for hallux rigidus work?

How to prepare for a percutaneous hallux rigidus surgery?

Preparation for a percutaneous surgery of hallux rigidus involves several crucial steps to ensure the success of the operation. These steps include a preoperative consultation and adherence to certain preoperative instructions.

Preoperative consultation

The preoperative consultation is an essential step before a percutaneous surgery for hallux rigidus, as with any surgical procedure. During this consultation, which takes place in our foot clinic, we assess the patient's general health condition and try to understand their expectations following a possible surgical procedure. It is essential to clinically evaluate a patient presenting with hallux rigidus, analyze their gait, joint stiffness, and estimate tissue quality. A standardized radiographic assessment is the natural extension of the clinical exam. Only after examining you and analyzing your X-rays can we make a surgical recommendation. When you contact our secretaries to book a consultation appointment, we send you the necessary prescription to have your X-rays done beforehand. If you book your appointment directly on Doctolib, you will read that it is necessary to have a radiographic assessment of both ankles and feet while standing before your consultation. You can contact us to receive the X-ray prescription via your Doctolib account once your appointment is booked.

Depending on your lifestyle, your professional life, your sports activities, your footwear habits, your physical exam, and your X-rays, we will be able to tell you which surgical procedure is appropriate for your foot and if the postoperative results may meet your expectations.

We remind you that the decision to undergo surgery is yours, and depends on the discomfort or disability you feel. It is important to understand that the primary goal is to offer you a surgical treatment adapted to your foot, whether it is a minimally invasive, arthroscopic, or percutaneous technique. The percutaneous surgical technique is one of the tools at our disposal, but it may not be the one we propose for you.

Preoperative instructions

After the preoperative surgical consultation, you will have a pre-anesthesia consultation with an anesthesiologist who is used to working with your surgeon. The anesthesiologist will give you the instructions to follow before your procedure such as:

• Stopping certain medications, such as anticoagulants and antiplatelet agents, as well as the timing and method for resuming your usual treatment.
• Fasting, usually 6 hours before the operation.
• Quitting smoking and alcohol, as they can affect healing and recovery.

It is important to follow these instructions to minimize risks and achieve the best possible result from the operation.

How is a percutaneous hallux rigidus surgery performed?

The surgical process

Percutaneous surgery for hallux rigidus is a minimally invasive procedure that requires either local or general anesthesia, depending on the choice of the patient, the anesthetist, and the surgeon. Once the anesthesia is in place, generally without using a tourniquet even though it is always positioned, the surgeon makes one or more pinpoint incisions around the big toe joint. The number of working holes depends on the lesions to be treated and the surgical strategy considered.

Using surgical instruments specifically dedicated to percutaneous surgery, the surgeon then removes the excess bone that causes pain and stiffness. This refers to the resection of osteophytes. This foot operation is performed under radiographic guidance to ensure optimal precision and to assess the bone resection.

It is also possible to combine additional surgical procedures, such as metatarsal or phalangeal osteotomies, or even more radical procedures such as arthrodesis for hallux rigidus, which involves refreshing the cartilage and subchondral bone to achieve joint fusion that requires fixation with surgical hardware.

The percutaneous technique can also allow for the treatment of lesions associated with hallux rigidus; we perform osteotomies of the lateral metatarsals for metatarsalgias or percutaneous tenotomies for the treatment of certain claw toes.

We almost never use the percutaneous technique for hallux rigidus because although the resection of bony blocks or a bump can be advantageous, the adjustment of a decompression osteotomy is not precise, and the joint preparation for arthrodesis may be insufficient or, conversely, the bone resection may be too extensive.

Once the surgical procedure is completed, the incision(s) are closed with stitches. The total duration of the operation varies depending on the surgical procedures carried out.

Dressing is very important after a percutaneous surgery; it is the main stabilizer in case of surgical procedures that did not require fixation with hardware, which can also be introduced percutaneously.

Recovery after the operation

After the operation, the patient is placed in the recovery room in case sedation or general anesthesia was performed for the foot surgery.

In the first days following the operation, the patient is advised to keep their foot elevated and limit movement to promote healing. Painkillers may be prescribed to manage postoperative pain.

Most patients can resume their normal daily activities within a variable period of two to six weeks after the operation, depending on the procedures performed. However, returning to more strenuous activities, such as sports, may require several months.

It is important to note that each patient is unique and that recovery time may vary depending on various factors, including age, general health, and the stage of hallux rigidus.

Finally, postoperative follow-up is essential to ensure that the foot heals properly and to assess the effectiveness of the operation. This follow-up generally includes several visits to the surgeon in the weeks and months following the surgery.

What are the benefits and risks of this surgery?

Advantages of Percutaneous Surgery

Percutaneous surgery for hallux rigidus offers several advantages.

• First, it is less invasive than traditional surgery. Making small incisions helps limit tissue dissection, which reduces postoperative pain, lowers the risk of infection, and promotes the healing process.
• Second, this procedure helps reduce pain and improve foot mobility. It is an effective solution for those having difficulty walking or performing certain activities because of hallux rigidus.
• Third, the procedure duration is generally relatively short, which reduces the time spent under anesthesia.
• Finally, recovery is usually faster than with open surgery. Patients can often return to their normal activities more quickly.

Possible Risks and Complications

Like any surgical procedure, percutaneous surgery for hallux rigidus carries certain possible risks and complications.

• A risk of infection, although reduced compared to open surgery, is still present. It is important to follow postoperative instructions to minimize this risk.
• Postoperative pain may occur. However, it is relieved by standard painkillers once the anesthesia wears off.
• If the joint was preserved during the procedure, there is a risk of painful recurrence of hallux rigidus. This may require another procedure to treat the osteoarthritis itself with a prosthesis or an arthrodesis.
• Finally, some patients may experience a certain stiffness or a decrease in foot mobility after the operation.

It is important to discuss these risks with your surgeon before the procedure. Together, we can determine whether percutaneous surgery for hallux rigidus may be indicated in your specific case.

Conclusion

Percutaneous surgery for hallux rigidus is a surgical technique that can be used in the treatment of hallux rigidus. Thanks to the specialization of our surgeons at La Clinique du Pied, we ensure high-quality care. Our goal is patient satisfaction and the improvement of their daily foot function.