Hallux valgus or bunion is a malposition of the first radius of the foot where the first metatarsal is inwardly directed and the big toe outwardly. As a result, the head of the metatarsal protrudes inwards, resulting in friction on the shoe.
The condition is more common in women than in men and has inherited features. The deformation is largely caused by the use of narrow and triangular footwear and is rarely observed in populations that do not wear footwear.
When deformity occurs it does not subside, but deteriorates over time. Gradually the second finger crosses over the big toe, resulting in further shoe friction. This condition is particularly painful and significantly restricts the patient’s mobility.
Hallux valgus is associated with outward malposition of the big toe.
Friction on the shoe causes significant pain and ulceration of the skin next to the head of the 1st metatarsal bone.
What are the indications for surgical treatment?
Surgery depends on the severity of the symptoms, that is, the pain and inability to walk, the location of pain, the presence of other conditions such as rheumatoid arthritis, diabetes and peripheral artery disease, and finally the patient’s expectations. There are some patients with minor deformity who report significant distress while others with significant deformity are not particularly distressed. Initially, special footwear that provides a lot of space in the toe area is very useful. The placement of silicone spacers between the first and second fingers has only a minor relief effect.
What measurements are taken on X-rays?
The most common measurements are two:
- The inter-metatarsal angle is the angle formed between the 1st and 2nd metatarsal.
- The angle of inclination of the big toe
What is the purpose of surgery?
Surgery is intended to correct skeletal deformity. This is performed with osteotomies, that is, the bone is divided and repositioned into the correct site. Bone retention is completed by osteosynthesis with screws or plates.
Is it possible to have laser surgery?
Laser is mainly used in soft tissue surgical interventions. There is no laser for bone cross-section.
Is it possible to perform the surgery without skin incision?
There is no way to perform correction of foot deformities without skin incision. Inadequate corrective techniques can exploit transdermal methods with small incisions without osteosynthesis materials and with inadequate correction of the deformity.
Is it true that the operation is accompanied by unbearable pain?
With modern anesthesia, that is, the regional anesthesia of the sciatic nerve and the saphenous nerve, the operation is completely painless.
Is it true that it takes a long time for the patient to walk?
The patient walks painlessly, but with a special shoe, a few hours after surgery. The special shoe is placed for 4-6 weeks.
Is it true that the deformity is recurrent?
If treated appropriately, the deformity does not recur.
Is it possible to correct deformities in both feet at the same time?
It is preferable to correct both legs simultaneously in order to reduce the patient’s total time off work. The severity of the operation does not increase significantly.
What are the interventions performed?
There are many interventions to correct the deformity. The type and severity of the condition should be assessed preoperatively and the design of the appropriate combination of interventions should be planned. The most commonly used osteotomies are the Chevron peripheral osteotomy in mild deformities and the Ludlloff osteotomy in severe deformities.