Hallux surgery is the only effective way to get rid of hallux valgus. Treatment of halluxes with conservative, non-surgical methods can only stop the progression of the disease in its initial stage. What determines the chances of a successful surgical treatment of halluxes?

Halluksyis a very common condition, affecting mainly women. In 70 percent. cases are influenced by genetic disposition. The deviation of the first toe in the metatarsophalangeal joint towards the second toe ( hallux valgus ) has a tendency to deepen. Especially if it results from hereditary tendencies or is accompanied by rheumatic arthritis. In an advanced state, the operation is necessary to restore the walking ability and eliminate pain. It is not worth delaying it, because it gives you a chance to regain full fitness, which often depends on the initial situation.

It is not worth delaying the decision on hallux surgery

There is no point in postponing the decision to have an operation due to the fear of pain or being excluded from everyday life for a long time, when surgery is the only way to deal with this ailment. The operation is not painful because it is performed under spinal anesthesia, which turns off the feeling from the waist down. Returning home takes place after a day (private clinics) or a few days (public hospitals). If the procedure was performed using a plaster-free technique, you can walk the next day, but in a special shoe that prevents overloading the front of the foot (it must be worn for 6 weeks). For the first 2-3 weeks after the operation, you can only walk a short distance and try to keep your legs as horizontal as possible so that your feet do not swell. The time it takes to return to work depends on your profession. If we have to walk a lot, stand for a long time (nurse, saleswoman), it will take about 2 months, but if we are sitting, we can take up work duties even after 3 weeks. After 4-5 weeks after the surgery, it is worth deciding to undergo rehabilitation (manual therapy). Thanks to it, recovery is faster, and the effect of the treatment - better. The risk of relapse of hallux after modern surgeries is minimal and amounts to less than 5%, after classic surgery - 25%. The former are performed in private clinics, but you can also count on them in public hospitals, if they have orthopedists working there.extensive experience in foot surgery.

Halluksy: treatment goals, or what the surgery gives

Dr. Cezary Michalak, a specialist in orthopedics and traumatology from the Enel Med hospital in Warsaw, emphasizes that before making a decision about surgery, it is necessary to determine what the patient's expectations are and whether it is possible to meet them. In the case of significant deformations or destruction of the metatarsophalangeal joint of the big toe, it may not be possible to achieve an ideal postoperative result - therefore it is necessary to explain what to expect after the procedure. - The patient should also be informed about the surgical method and postoperative procedure, i.e. rehabilitation, the need to report in order to change dressings and control the postoperative wound - emphasizes Dr. Michalak. - Of course, as with any surgical procedure, the operation carries some risk of, for example, infection, although it is not considered a dangerous procedure.

Qualification for the type of surgery

There is no universal surgery, the type of surgery depends on the severity of the changes. Light degree is valgus between 15 and 30 degrees, moderate - 30-40 degrees, severe degree is valgus greater than 40 degrees.

- Grading helps to decide the type of surgery, but is not a rigid standard. Other factors are also involved, e.g. the condition of the articular surfaces of the first toe joint. During the procedure, if possible, we correct other deformations, e.g. deformations of smaller fingers - explains Dr. Michalak.

  • With slight changes, with a slight deformation, a small procedure may be enough, i.e. removal of growths and strengthening of the loosened and releasing (cutting) contracted soft tissues, which, if necessary, is supplemented by a distal osteotomy of the first metatarsal bone (i.e. cutting this bone) in the segment close to the first toe joint). A valuable solution is the chevron procedure, where the shape of the bone cut resembles a rafter. During the procedure, the bone is fixed with a screw. With minor changes, sometimes a minimally invasive procedure is used, performed with the use of special instruments through a small surgical access.
  • To a moderate degree, the procedure involves a more significant correction of the position of the 1st metatarsal bone, which is achieved by cutting this bone at its base; there are numerous types of osteotomies: wedge, oblique, semicircular, proximal chevron, etc. During the procedure, the preferably positioned bone is fixed with plates and screws. The treatment is completed with the removal of growths and the strengthening of the loosened tissue and the release (cutting) of the contracted tissuessoft.
  • Severe hallux valgus is also performed osteotomy of the first metatarsal bone in the proximal part, with a greater correction of its position. If the metatarsophalangeal joint is damaged, it may be necessary to stiffen it surgically or to use a partial or total joint endoprosthesis. Sometimes it may be necessary to stiffen the joint at the base of the first metatarsal (Lapidus procedure).

Hallux surgery: modern plaster-free techniques

From the experience of dr. Michalak, patients often ask about the "plaster-free method". - Nowadays, we are observing a significant change in the possibilities of surgical correction of hallux valgus as compared to the methods used until recently. This is due to the appearance in orthopedic practice of specially developed anastomoses, screws, plates made of biocompatible materials, which, if it is necessary to cut and re-position the bones, enable their strong fixation and allow for the implementation of early rehabilitation, i.e. to move the finger practically immediately after the procedure. In such a situation, a plaster cast is unnecessary, although a small splint can only be used in the early postoperative period, i.e. for several days to protect the operated finger and reduce pain - explains the specialist. Dr. Michalak emphasizes that maintaining immobilization for a long time is unfavorable, as it may limit the mobility of the operated joint. Therefore, the next day after the procedure, the patient gets up and walks in a special shoe that relieves the forefoot (available for purchase at the rehabilitation equipment store).

Effective rehabilitation is necessary

Wound healing takes about 2 weeks, bone healing - about 6 weeks. Patients may partially load the foot in a shoe that relieves the forefoot (then the heel is walked on). After not less than 6 weeks, it is possible to resume walking in everyday shoes; sometimes this is hampered by the swelling, the greater the more advanced the changes were. Rehabilitation should be implemented as soon as possible after surgery. It consists mainly in active exercises (e.g. grasping small objects with your toes, rolling a paper tissue with your toes in a standing position) and passive exercises (e.g. massaging the inner side of the sole by rolling a ball on the floor) extended to manual therapy. There are also physical treatments: laser, cryotherapy, magnetic field, vortex massages.

According to an expertCezary Michalak, MD, PhD, specialist in orthopedics and traumatology, CM Enel Med Hospital, Warsaw

New materials, moderntechniques

The methods of supporting cut bones with wires temporarily inserted into the bone and the necessary plaster immobilization are becoming a thing of the past. Gypsum caused limitations and made it necessary to wait for the bone to heal, i.e. for about 6 weeks, otherwise there was a risk of destabilization of the anastomosis. It is possible to imagine how much longer the postoperative rehabilitation had to take, and to what extent it was difficult. As for the materials we use to fix the bones, the gold standard is titanium - a well-tolerated metal, which, however, remains in the body permanently. Anastomoses made of bio-absorbable polymers are also used, which, however, can cause unfavorable tissue reactions. The method I used recently seems to solve the problem of removing anastomosis. In October 2015, at the Enel Med Centrum hospital, I performed the first hallux valgus surgery in Poland with the use of bone fixation with screws made of an absorbable, biocompatible alloy called Magnezix. We have already performed 5 such operations with good results. In addition to good mechanical strength, this anastomosis also gives good tissue tolerance and also has the advantage that it dissolves in the body. Only time will fully confirm this, but initially Magnezix seems very promising.

Worth knowing

Non-surgical methods of hallux treatment

Pain in the metatarsus is alleviated by wearing insoles with a pelotte, while toes - using micro-rubber overlays to protect them from contact with shoes. Relief is also brought by marcin appliances and Hallufix orthoses correcting the position of the toe, physical therapy reducing inflammation (e.g. iontophoresis, local cryotherapy), general and local non-steroidal anti-inflammatory drugs and manual therapy.

Choose shoes carefully - you usually choose their shoes. You think less about whether they will be comfortable. And the wrong footwear can hurt your feet: high heels put your weight on the toes and midfoot instead of on the heels. This may lead, inter alia, to for metatarsal pain, hallux, blood circulation disorders in the legs, calf muscle contracture. 3-4 cm wide heels are safe. Narrow noses squeeze the fingers, which is conducive to the formation of hallux valgus, corns, calluses, and ingrown nails. So choose shoes with toes that allow you to move your toes freely. Slippers that are too small (too short) contribute to the formation of halluxes and hammer toes. Shoes should be half a centimeter longer than the longest toe. The thin, stiff sole does not absorb accompanying shockswalking, which may result in microtrauma to the foot. If the sole is completely stiff, it increases the risk of pain in the midfoot and heel spurs.

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Spine, bones, joints