Hallux valgus surgery
The surgical procedure
There are numerous therapies that can be used in treating the hallux valgus Tobe offered. First up is the possibility of a conservative approach checked while avoiding surgery. In the early stages you can insolesthat support the arch of the foot, slow further progression of the disease and relieve discomfort. Specific rails can relieve pressure on adjacent toes and help prevent pressure points. (please refer: Conservative therapy of hallux valgus)
Furthermore, the use is certain Shoe technology and gymnastics conceivable to compensate for the consequences of hallux valgus and to slow the progression of the disease.
At pronounced foot deformity however, surgery is often inevitable. While conservative measures only slow the progression of the disease, various surgical techniques can permanently relieve the patient of pain.
The indication for surgery is usually made by an orthopedic surgeon who is guided by the patient's clinical picture when making an assessment.
Especially Pain and chronic inflammation the ball of the toes make a surgical approach useful. The increasing inclination of the big toe in the direction of the little toe and a stiffening in the misalignment also give the doctor reason to recommend an operation.
In addition to deciding on the operation, the orthopedic surgeon will also discuss the type of procedure with the patient. The operation should eliminate pain and malpositions and that Big toe joint be stabilized in order to develop a Arthrosis in the metatarsophalangeal joint of the big toe to prevent. There are different approaches here, but they usually follow uniform principles.
Hallux valgus is fixed in its misalignment by various mechanisms. The operation must therefore start on several structures in order to guarantee permanent correct alignment of the big toe.
Since the joint capsule and tendons are also subject to pathological changes in hallux valgus, the joint capsule, which is stretched on the inside, is first gathered and the tendon course on the big toe is changed to make room for the subsequent one Bone rearrangement (Osteotomy) to accomplish.
The tendon-guiding bony structures include the so-called Sesame bones (Sesamoids), which are laterally offset in hallux valgus and must be re-centered in the course of the operation.
With the toes in a normal position, the eyes exert a pull along the toe beam. This can be greatly changed in hallux valgus, which is why the tendon may have to be shortened or lengthened.
While the bone deformity by a so-called Osteotomy, the severing and correction of a bone, are compensated, a soft tissue intervention on the ligaments and joint ensures the functionality of the corrected extremity.
In an osteotomy, the toe bones and metatarsal bones are divided in order to realign and fix them in the desired way. Metal screws, small splints and wires are used until the bone defect has healed.
If the disease is severe, surgery often cannot be performed to preserve the joints. The removal of the metatarsophalangeal joint of the big toe with subsequent stiffening (Arthrodesis) the joint-forming bones can be the measure of choice here to still relieve the patient of pain.
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My name is dr.Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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Pain during surgery
Hallux valgus surgery is a relatively small procedure, but like all operations it can be painful.
Due to the so-called foot block, the numbing of the nerves involved in the foot, there is often no pain immediately after the operation. Approximately 48 hours after the procedure, the pain may increase due to the decreased anesthesia.
The pain is limited to the surgical area and should not radiate. Adequate medication, which can be taken at home in the form of tablets, should take effect here. NSAIDs, non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac are preferred, which usually provide adequate pain relief. Pain medication is necessary for about two weeks after surgery. In the course of this time the symptoms should have receded significantly.
The postoperative pain can initially have a limiting effect on the choice of footwear, so that initially not all shoes can be worn pain-free. Long-term strains, such as those that occur during long walks, are often not possible after the operation due to pain and should be avoided in the interests of healing.
A sharp increase in pain in the first week after the procedure is rather unusual and indicates complications in the healing process.
Burning or dull throbbing pain, redness and swelling of the scar, the toe or the entire foot can be a sign of the infection of the operating area and must urgently be clarified by a doctor and, if necessary, treated with antibiotics.
Read more on the topic: Foot block
Risks of the operation
Like any operation, hallux valgus surgery is associated with certain risks.
Basically, the greatest danger comes from Infections out. Even if the greatest care is taken to comply with hygienic measures during the operation, it can never be completely ruled out that the materials used are contaminated or that germs are spread by the staff.
Classic signs of inflammation such as pain, redness, overheating and swelling should urgently be clarified and treated by a doctor.
Antibiotic therapy is usually sufficient, but if the infection has progressed a further operation may be necessary to clean up the focus of the infection.
The foreign materials used can lead to infections as well as to Irritation of the surrounding tissue come. The resulting pain must be counteracted by rest or surgical correction.
Since the anatomical conditions on the affected foot change after the operation, the stress on the tissue also changes. Pressure pain and skin symptoms in the new stress areas can be the result.
As you get used to the new anatomical situation, the symptoms should regulate themselves. Some people are also prone to excessive scarring or poor wound healingthat can make the healing process even more difficult.
The changed load on the bony structures can also cause problems. Stress fractures, i.e. breaks in particularly stressed bone tissue, are occasionally observed with rapid loading after an operation.
Even after a successful operation of a hallux valgus, it can recur over time and cause discomfort and the previously existing pain cannot always be removed by an operation. Footwear that was worn before the operation should be disposed of afterwards, as the material has adapted to the malposition of the foot and forces the corrected toe into a malposition again.
The surgical techniques at a glance
A total of over 200 different surgical procedures for the forefoot area are known. The six most common surgical procedures at the hallux valgus are the following:
- Exostosis chiselling with medial capsule gathering
- after Chevron / Austin
- McBride OP
- Operation after cellar fire
- Base osteotomy of the first metatarsal (Base-Wedge-OP or also proximal conversion)
- OP after SCARF
Exostosis chiselling:
The sole removal of the Exostosis for hallux valgus (Called a bone bulge or pseudoexostosis) is only rarely used today and with very little hallux valgus.
Chevron surgery or Austin surgery
This surgical method is used for moderate to severe forms of hallux valgus. A prerequisite for this joint-preserving procedure is at most one moderate osteoarthritis and an intermetatarsal angle of maximum 16 ° (Angle between the 1st and 2nd metatarsal bones).
In addition to the removal of the exostosis, a 3-dimensional changeover with tendon displacement is carried out so that the functional anatomy of the forefoot is achieved again.
The follow-up treatment takes place in the relief shoe for about 3-4 weeks, after which a comfortable normal shoe with a special insert can be worn.
This hallux valgus operation can be performed on an outpatient or inpatient basis. The reimbursement of costs is paid by the health insurance company if there is a medical indication.
McBride's surgery (soft tissue surgery)
In the McBride OP Hallux valgus (soft tissue surgery) occurs in the case of a misalignment of the big toe that has to be compensated passively, without or at best with a minor one arthrosis available in the big toe. It is a preferred hallux valgus surgery in younger patients.
The aim is to chisel off the protruding bone and to shift and tighten individual toe muscles (Adductor hallucis muscle) and the capsule.
The follow-up treatment consists of elevating the affected foot, local ice treatment, measures to reduce inflammation and Thrombosis prophylaxis. After about 6 weeks, the ability to work is restored.
Operation after Keller-Brandes
The hallux valgus surgery after Basement fire found more advanced in older patients with severe big toe deformity arthrosis in the Metatarsophalangeal joint and less stress on the forefoot in everyday use. A disadvantage of this surgical procedure is the shortening of the big toe, which is often cosmetically disturbing. The second toe protrudes lengthways over the big toe. The aim of the operation is to remove 1/3 of the metatarsal joint of the big toe and chisel off the protruding bone on the inside of the metatarsal bone. It is a relatively easy and quick surgical procedure.
Stiffening of the metatarsophalangeal joint of the big toe
In individual cases it may be better that Big toe joint to stiffen (med. arthrodesis). Various operational procedures are available for this. Screws are often used for this. A recurrence of the complaints is with this procedure Hallux valgus Operation extremely rare.
Prosthesis of the metatarsophalangeal joint of the big toe
There are now also prostheses for the metatarsophalangeal joint of the big toe. The material of these prostheses consists mostly of durable silicone or ceramic. The disadvantage of this method is the low resilience and durability of the silicone prosthesis, so that a replacement operation, i.e. a second operation, must very often be expected.
Ceramic prostheses often have poor mobility due to scarring. The Aftercare consists of elevation of the affected foot, local ice treatment, inflammation-reducing measures and thrombosis prophylaxis.
After about 6 weeks, the ability to work is restored.
Base osteotomy of the first metatarsal (base wedge operation)
In severe forms of hallux valgus (An angle of more than 50 degrees and an intermetatarsal angle of more than 20 degrees) the bone must be divided and repositioned at the base of the 1st metatarsal. A small bone wedge is removed from the base, the 1st beam is swiveled and screwed again in a new position. Compared to the Austin or Chevron surgery (see above), the bandage shoe / forefoot relief shoe is about 2 weeks longer. However, as with all of the above, heel load is also here. Surgical procedures allowed from the 1st postoperative day.
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