Minimally Invasive Hallux Valgus Surgery

Hallux Valgus: Definition

The human foot is a complex structure comprising numerous muscles, bones, ligaments, joints, and tendons. This intricate system, with its diverse functions, is susceptible to anatomical changes. One common consequence is hallux valgus, often referred to as a bunion.

A bunion is a bony bump that develops at the base of the big toe's joint. It forms when the hallux (big toe) angles towards the second toe, causing the joint to enlarge and protrude outward.

Pressure from shoes, particularly those with narrow toe boxes, contributes to hallux valgus, although genetic predisposition is the most significant factor. It's more prevalent in women and individuals over 40.

Other key causes include:

• Wearing smaller or tighter shoes;
• Arthritis;
• Congenital foot problems;
• Hereditary factors.

Consequences of the Deformity

Hallux valgus is a deformity with several consequences:

• Clinical Consequences: These involve foot disorders and repercussions on overall postural alignment (knees, hips, back, shoulder blades). The primary issue is the deviation of the first metatarsal head, moving outwards and upwards;
• Local Consequences: Misalignment of the metatarsophalangeal joint leads to asymmetrical function and cartilage wear, causing pain and arthritic degeneration. The metatarsal prominence rubs against shoes, forming painful bursitis;
• Metatarsalgia (hallux valgus pain): The dorsal elevation of the first metatarsal head disrupts forefoot structure, overloading the second and third metatarsals, resulting in pain and plantar calluses;
• Toe Deformities and Dislocations: Pressure from the big toe on other toes causes bending, leading to hammer toe deformity and lateral/dorsal deviation, disrupting the anatomical relationship between the toe base and metatarsal, potentially causing complete dislocation;
• Postural Consequences: Outward movement and hypermobility of the first metatarsal, due to ligament stretching, cause upward lifting with each step, flattening the medial longitudinal arch and causing inward foot rotation (pronation). This pronation affects the lower limb joints and skeletal musculature, impacting posture and the alignment of body segments. Internal rotation of the lower limb, pelvic tilting, and increased lumbar curvature (hyperlordosis) result, creating articular inconsistencies.

Paraclinical

Hallux valgus is often diagnosed through a physical examination. The doctor may check for restricted toe movement. X-rays may be needed to assess severity and identify the cause. Blood tests may rule out arthritis.

EXPRESS QUOTE

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Minimally Invasive Hallux Valgus Surgery

When conservative treatment fails, surgery offers excellent results. It can be performed at any time if no contraindications exist.

Surgery is typically indicated for patients with big toe deformity causing pain, discomfort, or difficulty wearing shoes.

Minimally invasive surgery uses small puncture incisions (under 1 cm) for osteotomies (bone cuts) to correct deformities. Correction may involve screws or wires.

When appropriate, minimally invasive surgery offers advantages over open surgery:

• Smaller incisions;
• Less postoperative pain;
• Faster mobility;

Hallux valgus: when to operate? Consult your doctor to determine the best treatment and resolve any doubts before surgery.

After Hallux Valgus Surgery

Postoperative pain is generally less with minimally invasive surgery due to smaller incisions.

Patients are often day cases or have a one-day stay. They begin moving their feet/toes immediately post-operatively and weight-bearing with an immobilization sandal.

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