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Hallux valgus OP
- When does it make sense?

HALLUX VALGUS SURGERY POSSIBILITIES

advantages and disadvantages of hallux surgery


from UXGO
28 September 2018, 11:38 a.m.

The good thing first of all: Hallux valgus surgery is only necessary if other treatment methods are no longer helpful at all! So first try out shoes with a feel-good factor, test Hallux valgus insoles, bandages and other orthopaedic aids. Or walk a lot without shoes, roll the fasciae smoothly and perform Hallux valgus gymnastics.

If you have tried all this – ointments, compresses, toe exercises, barefoot walking, hallux valgus insoles and comfortable shoes – and nothing has helped, then a non-binding consultation with a foot specialist can be sought.

Because the foot pain becomes a very great strain – because constant pain becomes a companion, the toes lose mobility and you can no longer walk properly – a hallux valgus surgery may be the right solution. 

You do not need Hallux valgus surgery if:

  • no constant pain is present
  • You in Hallux valgus shoes master the everyday life well
  • Hallux valgus inserts, bandages, toe spreaders and splints reduce pain
  • no movement restrictions exist

 

If this is not the case, surgery can be considered. The orthopaedist will first examine and palpate your foot. The subsequent X-ray image will provide information about the degree of severity and thus about possible surgical methods.  


When do you need a Hallux valgus surgery?

 

When does the physician advise Hallux valgus surgery?

When no surgery may be performed?

Contraindications for hallux valgus surgery are arterial occlusive diseases and, depending on their severity, a diabetic foot, since the foot is furthest away from the heart and therefore has less blood circulation than other limbs or organs. During surgery, the foot affected by an arterial occlusive disease is then even less supplied with blood and nutrients. This can lead to a worsening of the clinical picture. Previous Hallux valgus operations may also be a contraindication for further operations.  


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In most cases hallux valgus surgeries are performed with mild to moderate corrections on an outpatient and minimally invasive basis.

This has some advantages. Minimally invasive surgery is associated with fewer soft tissue injuries, i.e. muscles, tendons, tissues and baumlnder are less destroyed and therefore heal faster. Another advantage is the immediate resilience of the foot after the operation. It is possible to walk in an adapted forefoot load shoe at the same time, as this prevents the foot from rolling over the operated area.

The mobility is also restored more quickly after a minimally invasive operation, physiotherapeutic exercises can be carried out more effectively and it can be said that the patient generally recovers more quickly. The first phases of inflammation after Hallux valgus surgery last up to 6 weeks, but depending on the individual healing process up to 3 months and longer. Fixation materials – these are screws/plates used to fix toes in the desired position – are often left in the foot if they do not bother the patient. After 4 weeks, the attending physician will perform a check up to see how the healing process is progressing.

What else can you do for your friends?

For thrombosis prophylaxis the foot should often be elevated, in addition physiotherapy with lymph drainage, strengthening and mobilisation can accelerate the healing process. Foot gymnastics after Hallux valgus OP – of course, is important! The toe is not plastered and can be moved by a therapist. The Hallufix® Hallux valgus splint fits into UXGO shoes width H and can be worn immediately after surgery in your desired shoes. In this way you give the foot the necessary space and the important fixation so that there is a nice operation result. You are welcome to browse our online shop, let yourself be inspired, find “friends“ for life and let off steam in our world of shoes.

You want new freedom for your toes?
Here you go directly to the shop!

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Hallux valgus – Was hilft bei einem Ballenzeh?

Forschung zur Hallux valgus OP

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Klinische Forschung ist die Grundlage für evidenzbasierte Medizin und macht medizinischen Fortschritt erst möglich. Um die Wirksamkeit, Überlegenheit und Sicherheit von Operationsmethoden zu untersuchen und sie somit vergleichbar zu machen, sind randomisierte und kontrollierte klinische Studien nötig. Davon gibt es kaum welche für Hallux valgus Operationsmethoden. Dem liegen verschiede Ursachen zu Grunde, wie z.B. kleine Fallzahlen.

Was heißt das für Patienten?
Auch wenn die klinischen Ergebnisse (also der Verlauf der Operation) gut sind, gibt es kaum wissenschaftliche Untersuchungen zur Effizienz der Methoden. So muss auf die Erfahrung und Einschätzung des Operateurs vertraut werden.

Quelle: Ärzteblatt 2011, 2012

Science:

The study situation on hallux valgus surgical methods is unsatisfactory. Although there are numerous clinical trials, unfortunately there are hardly any randomized trials (see box). Surgical methods were compared without a clear result and it is up to the surgeon and his experience which technique he uses. It is therefore very difficult on the part of scientists to make therapy recommendations to doctors on a high level of evidence.

gravity:

The more pronounced the deformity is, the further back at the toe ray the Hallux valgus operation must be performed and the longer the follow-up treatment and healing process will take. Which surgical technique is used therefore depends on the angle of the deformity.


1. Slight misalignment (mild deformity):
Hallux valgus surgery before the metatarsophalangeal joint of the big toe, minimally invasive surgery, hallux can still be moved manually into the correct position, the bump on the ball is visible. There is no limitation of movement at the metatarsophalangeal joint and no arthrosis.

2. Medium malposition: Hallux valgus OP at metatarsophalangeal joint

3. Severe deformity: Hallux valgus surgery on the metatarsophalangeal joint (= connection between metatarsal and tarsal bones)

Often implants and screws are necessary for fixation, which – as already mentioned – seldom have to be removed.

You want to know more about the causes of Hallux valgus?
Here you go directly to the article

Learn more


Common surgery methods 

The aim of hallux valgus surgery is to bring the toes back into a “normal“ position and, if still possible, to preserve involved joints. Depending on the degree of severity and deformation, different methods can be used to do this.

  • CHEVRON osteotomy
  • AKTIN osteotomy
  • SCARF osteotomy
  • LAPIDUS-ARTHODESE
  • Resection arthroplasty
  • MANN, soft tissue intervention

 

The hallux valgus surgery is usually performed in combination with soft tissue correction. Duration of surgery: An experienced surgeon usually needs 30-45 minutes.

In the case of hallux valgus on both sides, the operations usually do not take place simultaneously so that the freshly operated foot can be spared a little and the healthy foot has a good influence on healing. It is recommended to wait at least 3, more likely 6 months until the second Hallux valgus operation.

How long will I be on sick leave?

4-6 weeks. But it also depends on the everyday situation, because it makes a big difference whether someone has a Bürojob or is a letter carrier.

What complications may occur:

Postoperative complications range from chronic pain to infections and other inflammatory processes (due to the fixation material used, such as screws) to stress fractures or cancellations (meaning all possible forms of injury) due to the stress change. Swelling after hallux valgus surgery usually subsides after 3 weeks. The risk of wound healing is significantly higher on the foot than on the heart during surgery. In general, the blood supply to the foot is poor and it is exposed to high stress.

What can happen at worst if I don't operate?

What certainly has the most influence on your quality of life is the constant pain. If the functional restriction is so great that you start limping and adopt a gentle posture, this can have an unfavourable effect on other joints. The development of hammer toes and claw toes is favoured and chronic inflammations damage the tissue. The risk of arthrosis, i.e. wear and tear of the cartilage in the toe joint, also increases.

 

 

 


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The Hallux valgus surgical methods

 

1. CHEVRON-Osteotomy
Has been performed since 1962, also known as Austin-Osteomy.

Application: mild deformities

Procedure: The metatarsal 1 head is severed with v-förmigem bone incision and shifted laterally to correct the intermetatarsal angle. Knöcherne Ausl;chse can be removed and the capsule gathered so that it encloses the joint tightly again. This position is then fixed with small implants. After Hallux valgus surgery it is very important to stabilize the axial position with a bandage.

2. AKTIN-Osteotomie
This procedure first appeared in the literature in 1925 and is now mostly used in combination with other surgical methods such as chevron osteotomy.

Application: Defective position in front of the metatarsophalangeal joint of the big toe.

Drain: The bone on the metatarsophalangeal joint of the big toe is notched, i.e. a small wedge is removed. The big toe can then be placed in the desired position. Fixation is usually performed with a titanium screw or a bioresorbable screw. Field of application: malposition in front of the metatarsophalangeal joint of the big toe.

3. SCARF osteotomy
Has its beginning in 1994.

Application: This Hallux valgus OP is preferred for mild and moderate deformities.

Procedure: In this correction method of hallux valgus, the first metatarsal is cut z-förmig. The bone is moved outwards and bone parts are fixed with material. Here the metatarsals 1-5 are marked red Intermetatarsal angles are fixed. Here, too, bones can be smoothed and soft tissues such as the capsule can be tightened.


4. LAPIDUS-ARTHRODESE
1934 introduced by its namesake.

Application: severe deformation and arthrosis as well as instability in the joint. Often used in active patients with older age.

Procedure: Here, the surgeon stiffens the joint with screws, plates, drilling or bone clasps in the desired position. Any remaining cartilage is removed and tendons corrected. The joint is then brought into the optimal position and fixed in place. The joint is no longer mobile and is sacrificed for pain reduction. The swelling after this hallux valgus surgery can last 4-6 months.

5. Keller-Brandes – Resection Arthroplasty
Known since 1904.

Application: severe malpositioning and osteoarthritis, application to inactive, older patients

Procedure: Removal of the base member of the toe with the aim of pain reduction often with reduced functional capacity.

 

6. MAN – Soft tissue intervention
The soft tissue intervention is carried out according to Mann and Coughlin (1992).

Application: When the articular surfaces are no longer in harmony with each other; in many cases of hallux valgus operations, this procedure is also used.

Drainage: severing of the ligament between the toes, shrunken capsule, and involved muscles. 

Conclusion

 

Hallux valgus surgery can be a solution if you suffer from permanent pain and movement restrictions. In consultation with the treating physician, the appropriate surgical method can be discussed depending on the diagnosis. As with any surgical procedure, hallux valgus surgery is also associated with risks. What are your experiences with Hallux valgus surgery? We are looking forward to your experiences!

Translated with www.DeepL.com/Translator

Important note:

This article contains only general information and must not be used for self-diagnosis or self-treatment. It cannot replace a visit to the doctor. In case of foot pain caused by Hallux valgus, make an appointment with an orthopaedist, preferably a foot specialist. 

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