Hallux valgus, commonly referred to as a bunion, is a deformity of the first ray of the foot in which the first metatarsal bone rotates inward, and the big toe points outward. As a result, the head of the metatarsal bone protrudes inward, leading to friction with footwear.
This condition is more common in women than in men and has a hereditary component. The deformity is largely caused by the use of narrow, pointed shoes, which is why it is rarely observed in populations that do not wear footwear.
Once the deformity appears, it does not resolve on its own but instead progressively worsens over time. The second toe gradually overlaps the big toe, causing further friction with footwear. This condition is particularly painful and significantly restricts the individual’s mobility.
What is the indications for Surgical Intervention?
Surgical intervention depends on the severity of symptoms, including pain and difficulty walking, the location of pain, the presence of other conditions such as rheumatoid arthritis, diabetes, and peripheral arterial disease, and the patient’s expectations. Some patients with minimal deformity report significant discomfort, while others with severe deformity may not be as affected. Initially, the use of specially designed shoes that provide ample space in the toe area is very helpful. The placement of silicone spacers between the first and second toes offers only minimal relief.
The intermetatarsal angle is the angle formed between the first and second metatarsals.
What is the goal of the surgery?
The goal of surgery is to correct the skeletal deformity. This is achieved through osteotomies, where the bone is divided and repositioned into the corrected alignment. The bone is then stabilized using screws or plates.
Can the surgery be performed using laser?
Laser is primarily used in soft tissue procedures. There is no laser available for bone cutting.
Can the surgery be performed without a skin Incision?
Currently, surgery to correct foot deformities without a skin incision is not possible. Inadequate correction techniques may use percutaneous methods with small incisions but without osteosynthesis materials, leading to insufficient correction of the deformity.
Is it true that the surgery is accompanied by excruciating pain?
With modern anesthesia, specifically regional anesthesia of the sciatic and saphenous nerves, the procedure is completely painless.
Is it true that a long recovery period is required for walking?
The patient can walk without pain but with special footwear just a few hours after surgery. The special footwear is worn for 4-6 weeks.
Is it true that the deformity recurs?
If the appropriate surgery is performed, the deformity does not recur.
Can deformities in both feet be corrected simultaneously?
It is preferable to correct both feet simultaneously in order to reduce the total time away from work. The severity of the procedure does not significantly increase.
What are the types of surgical procedures performed?
There are several procedures available to correct the deformity. The type and severity of the deformity should be carefully evaluated preoperatively, and the appropriate combination of procedures should be planned. The most commonly used osteotomies are the peripheral Chevron osteotomy for moderate deformities and the Ludloff osteotomy for more severe deformities.
The projection of the first metatarsal head during surgery: All the exostosis should be removed.
In Chevron corrective osteotomy, the peripheral end of the first metatarsal is subjected to osteotomy and stabilized with screws. This osteotomy is used for moderate deformities.
In Ludloff corrective osteotomy, the entire metatarsal is subjected to osteotomy and stabilized with screws. This osteotomy is used for more severe deformities.