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Hallux Valgus

Hallux Valgus

What is a Hallux valgus deformity?

Hallux valgus is primarily a hereditary condition that most often progressively worsens throughout life. They can affect anyone, although they are most common in women. Bunions will usually be visibly present for many years before they become painful. A change of shoes, activity, or body weight can cause previously nonpainful bunions to become painful. A bunion occurs due to multiple factors which result in a mal alignment of the bones with the big toe drifting toward the second toe. Additionally, there is an enlargement of the “hump” on the inner side of the foot, next to the big toe. As a bunion deformity progresses, the “hump” or bony enlargement increases in size. In addition, the big toe can rotate, and continues to move towards, often over-lapping or under-lapping the second toe.

Hallux Valgus

A bunion is a bone problem. It is not a skin problem or a cyst. As you walk more the symptoms become worse. As the bunion increases in severity it can cause other associated foot problems, such as hammertoes, arch pain, and painful bursitis on the bunion and/or calluses on the bottom of the foot. Pain is often the result of rubbing of the enlarged bunion against the inner side of a shoe. There may be pain from within the actual bunion joint or when the great toe presses against the second toe. The exact cause of bunions is unclear. Some of the causative factors include heredity, flat foot structure, ligamentous instability or laxity, muscular imbalance within the foot and birth defects. Improper shoes during childhood may contribute to the formation of bunions, but this is uncommon. Inappropriate shoes during adolescence and early adulthood may aggravate an existing bunion formation

Hallux Valgus Surgery ad modum Turan

Our technique includes realigning the bone for proper function, and the use of a surgical screw for the most reliable and stable bone alignment. The proper use of the surgical screw is technically more difficult than other methods, but it is worth the additional time and effort. There are several other methods of fixation that can be used in performing a bunionectomy. The screw provides the greatest amount of compression, strength and stability.

Some patients request the removal of the screw after the surgery. If required, the screw can be removed easily during a ten minute office procedure. This procedure may be performed when patient have problems with screw. The screw will not affect the security metal detectors at airports.

Do bunions ever return?

No surgeon can guarantee perfect results. Unfortunately, if the wrong procedure is performed, the recurrence rate can be quite high. Many of the minimal invasive procedures and laser techniques have a high recurrence rate because they generally cannot accurately realign the bones. These types of procedures have become less popular recently due to the incidence of recurrence as well as other problems. There are several bunion procedures. The choice of the correct bunion procedure is critical. The skill of the precision in which the bone is cut, shaped and realigned is essential in producing an excellent result.

Photo of Hallux Valgus before and after surgery

Photo of Hallux Valgus before and after surgery

Timeline for Hallux valgus surgery

Day 1-Day of surgery:

The surgery is performed on this day, and requires approximately 30 minutes of surgical time. In addition, preparation time before the surgery and recovery time after the surgery is also needed. The total amount of time spent at the surgical facility or hospital is about 2 hours. Arrangements for transportation home after the surgery must be made prior to surgery.
The procedure is performed either under local anaesthesia – or under intravenous sedation where the patient is under sedation breathing with the assistance of an oxygen mask. With intravenous sedation anaesthesia there is no memory of pain or hearing undesirable sounds during surgery. Due to careful anaesthesia and careful monitoring during anaesthesia there is rarely any nausea after the surgery. Usually the surgical procedure is pleasant for the patient with little or no memory at all of the surgery.

The patient leaves the facility walking with a special surgical shoe that will be provided for the patient. Crutches or walkers are NOT needed. There is no cast on the foot, only a soft gauze dressing. The dressing must stay dry and is not changed until the first post-op office visit.

The patient may ambulate for short distances within the home or to a car during this period, using the surgical shoes.

It is equally important during 4 weeks following surgery to keep the foot elevated to the level of the waist, supported by a chair or small table.

The reduction of foot swelling during this period will have a significant effect on the entire recovery process.

First Post-Operative Visit – Day 14:

The patient comes to the office. The sutures (stitches) are removed and bandages are changed at this visit.

It is normal to see mild bruising and some dry blood on the foot.

The patient continues to wear the same surgical shoe, with limited and gradually increasing ambulation.

It is extremely important to avoid excessive ambulation during the first four weeks, as it will cause increased foot swelling and a delay in healing.

Week Four:

The patient removes the bandage and may now take a complete shower but not Jacuzzi or hot tub which may cause increased swelling. During this period, the patient will start wearing a wider shoe or half-size larger athletic shoe. The comfort levels will vary. Do not push yourself. The larger shoe is needed due to moderate foot swelling which is normal at this time.

Be sure to do the big toe exercises twice a day, as described in the office. Depending upon need, physical therapy may be recommended at this time .

Week Five:

Mild exercises may begin, including short distance walking. Avoid strenuous exercises such as tennis.

You should notice a significant decrease in foot swelling (edema).