hallux valgus is one of the most widespread diseases of the foot.It appears as a lateral deviation of the big toe which, gradually leaning towards the other fingers, causes an axial deviation of these to chain as well. At the same time, a bony protrusion is formed on the side of the base of the finger which, in conflict with the shoe, leads to the formation of a painful bursitis which sometimes even results in an ulceration of the skin.
Hence the difficulty or impossibility of finding a suitable shoe, with the serious functional damage that derives from it. In addition to an annoying aesthetic damage.
What are the causes of hallux valgus?
The causes of the onset of hallux valgus are essentially of two types.
In primitive hallux valgus they are genetic and constitutional .
This pathology develops over the years, often tracing a defect already present in the same family.
It is called primitive or idiopathic hallux valgus, because it cannot be traced back to other causes or evident situations that could predispose its formation.
In the secondary hallux valgus , to determine this deformity can be acquired causes , such as autoimmune diseases (e.g. rheumatoid arthritis ), degenerative (e.g. pronated foot post-menopause), post-traumatic or the presence of an incorrect axis of the hindfoot with calcaneus valgus and pronation under astragalic.
The type of shoe is never among the causes that determine the onset of hallux valgus or its worsening, but it is rather the hallux valgus that is not tolerated in a specific shoe (high heel, narrow toe), since this the latter aggravates inflammation and redness.
It is an essentially female pathology , occurring in the majority of the vessels after 40 years of age, even if the male sex is not completely free of it.
What are the symptoms of hallux valgus?
- Pain at the base of the big toe where a bony protrusion (exostosis) is formed on the internal side, surmounted by an increasingly inflamed and reddened bursitis (so-called “onion” or “potato”)
- At the same time, the big toe tilts progressively laterally towards the fingers, causing a secondary axial deviation also of the latter.
- With the worsening of the pathology, the big toe can even be located under the second finger which, at this point, dislocates on the metatarsophalangeal joint, until it is raised and hyperextended. More rarely, however, it is placed above the second finger, pushing it plantarly.
- The other fingers , also in an increasingly serious way, assume the hammer attitude (in a more or less rigid flexion of the intermediate joint with painful calluses on the back of the finger), up to dislocating themselves on their respective metatarsals.
- At the same time, there is the formation of painful calluses on the sole of the foot, due to the excessive plantar protrusion of the metatarsals (“Fall of the metatarsals”), following the altered distribution of the load.
- Orthopedic specialist examination
- For the assessment of the severity or association of other pathologies, however, a traditional and simple X-ray taken in loading and in the two standard projections is necessary.
- It may be necessary to perform a CT scan or magnetic resonance imaging of the foot , if the coexistence of other pathologies is suspected in the clinical examination, capable of determining different choices in surgical treatment or of changing their priority (eg Morton’s neuroma , congenital malformations or upstream pathologies in the case of secondary hallux valgus, etc.).
Some measures can be adopted to alleviate the symptomatology affecting the foot, which however are not able to cure deformity:
- Avoid activities that force you to stand for long periods of time;
- Use appropriate footwear : the best shoe to wear takes on the natural shape of the arch. The heel should not exceed 4-5 cm., Because excessively high heels force the foot to an unnatural position;
- Orthotics : they allow to avoid an overload of the front part of the foot and help to minimize painful symptoms;
- Physiotherapy treatments to reduce symptoms and ease pain;
- Medicines : they can be indicated to reduce pain and inflammation.
If the symptoms are severe and alternative treatments are not effective, the solution is surgical treatment .
The innovative percutaneous technique has revolutionized and improved the surgical treatment of hallux valgus , while traditional techniques are now reserved for cases in which the percutaneous is clearly contraindicated. These are the cases in which there is a serious joint pathology from degenerative and post-traumatic causes, in the presence of which it would not make sense to simply restore the correct axial structure of the big toe and fingers.
In these cases, in fact, the surgical intervention must be aimed at the treatment of joint damage with traditional techniques of arthroplasty with or without implantation of prosthetic material, atrodesis, etc., through which the correction of valgus is a secondary consequence.
Otherwise, in a common hallux valgus, the percutaneous technique is always possible and it is no longer the severity of the deformity that determines a contraindication.
The percutaneous technique
The percutaneous technique is characterized by the use of small cutters similar to those used in the dental field for the modeling and section (cutting) of the bones, introduced through the skin and in contact with the bone, through tiny holes, without the need for incisions surgical.
The different typology of these drills allows the execution of different surgical gestures (milling of exostoses, section – osteotomy of metatarsals or phalanges), often not dissimilar from those performed invasively in traditional surgery.
The correctness of the sections (cuts) or of the modeling of the bones is checked during the intervention through the use of the intra-operative fluoroscope, so that the image of the operating field is always visible on the monitor by means of a scope (use of x-rays) .
Obtained in this way, a “sweet” foot to the manulae correction, by moving the small fractures practiced and then left free, the final correction is ensured by a special containment bandage that in no way must be removed, if not by specialized personnel.
The advantages of percutaneous technique
The percutaneous technique for the treatment of hallux valgus is characterized by:
- Speed (15/20 minutes of intervention)
- Absence of surgical scars
- No need for synthesis means (nails or screws)
- Immediate walking (the patient can walk immediately after surgery)
- Quick recovery
- Minimization of post-operative complications
Frequently asked questions
Is surgery for hallux valgus painful?
If performed with percutaneous technique, pain is often absent or limited to the sensation of discomfort. Only in some cases the pain occurs, but always in a tolerable form and never as severe as in traditional surgery, so in the first days the use of an analgesic may be necessary. For this purpose, the collaboration of the anesthesiologist is very important in the use of long-lasting anesthetics and preventive treatment of pain before the effect of the anesthesia disappears.
Is physiotherapy necessary after surgery?
It is not necessary because the patient can walk independently, without the aid of aids.
Is it possible to operate both feet simultaneously?
Since immediate walking is necessary with the percutaneous technique, the possibility of safe support on a healthy foot is just as necessary. Therefore bilateral treatment is not possible which would otherwise force the patient to an incorrect gait, with unbalanced load and consequently an incorrect arrangement of the fractures left free.
How long can I drive again?
After the operation, it is advisable not to go back to driving before 20 days, in order to ensure at least a fibrous stabilization of the fractures, in order not to risk an anomalous displacement of these.
When can I go back to sports?
Not earlier than three months in the case of sports practiced in standing position, walking, running. Otherwise, common sense makes the rule, considering that as long as the bandage is present, this must be preserved.
What shoes can I wear after the surgery?
Immediately after surgery, it is necessary to wear a special shoe that allows you to walk despite the size of the containment bandage. Then, after three / four weeks it will be possible to wear a shoe with a higher number and with a broad and pointed toe (e.g. men’s shoe). After healing, there are no limitations.
What is the best time of year for surgery?
Each period has its advantages. In winter, the cold helps control edema and sweating.
On the other hand, it is more difficult to find a closed shoe that can contain the bandage without forcing the foot.
In spring and summer, if on the one hand, the higher temperature can facilitate sweating and sometimes slight skin maceration under the bandage, it is however easy to use open shoes and flip flops.
Do I have any friends who have undergone this surgery whose deformity has manifested itself again?
With the percutaneous technique the possibility of recurrence of the deformity has further reduced, even if still present. In such cases, it is a very partial, non-painful recurrence. Often, even, it is more than a recurrence, an incomplete correction in cases of particularly serious departure