The condition

Hallux valgus is a crooked big toe joint. This is often the result of wearing too narrow shoes and/or too high heels for many years. This is very common in women. Sometimes a familial tendency can also play a role. There can also be cases of juvenile hallux valgus.

Due to this condition a painful bump or bunion is often formed on the inside of the big toe. This bump can sometimes become inflamed and is often cumbersome when wearing shoes. In the long-term the smaller toes can also become affected, developing deformities such as crooked toes and possibly hammer toes, and the big toe will grow under or over the second toe.

In the long run the big toe can become partially dislocated, combined with a deterioration of the deformity and progressive arthrosis. The condition can also remain relatively stable, though. If you find this condition too cumbersome, it would be best to have your toe put in a straight position again. This can be done in several ways, depending on how severe the damage is.

Technique

- The operation is performed under peridural or general anaesthesia. It would be best if you talked about this with your anesthesiologist.
- You will usually stay in hospital for about two nights.
- The operation will be performed in a so-called bloodless field: The blood is squeezed out of the extremity using a rubber band, then a strap, such as a blood pressure meter cuff, is placed. This makes it possible to perform bloodless surgery.

- An incision will be made on the inside of the big toe and the forefoot. Sometimes an additional incision is also made in the back of the foot and, if needed, in the smaller toes.

A technique will be chosen according to the seriousness of the condition. Of course, this will have already been decided upon at your doctor’s visit.

An osteotomy (or correcting fracture) is usually performed on the first metatarsal as well as on the first phalanx. This is usually fixed (osteosynthesis) with screws and staples. Additional corrections on the small toes (for instance for hammer toes) are generally fixed temporarily with small pins for a period of roughly 5 weeks. After this period the pins can simply be taken out at the surgery.

Arthrodesis : In case of severe arthrosis the big toe will sometimes need to be fixed in a corrected position. The toe will be placed in a way that allows the foot to roll normally as you step. For this it will have to be directed upward.

Normal consequences and follow-up care

After surgery a temporary bandage will usually be applied. It will be replaced before your discharge from hospital. You will get a postoperative bandage shoe, which will allow you to stand immediately.

The sutures are dissolving, so they will reabsorb spontaneously.

- The first days after surgery your foot can be painful. You will receive the necessary pain therapy for this. Usually, a pain pump is provided. The pain will gradually ebb away.
- In the first weeks it is recommended to elevate your leg regularly, since it still swells easily when hanging down for too long, resulting in an increase in pain.
- In the first weeks antithrombotic prophylaxis is administered. This consists of daily hydrodermic injections to prevent phlebitis or embolisms.
- If pins were used, they will be removed after 5 weeks.
- If possible, you can try on some normal shoes (wide enough) after 6 weeks. Sometimes there is still some swelling, though, but that will go down gradually. You can start walking wearing wide sandals then.
- In future it would be better not to wear any narrow shoes or too high heels anymore, since the condition can recur.
- Despite the surgery it can be necessary to wear arch supports in your shoes afterwards.

Complications

The following complications are possible after hallux valgus surgery, among others.
- Wound infection: as in any surgical procedure an infection of the wound can occur, despite all the precautionary measures taken. This infection is usually easily treatable with antibiotics.
- Pin tract infection: When using percutaneous pins an infection can also occur. If antibiotics do not help, the pins sometimes need to be removed prematurely.
- Deep vein thrombosis, phlebitis and lung embolism: Despite the administering of anticoagulants this complication can sometimes occur. A blood cot forms in a vein and travels to the lungs (embolism). The patient has to be admitted to hospital for anticoagulant therapy that will be continued at home by means of medicines.
- Loss of sensation: Since the cutaneous nerves sometimes cross the area of incision, an injury can occur from the incision or from wound traction (a nerve bruise). This causes a temporary numbness in a part of the feet. It is rarely permanent.
- RSD: is an unexpected disorder of the local blood supply that causes swelling, warmth sensation, tingling, sweatiness, clamminess, and shining skin as well as local osteoporosis. If you have these symptoms, you must contact your physician quickly, since the prognosis is usually positive if treated early.
- Pseudarthrosis or the inadequate healing of bones: Despite the best fixation techniques the bones sometimes do not want to heal properly. Additional surgery will then be required.

Bandage instructions

Wrap the bandage around the foot a few times. Go behind the big toe and pull it up. Go over the big toe, back to the inside of the sole of the foot, and wrap it around the front of the foot again while the toe is being pulled to the inside. (away from the other toes). Repeat this number 8 shape for a few times without tying off.