Hallux Valgus "Bunion"
What is a hallux valgus deformity?
A bunion, in medical terminology also known as hallux valgus (in Latin: Hallux – a big toe; Valgus – bending of the joint to an abnormal position). When the big toe starts pointing inwards, it causes the bones of the foot to realign in a new position. The soft tissue and the bones then form a prominence on the medial, or inner side of the foot. In some cases, bunions can also form on the lateral, or external side of the foot too. This happens when the bones of the fifth toe are dislocated. Hallux valgus deformity does not appear out of nowhere. It actually takes a while for the bones and soft tissue to relocate, and thus, form a bunion.
Deformity: At first, the patient may just notice a small change in the position of the big toe. If nothing is done to prevent hallux valgus, the deformity of the foot will progress further.
Pain: At a late stage, hallux valgus leads to pain and impaired movement. It may become difficult to balance on one foot or step on the toes.
Shoes: What is more, bunions make it extremely difficult to find the right pair of shoes, since the form of the foot changes dramatically. Women are 10 times more likely to have a bunion formed.
Hallux valgus is a common problem in the general population. Approximately 23% of people will have some form of hallux valgus with an increase to 37% in patients older than 65 years of age. Because of more flexible joints, women are 10 times more likely to have a bunion formed at some time in their life. Hallux valgus may be a result of tight footwear, congenital deformity, inflammation of the joint, or joint disease (osteoarthritis).
When does hallux valgus deformity require surgery?
Untreated hallux valgus causes inflammation, pain, and misalignment of the toes. The symptoms often worsen when wearing uncomfortable shoes. Since the structure of the bones and soft tissue changes, bunions may also be responsible for a decreased sensation around the bunion. Fortunately, it is possible to treat hallux valgus through surgery, and thus, regain pain-free and aesthetic feet. The surgery helps to straighten the big toe, correct claw toes, and remove the ball of the foot (if one is present).
For many patients, hallux valgus surgery is mainly a way to achieve cosmetic goals and wear open-toe shoes again.
However, bunion treatment is not only about aesthetics, but also about restoring the alignment of the bones and correcting weight distribution on the foot.
Another reason for undergoing hallux valgus surgery may be pain which does not subside when wearing comfortable shoes, bunion insoles, or after doing foot exercises. It is medically justified to perform hallux valgus surgery when the bunion restricts living actively.
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Appointment: First of all, a prospective patient should contact the clinic and schedule the first appointment. A surgeon will assess the symptoms one has and other particular information that may be important for the treatment. There are more than 100 different techniques to remove hallux valgus, therefore, the type of surgery depends on the individual case. The severity of the misalignment usually determines in what way the bunion will be removed.
Medical Tests: A patient will have to undergo several medical tests, such as X-rays of the feet and electrocardiogram to check the heart function. In order to see if there are any underlying illnesses, urine and blood works are also performed.
Smoking and Alcohol: Tobacco and alcohol consumption is strictly prohibited at least a few weeks before and after the surgery.
Medications: The patient is required to stop taking blood-thinning medications, such as aspirin, a few days before the surgery.
Other Instructions: Patients are asked not to eat or drink at least 8 hours before the surgery. The doctor will provide a detailed plan to follow in order to avoid any possible complications.
Hallux valgus surgeries are performed under spinal anaesthesia and deep sedation, meaning that the patient is asleep during surgery. After the foot is bandaged, the patient can be taken down to the recovery room. The heart rate and blood pressure will be monitored while waiting for the anaesthesia to wear off. Hallux valgus surgery is an inpatient procedure and the patient is discharged the following day. In more difficult cases, hospitalization may take up to 2 days.
Recovery is a crucially important part of the whole treatment. The foot is not immobilized following the surgery, thus, post-operative care includes regular changes of the dressings, wearing a night splint, and elevating the operated leg. The earliest flight home can be scheduled 5 days after the surgery.
After leaving the hospital, initial rehabilitation will take about 2 weeks. When recovering, the operated leg should be kept elevated for as much time as possible.
Pain Control: For pain control the doctor may recommend taking anti-inflammatory drugs, such as ibuprofen or paracetamol. It is recommended to have someone to check on the patient for the first 24 hours after the surgery. The patient’s knee should be elevated for the first few days to reduce swelling. It is advised to apply ice compresses which helps to alleviate pain and promote healing.
Bandages and Sutures: It is recommended to avoid wetting the bandages for about 12 days. Sutures are also removed in 12-14 days.
Shoes: For 4 to 6 weeks post-surgery patients have to wear forefoot decompression
shoes to aid in walking. In 5 weeks patients can wear wide, soft, comfortable shoes again.
Full Recovery: Depending on their line of work, with a doctor’s consent patients can return to a sedentary job as soon as 2 weeks after the surgery. Patients are allowed to drive from week 4. If possible, patients are advised to take one month off work to fully rest and recover.
Exercise Routine: The patients are provided with an essential exercise routine which strengthens the muscles and stabilizes the foot.
It is recommended to have hallux valgus surgery on one foot at a time. If surgery has to be performed on both legs, it is recommended to wait at least 3 months to continue with the second foot. Having surgery on both feet at the same time will make the recovery and rehabilitation extremely difficult with a bigger risk of not regaining full function.
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