Percutaneous hallux valgus
What is percutaneous hallux valgus surgery?
Percutaneous hallux valgus surgery is a minimally invasive operation to correct the position of the bones of the foot without damaging the surrounding anatomy.
The operation uses instruments with a very small (1 mm) blade to make an opening for other instruments resembling a dentist’s drill. There is no scar left by this “micro-incision”, and no need to implant any metallic material such as screws or pins, which would then have to be removed subsequently.
Percutaneous surgery can correct small to moderate hallux valgus
The advantages of percutaneous surgery for hallux valgus
Compared to classical “open” surgery, the advantages are:
- No incision, so no visible scar afterward
- No screws, pins or other metallic foreign bodies in the foot
- Less postoperative pain, as the soft tissues are not involved
However, the technique doesn’t avoid the swelling (edema) after the operation.
How does the operation proceed?
Hallux valgus surgery is essentially day surgery, with no overnight stay, under locoregional anesthesia: that is, just the operated foot is anesthetized.
For patients living alone or very far from the hospital, however, an overnight stay is recommended. It is also possible to operate on the hallux valgus percutaneously under general anesthesia; the surgeon administers an injection on top of the anesthetic, to reduce postoperative pain. If operating rooms scare you, you can come with your MP3 or whatever and listen to your music “in theater”.
Watch a percutaneous hallux valgus operation on Vimeo, using the password hv2016: https://vimeo.com/169206508
Can you have both feet operated on at the same time?
Technically, it’s possible – but it is not recommended, as you wouldn’t be able to use the healthy foot to let the operated foot rest. There is also a risk of more serious complications in bilateral surgery, and especially of nosocomial infection. For these reasons, most surgeons recommend an interval of at least 2 weeks between the two operations in case of bilateral involvement.
Is the operation painful?
Hallux valgus surgery has the reputation of being painful. The percutaneous procedure also involves bone cuts, and this can cause pain.
To relieve the pain, pain-killers (analgesics) are prescribed starting from the preoperative consultation. The best strategy to combat pain is to take the pain-killers even before any pain sets in, for at least the first two days. In this way, the operation can be not too disagreeable an experience.
NB: one of the prescriptions you will be given in the consultations is for morphine (low dose, of course) and is valid only for 3 days. So you should get it filled at your pharmacy on the same day, at store it somewhere safe.
What restrictions are there after the operation?
The first concerns dressings. No screws have been used to fix the bones, which are kept in position by a special bandage, applied in the operating room. It is essential not to interfere with this bandage before the first check-up 1 week after surgery. Afterward, a splint and other bandages will maintain the correction.
You will have to plan for 2 to 4 weeks’ complete rest at home, depending on the type of operation. During this period, you can walk at home for everyday purposes, but not go out or drive. So far as possible, let the foot rest higher than heart level, to help the swelling go down. Foot surgery requires some advance organization!
Time off work after these operations is on average quite long: 3 to 8 weeks, depending on your occupation. The bones of the foot need time to consolidate after reaming. On the other hand, you can put your weight on the operated foot even on the same day as surgery, and crutches are not a good idea. Athletic patients will have to suspend their sports activities for 4 to 12 weeks.
The foot may remain swollen for 3 to 6 weeks, and this is nothing to worry about.
You can wear any kind of shoes after the operation. The big toe is not blocked with this technique, so the fanciest footwear is fine! But you will have to wait 3 months after the operation before attempting heels higher than 3 cm (1 inch), and even then it may be uncomfortable due to the edema.
Can all deformities be treated percutaneously?
All deformities can be corrected, as long as the joint has not been completely destroyed by arthritis. If it has been, correction is still possible, but pain will not be relieved; it would be better to resort to classical surgery. The other limitation is the risk of recurrence, which is high in severe deformity; this can be very well assessed in consultation by examining the architecture of the foot on X-rays.
Are there age-limits to percutaneous surgery?
Age is never a contraindication, whether you are adolescent or elderly.
The technique involves no incision, and so there are hardly any healing problems and the bone consolidates very effectively. Moreover, as the operation is almost always performed under local anesthesia, age-related risks are slight. It’s never too late to put nice shoes on!
The only real contraindications to percutaneous surgery are smoking and non-controlled diabetes.
How to find out more about the postoperative period:
Watch these explanatory videos: