THE VARIOUS TREATMENTS FOR HALLUX VALGUS

Ranging from simple correction to surgical operation, treatment for hallux valgus depends on the degree of the deformity and the disabling impact.

If the hallux valgus is not very great and pain is only mild, it’s the footwear that should be adapted to the foot: wide, deformable fittings, adapted to the architecture of the foot.

If there are deformities such as flat foot aggravating the pain, orthopedic insoles are recommended to reduce deformity and pain.

If the hallux valgus is advanced and contact with even a wide shoe is painful, surgery becomes an important option. It’s the foot that has to adapt to the shoe and to the standing position.

Simple “reaming” surgery

Simple surgery on the soft tissues (tendons and skin) with reaming of the hump is no longer practiced, as results were moderate at best and not lasting. Surgeons used to say that the results of foot surgery lasted no more than 5 or 6 years before you had to start again.

Surgery by osteotomy

Nowadays, we propose osteotomy to treat hallux valgus. This associates bone cuts to put the bones back in position, well aligned, and fixation using surgical material: screws, staples or plates. These techniques are derived from woodworking and marquetry. Several types of osteotomy can be performed in the first metatarsal and first phalanx of the big toe, all in the same operation.

First metatarsal osteotomy

For the first metatarsal, the surgeon can choose between several types of osteotomy to realign the bone, near either the base, the middle or the distal end of the metatarsal.
More than 20 techniques have been described, all restoring good alignment. The choice depends both on your individual foot and on your surgeon’s habits. But all of them have been validated.

If the surgeon decides on a distal cut, as tends to be the case in France, the most well-known procedures are known as “chevron” or “Scarf” osteotomy.

Scarf osteotomy

Chevron osteotomy

These osteotomies get rid of the hump while conserving joint motion. However, the deviation of the big toe also needs correcting, as it remains tilted sideward and the result is incomplete.

Big-toe phalangeal osteotomy

Big-toe phalangeal osteotomy completes the realignment; it is often known as Akin or P1 (first phalanx) osteotomy.

Osteotomy of the first phalanx of the big toe

Correcting the deviation of the metatarsal and of the first phalanx realigns the foot.

Correction of hallux valgus and its complications

The choice of osteotomy depends on various factors, but all of the different types have proved effective. In all cases, needless to say, the big-toe joint is conserved and its motion is normal. If you want to wear high heels, no problem!

Big-toe fusion (or arthrodesis)

In some cases, osteotomy is not enough to correct the deformity, and arthrodesis (consolidating, blocking, fusing the joint) needs to be considered.
Fusion, or arthrodesis, consists in blocking the defective joint in the correct alignment position, which will then be definitive. It is advised in case of severe deformity, recurrence of hallux valgus, infection sequela or inflammatory rheumatism.

   

Fusion guarantees a good result, with perfect big-toe alignment no matter how severe the original deformity; above all, the result is definitive, with no risk of recurrence. Just one little drawback: heels higher than 5 cm (2 inches) aren’t easy to wear.

Big-toe fusion (arthrodesis)

Treatment of associated lesions

Treatment of hallux valgus is not just a matter of treating the protrusion. It is also necessary to treat the complications: claw-toe, hammer-toe, corns and calluses. This is what is meant by “treatment of associated lesions”.

Claw-toe: 

   

Several procedures have to be combined: lengthening tendons, resecting corns and calluses, removing bone fragments, fusing small joints, and then perhaps stabilizing everything with a pin or internal implant.

Treatment of claw-toe by arthroplasty

Treatment of claw-toe by fusion

Metatarsalgia:

To treat metatarsalgia (plantar pain and calluses), it is sometimes necessary to lengthen some tendons and make some cuts (osteotomies) in one or more tarsal bones, possibly fixing them with screws, either opening the site so as to be able to check everything or else using a minimally invasive percutaneous technique. These procedures are performed at the same time as the hallux valgus surgery, and depend on the lesions that are present.

Postoperative course and recovery:

Recovery depends on the state of the foot before the operation, and on your age, medical history and the chosen treatment: no two feet are the same!

Generally speaking, you should plan for 1 month at home, with special postoperative shoes and dressings, then 2 more months with comfortable shoes (sports shoes, sandals, wide boots). So it takes about 3 months to be able to get back to elegant shoes, as the edema can last quite a while.

The cause is, of course, the operation, but also possible decompensation of poor preoperative venous status. So it takes about 6 months to be really okay, and nearly a year to be able to put it all behind you. Returning to work depends on the type of work and the hours, travel time and any special footwear requirements: safety shoes in a factory, court shoes for stewardesses… You will need 1 to 3 months off work.

tbwebThe various treatments for hallux valgus
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