Patients with hallux valgus (bunion) usually think about surgery when there is great pain at the level of what we know as “exostosis” (the bump), accompanied by difficulties with footwear. And almost more frequently when they come to the consultation for the consequences that the bunion causes in the rest of the forefoot, either hammertoes, metatarsalgia (pain in the sole of the foot) or even Morton’s neuromas (very painful inflammation of a nerve in the sole of the foot).
If a forefoot presents multiple deformities and among them is the bunion, this should always be operated and, if possible, at the same time as the rest of the forefoot, since the big toe acts as a real post that prevents the rest from collapsing and deforming. We must remember that if we correct hammertoes and we do not correct hallux valgus, these toes will most likely deform again. Only in elderly patients in poor health can this rule be skipped.
Not only the lump needs to be removed
Only removing the lump is one of the most frequent and serious mistakes. In most cases this would lead us to an absolutely insufficient reduction, not to say null, since the origin of the deformity comes from two elements: the deviation of the metatarsal and that of the toe, at the apex of both we find the “exostosis”, the lump. In other words, to correct hallux valgus we must cut the metatarsal (osteotomy) and the first phalanx of the big toe, varying its position until it is completely straightened. Finally, obviously, the so-called bulge must also be eliminated.
Another common mistake is to think of intervening both feet at the same time (if the patient suffers from both feet). In most cases I recommend doing only one foot, usually the more painful one, so recovery is faster because the other foot can be used normally. In general the recovery time can be more than twice as long. In the past, both were done at the same time because foot surgery was an extremely painful experience, and so it was a way for the patient to suffer only once. Today the minimally invasive techniques we use, such as percutaneous surgery, allow this suffering to be infinitely less.
Painless
Nowadays, foot surgery is almost painless thanks to the use of less aggressive surgical techniques such as percutaneous surgery and the good work of our anesthesiologists who use techniques of “nerve block” that achieves a long duration of anesthesia, aided by the use of anesthetic drugs also of long duration. For this reason most of our patients can go home the same day of surgery.
Current percutaneous surgery allows us to correct approximately 90% of hallux valgus, while the rest require open surgery. These evolved techniques allow us to use screws, for example, in the most severe cases without having to “open”, and with this we can achieve results absolutely comparable to open surgery, with the advantage that the scars are minimal, the postoperative period is more pleasant, without admission, the pain is minimal and, what is very important, the degree of mobility of the big toe is very good, which greatly favors a rapid recovery and the use of a normal shoe very early, even with an elevated heel.