Anyone in Switzerland looking for a proven specialist in ankle and foot conditions or injuries is highly likely to end up with him: Dr Isam El-Masri Isam El-Masri runs his renowned ‘Fuss-Paxis Bern’ in the heart of Bern’s beautiful old town, where he offers the full range of treatments with immense expertise and boundless empathy – from the latest conservative methods to innovative minimally invasive procedures. Nevertheless, he has devoted himself with great passion to a field that affects many people: when it comes to hallux valgus, his professional judgment is sought after internationally.
The patients who place themselves in the experienced hands of Dr Isam El-Masri certainly do not come only from the region around the Swiss capital. The specialist, who grew up in Berlin and has been practicing in Switzerland since 2005, has a reputation that extends far beyond Switzerland’s borders. Some people undertake long journeys because they know that Dr El-Masri has an unerring eye even at the diagnostic stage – and particularly when it comes to complex surgery on the foot or ankle, it is important to turn to a true expert: After all, the feet bear the entire body weight when walking, enable balance and are therefore among the parts of the body that are subjected to the greatest strain. With a total of 26 bones connected by joints and ligaments, the foot and ankle are also particularly complex. The Leading Medicine Guide spoke to Dr El-Masri about his specialist field. He also immediately dispelled a long-held myth.
First of all: what exactly is hallux valgus? Behind this rather dynamic-sounding name lies a painful misalignment of the big toe. In the German-speaking world alone, well over ten million people suffer from this condition, also known as a bunion: In advanced cases, the big toe is noticeably crooked. This is not only a visual problem for those affected, but also a physical one, as this crookedness of the toe can also be very painful. A common symptom of hallux valgus, alongside the misalignment of the big toe, is the gradual displacement of the second toe, which can lead to additional painful strain. It also becomes increasingly difficult for those affected to find suitable footwear in which the foot still fits comfortably. Incidentally, more women than men suffer from hallux valgus, which is primarily due to hormonal factors.
Hallux valgus can often be recognized immediately by the bunion © luaeva/AdobeStock
Debunking the myth: Dr El-Masri sets the record straight
“If you search for the term hallux valgus online, you’ll find a great many explanations containing misinformation,” emphasises Dr El-Masri right at the outset. He continues: “It is not true that hallux valgus is caused by wearing the wrong shoes,” he points out, “but it is still widely believed that women are prone to hallux valgus because they often wear high-heeled and overly tight shoes.” Which does not mean that ill-fitting shoes have no consequences: “The development of hammer toes or claw toes can be caused by ill-fitting footwear, but hallux valgus has a purely genetic cause.” It is clear to see: the renowned foot specialist is keen to dispel this myth.
The emergence of this myth is also linked to the status that foot specialists have long held within the field of orthopedics: “The profession of foot surgeons has been neglected for a very long time. Today, we are among the youngest group of specialists within the surgical field, with one of the fastest rates of development in terms of research,” states Dr El-Masri.
The consequences of wearing the wrong shoes: hammer toes and claw toes
People who frequently wear shoes that are too tight or too high are likely to develop so-called hammer or claw toes – that is, deformities that usually affect the second to fourth toes of the foot. If, for example, a toe is overextended at the metatarsophalangeal joint but bent at the middle and distal joints at the same time, this is referred to as a claw toe. A hammer toe is only bent at the middle joint. Hammer and claw toes are usually painless and merely present a cosmetic problem. Over time, however, pressure points and ‘corns’ can form, making it almost impossible to wear normal footwear. This also encourages misalignments of the other toes. In any case, a podiatrist should be consulted here too.
Hallux surgery – yes or no?
The key question with hallux valgus is, of course: should the deformity be operated on – or can surgery be avoided? “My clear answer is that surgery is not absolutely necessary,” says Dr El-Masri. Like many highly specialized doctors, he always prefers conservative treatment where possible: “The recommendation for surgery depends on the level of suffering,” he explains: “As soon as you are experiencing significant suffering with a reduced quality of life, the hallux valgus deformity should be surgically corrected. In the early stages, symptoms can often be alleviated with foot exercises, physiotherapy and appropriate footwear. For me, surgery is always the last resort.”
Children can also suffer from the development of hallux valgus; boys are affected later than girls due to delayed development. Surgery is only possible here once the bones have fully matured, usually from the age of 14.
Development of hallux valgus deformity: Left healthy, right hallux valgus © barbulat/AdobeStock
Minimally invasive surgery
“However, with hallux valgus, only the symptoms can be treated conservatively. For example, if someone comes to see me early on with a hallux valgus that is not yet very pronounced, I can help them with a minimally invasive procedure. To put it simply, without sawing or open surgery,” he explains. What sounds a bit brutal is, in fact, the reality of open surgery. With a minimally invasive procedure, hallux valgus can be easily corrected using a drill. “Such a procedure takes only about ten minutes,” says Dr El-Masri, describing the operation. It goes without saying that the well-equipped “Fuss-Praxis Bern” has the full range of expertise required for this. There are now more than a hundred surgical procedures available for treating a “crooked toe”. Following a minimally invasive procedure, patients can walk again without difficulty very quickly – and can even resume sporting activities after around six weeks. As a rule, patients are symptom-free after a short rehabilitation period. The hospital stay and time off work are significantly reduced thanks to this innovative surgical method.
Open Lapidus surgery
If a patient waits too long, surgery becomes unavoidable. “In open surgery for hallux valgus, such as a so-called Lapidus procedure, the toe bone must be cut and a stabilizing correction made to the tarsus. This correction is then supported with screws. I usually use headless screws, which can remain in the foot. Screws with heads can cause discomfort after a while and must then be surgically removed,” explains Dr El-Masri. Of course, open surgery is always much more invasive: “With open surgery, there is a wound site, the likelihood of scar sensitivity is high, and the foot must not be rolled on for a prolonged period to protect it,” he explains.
Why women get the ‘shorter’ one
There is a direct link between the development of hallux valgus and the nature of the connective tissue. “Many women often develop hallux valgus after pregnancy due to hormonal changes. This also affects women in the middle and at the end of the menopause, when their hormonal balance changes completely,” says Dr El-Masri, emphasising: “I treat mostly women in my practice – they are affected much more frequently, as the hormonal influence of estrogen usually causes a general weakness of the connective tissue.”
Complications of untreated feet
Anyone who ignores a hallux valgus or any misalignment of the toes risks significant consequential damage. “You have to imagine that our feet bear our entire weight. We have what is known as a mechanical chain running from the feet, through the knee and hip, right up to the back,” concludes Dr El-Masri. So anyone who walks “crookedly” all the time due to a toe deformity, or even puts weight on one side while walking, must expect further consequences within this mechanical chain.
Walking barefoot frequently is good for your feet © Halfpoint/ AdobeStock
“Do something for your feet!”
And what shoes does the specialist recommend? Is walking barefoot an option? “Anyone who walks barefoot a lot is doing their feet a favor. Wearing flip-flops in summer is the closest thing to walking barefoot. However, your toes shouldn’t cramp up when you try to hold the shoes in place using the flip-flops’ toe straps. Whenever you get the chance, walk barefoot!” recommends Dr El-Masri. Changing the type of shoe you wear regularly is also advisable. “Try to avoid wearing shoes with insoles all the time. Your foot gets used to this protected position and the muscles of the arch of the foot become increasingly weakened,” he explains.
A wish and a look to the future
During the conversation, Dr El-Masri ventures a look into the future – and expresses a hope: “A great wish of mine would be X-ray machines that emit no or only minimal radiation, so that a practice could work with a portable device without the lead-lined walls and glass panes currently required.” He adds hopefully: “I also hope that in future, patients will come forward for a consultation at an early stage to avoid potential complications. Furthermore, I aim to perform minimally invasive surgery using screws even in cases of severe foot deformities.” And finally: “Overall, there is still a great deal more research to be done into foot deformities.” As foot surgeons are the smallest but also one of the most active groups among surgeons, we can look forward to new findings from research. It’s good to know that Dr Isam El-Masri is also actively involved in research!
Dr El-Masri, thank you very much for the informative conversation! Anyone wishing to contact this renowned specialist directly can do so very easily via his profile page on the Leading Medicine Guide.
