Hallux Valgus Surgery - Medical Experts

Hallux valgus surgery is considered when the misalignment causes symptoms and non-surgical treatments have not provided sufficient relief. In hallux valgus, the big toe deviates towards the other toes, whilst a bunion protrudes on the inside of the foot.

The individual symptoms are the decisive factor. They can affect walking, choice of footwear and everyday life. The aim of the operation is to correct the position of the big toe.

Before the procedure, the guidelines generally recommend three months of non-surgical treatment. A correction sought solely for aesthetic reasons is not considered medically necessary. Whether surgery is appropriate can only be assessed following a medical examination.

Preparation involves a discussion about the planned procedure, the anaesthesia and any potential risks. It is best to make a note of your questions before your appointment. You should also clarify when you will be able to put weight on your foot again and how long you are likely to be off work.

Smokers can reduce the risk of wound-healing problems by giving up smoking a few weeks before the procedure. Discuss any plans to give up smoking with your doctor in good time.

Possible procedures include corrective osteotomies. This involves cutting through a bone and surgically altering its position. Chevron and Scarf refer to different types of this bone realignment.

The procedure used depends on the specific findings:

• Chevron and Scarf osteotomies: These procedures differ in the shape of the bone realignment.
• Lapidus procedure: The joint between the first metatarsal bone and the tarsus is fused.
• Akin osteotomy: A procedure on the proximal phalanx corrects the position of the big toe.
• MICA technique: This minimally invasive procedure combines the Chevron and Akin osteotomies.

The procedure is divided into the following steps:

1. During the pre-operative consultation, the procedure, anaesthesia and risks are discussed.
2. The doctor selects the surgical technique appropriate to the findings.
3. Pain relief is often provided via general anaesthesia. Alternatively, regional anaesthesia may be considered.
4. The surgeon corrects the big toe using the previously selected technique.

Depending on the procedure, the operation takes around 30 to 100 minutes. It is often carried out under general anaesthesia. A hospital stay of several days may be required afterwards.

Regional anaesthesia may also be an option. This involves temporarily blocking the nerves in the affected area using an anaesthetic. The most suitable form of anaesthesia is determined on an individual basis prior to the procedure.

The operation can correct the position of the big toe, but does not guarantee a permanently symptom-free outcome. In an older review of surgical studies, approximately 5 per cent of patients who underwent the operation experienced a recurrence of the deformity.

In the same review, around 11 per cent of those who underwent surgery were dissatisfied with the result. Around 2 per cent reported pain in the metatarsophalangeal joint of the big toe following the procedure.

A case series on the MICA technique showed predominantly good or excellent ratings from the patients treated. However, it is not possible to derive a general success rate for all methods from this. Testimonials from other patients are therefore no substitute for a personal examination and consultation.

Possible consequences of the operation include pain, infections and a recurrence or excessive deformity. The level of personal risk depends, amongst other things, on the procedure chosen.

Studies have identified the following risks, amongst others:

• Pain: Significant pain may occur after the procedure, requiring effective pain management.
• Infections: In an analysis of Scarf osteotomies, around 2 per cent of the operated feet were affected.
• Complex regional pain syndrome: In the same review, this persistent pain reaction occurred in around 5 per cent of the feet that underwent surgery.
• Hallux varus: Overcorrection in the opposite direction was recorded in around 3 per cent of the feet that underwent surgery.

Complications were also recorded in minimally invasive Chevron osteotomies. The study results relate specifically to the technique under investigation and therefore do not describe a standardised risk for every hallux operation.

When you can put weight on your foot again depends on the method chosen. In a study of a specific procedure, starting to bear weight early did not increase the rates of implant failure or recurrence of hallux valgus observed. This finding cannot be readily generalised to other procedures.

In a small study on a minimally invasive technique, participants returned to work and resumed normal walking after around four weeks. They wore wide shoes after around three weeks, ordinary shoes after around twelve weeks and high-heeled shoes after around 16 weeks. These figures do not represent fixed timeframes for other procedures.

In another study, patients wore an orthopaedic shoe for six weeks. Follow-up care also includes regular wound checks and dressing changes.

Non-surgical measures are more likely to relieve pain than to improve the position of the big toe. Well-fitting shoes provide more space and can reduce pressure, but they do not correct the bunion. Splints do not straighten it permanently either.

Insoles are also among the non-surgical options; they can alleviate symptoms but do not permanently alter the position of the bone. Physiotherapy, custom-made shoes and splints have so far only been investigated in a few studies.

Surgery requested solely for aesthetic reasons must be paid for privately. Privately insured patients should submit a cost estimate in advance and clarify whether the costs will be reimbursed.

There are no fixed prices for self-pay services. It is therefore not possible to quote a flat-rate amount in euros for the standard procedure. If cost coverage is not guaranteed, you must be informed in writing of the estimated costs before treatment begins.

Orthopaedics and trauma surgery is the relevant specialism for surgical procedures to correct foot deformities. The sub-specialism of specialised orthopaedic surgery includes, amongst other things, corrective osteotomies and fusion surgery on the foot.

An additional indicator of quality may be the ‘Specialist Foot and Ankle Surgery’ certificate awarded by the relevant professional association. Foot and ankle surgery is the relevant specialism.

You can ask the following questions during your initial consultation:

• Which procedure do you recommend in my case, and why?
• How much experience does your practice or centre have with this method?
• What personal risks do I face?
• What are the plans regarding weight-bearing, footwear and follow-up care?

An expert should explain the benefits, limitations and alternatives in a way that is easy to understand. You can consult another specialist for a second opinion. You will find specialists in hallux valgus surgery listed at the end of this text.