Introduction
Hallux valgus can be corrected by multiple different operations and the surgery undertaken depends on the severity of the toe deformity and its capacity to be corrected.
Indications
The toe deformity which may be progressive causes medial foot pain. This may be due to the associated soft tissue problems on the medial side of the toe, or the degree of bony deformity or the degree of joint deformity. When any or even all of these problems are present, only surgery can correct the problem.
Preoperative Instructions
No specific pre-operative planning is required for this. It may be helpful to be able to use crutches but you do not necessarily need crutches to mobilise after this surgery.
Procedure
There are three operations which may be performed. The first is a soft tissue reconstruction which deals with the stretched medial soft tissues and settles rapidly post-operatively. The second involves an osteotomy which is fixed with a wire that usually does not have to be later removed, at the distal end of the metatarsal and an associated soft tissue reconstruction. The third involves an osteotomy of the proximal end of the metatarsal which is required when the deformity is very severe and the toe deformity not easily correctable. This is held with a plate and screws. A wire into the big toe may also be required to hold the corrected alignment until the soft tissue reconstruction and the bone have healed about a month and a half later.
Postoperative Instructions
Each operation requires a splint to be worn to maintain the correction until healed. This is usually in about six weeks. You can use crutches if walking unaided is difficult. When the toe has healed, you can take full weight on it and this encourages recovery of the upward mobility of the big toe joint. The correction is permanent.
Risks
There are always some risks with any operation. The problems that may rarely arise after this surgery are blood clots, wound infection or perhaps a failure of the bone to unite before the plate breaks. All these problems are exceedingly rare.
Treatment alternatives
By the time you have been advised to have surgery, you will have tried splints orthotics and passive stretches. These deformities do not respond to these therapies and the only way of establishing normal alignment in a permanent way is by surgery.