Hallux valgus as well as hammer toes, claw toes, hallux rigidus and Digitus quintus varus are common deformities of the foot or the toes (foot deformities, toe deformities). Different surgical procedures are used to treat these conditions.
Hallux valgus is a malposition of the big toe which causes the latter to shift inwards. This condition often occurs concomitantly to splay foot and deformation of the toes in the form of hammer or claw toes. Women are affected by it far more frequently than men. A genetic predisposition and the wearing of tight-fitting shoes are the main reasons by hallux valgus occurs.
Hallux rigidus is a type of osteoarthritis which occurs in the metatarsophalangeal joint of the big toe. It is usually caused by injuring or straining the joint, and is common in footballers or ballet dancers.
Inward malposition of the small toe, referred to in medical terms as Digitus quintus varus, often accompanies hallux valgus. This malposition is also attributable to overly tight shoes.
What preparations are carried out before the procedure?
Before the operation, the malposition and deformity of the foot and toes are carefully examined using x-ray imaging. Then, the corrective options are discussed with the patient and the surgical procedure determined.
All the usual pre-operative assessments, such as a blood test, blood pressure measurement and an ECG, are required beforehand. All blood-thinning medication must be discontinued prior to surgery and patients should have an empty stomach for the procedure.
How is the operation carried out?
Depending on the deformity and malposition of the toes, different surgical treatments are used. In the case of hallux valgus, malpositions of the metatarsal bones and toe bones are corrected. In the case of osteoarthritis, the joint is "cleaned" and also fused. Procedures on the foot are carried out under general anaesthetic or with spinal anaesthesia.
Surgery for bunions, splay foot, hammer toes, claw toes
Hallux valgus surgery corrects the malformation of the metatarsal bone and the toe bone. Irritating soft tissue enlargements (footballs) are also usually reduced in size. The affected foot bones are set and straightened with incisions in the bones, and then fixed in the corrected position with small screws. Depending on the malposition, the bones are shortened in the process, lengthened or only corrected in the axis. Hammer toes or claw toes are also set and fixed.
If a patient has severe malposition, the metatarso-phalangeal joint of the large toe must be fused surgically.
Bunion surgery, osteoarthritis of the big toe joint
After making an incision in the skin, the joint is opened. This allows bone spurs, deposits and damaged joint material to be removed. If the patient in question has early-stage osteoarthritis, the joint can be retained in the process. If the joint is too heavily damaged, fusion surgery (arthrodesis) is carried out. This involves removing the joint cartilage completely and connecting both bones with screws.
Surgery in the event of small toe deformation, digitus quintus varus
Similar to bunion surgery, the bone is severed, set and fixed with small screws if there is malposition of the small toe.
What is the success rate of this procedure?
The symptoms caused by foot and toe deformities can usually be well treated with surgery. The advantages and disadvantages of the different procedures are weighed up before the patient undergoes the operation. If anything, joint fusion can eliminate pain completely. However, the consequence is limited movement.
What are the possible complications and risks of this procedure?
Surgery for foot and toe deformities are low-risk and generally occur without complications. As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots.
What happens after the operation?
After the operation, the patient is monitored temporarily and the foot in question should be elevated. The affected joint is mobilised soon afterwards with gentle exercise. Thanks to a customised forefoot offloading shoe, it is usually possible to leave hospital the day after the operation. This shoe enables you to walk on your heals without crutches and must be worn for six to eight weeks. It usually takes this long for the bones to fully heal.
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