For hallux valgus, there are a variety of surgical procedures that can be used depending on the exact symptoms. The therapeutic goal is pain reduction. Indication
- Surgery for hallux valgus is indicated only if symptomatic.
Contraindication (contraindication)
- Peripheral arterial occlusive disease (pAVK)
The surgical procedures
More than 100 surgical procedures are described, and they can be reduced to the following described procedures:
- Surgery according to Akin (corrective osteotomy* ; synonym: conversion osteotomy) – For this purpose, a bony wedge is removed from the proximal phalanx of the great toe, and after correction of the malposition by just this angle (of the wedge), the osteotomy (cutting of bone) is fixed with a bone suture, a clamp or a screw.
- Arthrodesis (stiffening) of the metatarsophalangeal joint or base osteotomy in cases of severe deformity (corrective osteotomy), i.e. higher degree joint damage (in the sense of hallux rigidus / due to arthritic changes stiff big toe metatarsophalangeal joint).
- Surgery according to Austin (= chevron osteotomy; corrective osteotomy) – is used for less pronounced deformity, i.e. for mild to moderate deformities.
- Op after Hohmann (corrective osteotomy).
- Surgery according to Hueter (resection arthroplasty/change of shape by removal of tissue).
- OP after Keller-Brandes (resection arthroplasty) – is mostly used in older patients.
- OP after Lapidus (stiffening) – is used in osteoarthritis or unstable joint.
- Op nachMcBride (soft tissue balancing with relocation of the adductor tendon).
- OP after Scarf (corrective osteotomy; Scarf osteotomy) – is used for moderately severe forms of hallux valgus, i.e. with less pronounced deformity.
- Minimally invasive retrocapital osteotomy MT I
- Soft tissue intervention (soft tissue balancing – usually in combination with basic osteotomy).
* Whether to correct the intermetatarsal angle or to cut the adductor tendon, for example, must be decided in each case based on the deformity. It is not possible to say which of the above surgical procedures is most appropriate on the basis of randomized controlled trials, since these do not have sufficient case numbers and the follow-up time is too short. The following recommendations can be made depending on the severity of the deformity:
- Mild deformities: osteotomy distal to metatarsal I (especially the chevron osteotomy).
- Severe deformities: Soft tissue intervention at the metatarsophalangeal joint of the big toe and, as a rule, also an osteotomy at the base of metatarsal I.
- Osteoarthritis: in the presence of osteoarthritis of the metatarsophalangeal joint of the big toe, as well as in elderly patients, arthrodesis of the metatarsophalangeal joint of the big toe or resection arthroplasty lead to the best result.
- Hallux valgus et rigidus (Hallus rgidus: arthritic changes of the metatarsophalangeal joint of the big toe that has become stiff): Reconstructive procedures are no longer indicated here, because the joint mobility usually does not recover sufficiently. Often, the pain also remains.
Possible complications
- Wound healing disorders (2-4%)
- Osteonecrosis (bone necrosis)
- Shortening of the first beam
- Functional impairment in the metatarsophalangeal joint of the big toe
- Hallux varus (overcorrection)
- Pseudarthrosis (impaired fracture healing with the development of a false joint).
- False joint recurrence
- Functional limitations in extensor and flexor tendon lesions.
- Chronic regional pain syndrome (CRPS)
Aftercare
- Full weight-bearing of the foot in a flat dressing shoe or forefoot relief shoe for 6 weeks. The bandage shoe usually represents a low shoe with a flat and stiff sole.
- In reconstructive surgery, the surgical result is secured with redressing bandages until the soft tissues are healed in the desired position (duration: 6 weeks; daily dressing change by the patient).
- Wg. edema tendency regular elevation of the feet.
- Osteosynthesis material can be removed after about 6-9 months postoperatively (in older patients, this can be left if it does not cause discomfort).
