The surgical procedure
There are numerous therapies that are offered in the treatment of hallux valgus. First of all, the possibility of a conservative approach avoiding surgery is being examined. In the initial stages, insoles that support the arch of the foot can slow down further progression of the disease and relieve symptoms.
Special splints can reduce pressure on adjacent toes and help prevent pressure sores. (see: conservative therapy of hallux valgus)Furthermore, the use of certain shoe techniques and gymnastics is conceivable to compensate for the consequences of hallux valgus and slow down the progression of the disease. In the case of a pronounced foot malposition, however, surgery is often unavoidable.
While conservative measures only slow down the progression of the disease, various surgical techniques can relieve the patient of pain permanently. The indication for surgery is usually determined by an orthopedic surgeon, who is guided in his assessment by the clinical picture of the patient. Pain and chronic inflammation of the ball of the toe are the main reasons for surgery.
The increasing inclination of the big toe in the direction of the little toes and a stiffening in the malalignment also give the physician reason to recommend an operation. In addition to the decision to operate, the orthopedist will also discuss the type of procedure with the patient. The aim of the operation is to eliminate pain and malpositioning and to stabilize the metatarsophalangeal joint of the big toe in order to prevent the development of arthrosis in the metatarsophalangeal joint.
There are different approaches to this procedure, but they usually follow uniform principles. The hallux valgus is fixed in its defective position by various mechanisms. The operation must therefore be performed on several structures in order to guarantee a correct alignment of the big toe in the long term.
Since the joint capsule and tendons are also subject to pathological changes in hallux valgus, the joint capsule, which is stretched on the inside, is first gathered together and the course of the tendons in the big toe is changed to make room for the subsequent bone repositioning (osteotomy). The tendon-bearing bony structures include the so-called sesamoid bones (sesamoids), which are laterally offset in hallux valgus and must be re-centered during the operation. In normal toe position, the tendons exert a pull along the toe ray.
This can be greatly altered in hallux valgus, which is why the tendon may have to be shortened or lengthened. While bone malpositioning is compensated by a so-called osteotomy, the cutting and correction of a bone, soft tissue surgery on ligaments and joints ensures the functionality of the corrected extremity. During osteotomy, the toe bones and metatarsal bones are cut through in order to realign and fix them in the desired way.
Metal screws, small splints and wires are used until the bone defect has healed. If the disease is severe, it is often not possible to operate to preserve the joint. The removal of the metatarsophalangeal joint at the base of the big toe with subsequent stiffening (arthrodesis) of the joint-forming bones can be the measure of choice here to relieve the patient of pain nevertheless.
