Pain during the operation | Operation of a hallux valgus

Pain during the operation

The operation on a hallux valgus is a relatively small procedure, but like all operations it can be associated with pain. Due to the so-called foot block, the anesthesia of the involved foot nerves, there is often no pain directly after the operation. About 48 hours after the operation, the pain may still increase due to the decreasing anesthesia.

The pain is limited directly to the area of the operation and should not radiate. Here, an adequate medication, which can be taken at home in the form of tablets, should be effective. NSAIDs, non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac are preferably used, which usually provide sufficient pain relief.

Pain medication is necessary for about two weeks after the operation. In the course of this time the pain should have diminished considerably. The postoperative pain can initially have a limiting effect on the choice of footwear, so that not all of the usual shoes can be worn painlessly at first. Even continuous stress, such as that which occurs during long walks, is often not possible after the operation due to the pain and should be avoided for the time being in order to heal.A strong increase in pain in the first week after the procedure is rather unusual and indicates complications in the healing process. Burning or dull throbbing pain, redness and swelling of the scar, toe or entire foot can be a sign of infection of the surgical area and must be urgently clarified by a doctor and treated with antibiotics if necessary.

Risks of the operation

Like any operation, hallux valgus surgery is associated with certain risks. The greatest danger is generally caused by infections. Even if the greatest care is taken to ensure that hygienic measures are observed during the operation, it can never be completely ruled out that the materials used are contaminated or that the personnel carry germs.

Classic signs of inflammation such as pain, redness, overheating and swelling should be urgently clarified and treated by a physician. In most cases, antibiotic therapy is sufficient, but if the infection is very advanced, another operation may be necessary to clear the site of infection. Due to the foreign materials used, not only infections but also irritations of the surrounding tissue can occur.

The resulting pain must be counteracted by sparing or surgical correction. Since the anatomical conditions on the affected foot change after the operation, the load on the tissue also changes. Pressure pain and skin symptoms in the new stress zones can be the result.

As the patient becomes accustomed to the new anatomical situation, the complaints should regulate themselves. Some people also have a tendency to excessive scarring or poor wound healing, which can further complicate the healing process. The altered load on the bony structures can also cause problems.

For example, stress fractures, i.e. fractures of particularly stressed bone tissue, are occasionally observed in cases of rapid loading after an operation. Even after regular surgery for hallux valgus, it can recur and cause discomfort over time and not always the previously existing pain can be eliminated by surgery. Footwear that was worn before the operation should be disposed of afterwards, as the material has adapted to the foot malposition and forces the corrected toe back into a defective position.

There are over 200 different surgical procedures for the forefoot. The six most common surgical procedures for hallux valgus are as follows: Exostosis chiseling:The sole removal of the exostosis in hallux valgus (called bone bulge or pseudoexostosis) is rarely used today and only in cases of very low grade hallux valgus.

  • Exostosis chiseling with medial capsule tightening
  • After ChevronAustin
  • Surgery after McBride
  • OP after Keller-Brandes
  • Base osteotomy of the Os metatarsal I (base-wedge surgery or proximal repositioning)
  • OP after SCARF

This surgical method is used for medium to severe forms of hallux valgus.

The prerequisite for this joint-preserving procedure is at best a moderate arthrosis and an intermetatarsal angle of maximum 16° (angle between the 1st and 2nd metatarsal bones). In addition to the removal of the exostoses, a 3-dimensional repositioning with tendon displacement is performed, so that the functional anatomy of the forefoot is regained. Aftercare is performed in a relief shoe for about 3-4 weeks, after which a comfortable normal shoe with a special insole can be worn.

This operation of the hallux valgus can be performed on an outpatient or inpatient basis. The costs are reimbursed by the health insurance company in case of medical indication. McBride’s hallux valgus surgery (soft tissue surgery) is available for big toe malpositioning, which can still be compensated passively by the patient, without or at best with minor arthrosis in the big toe.

It is a preferred surgery for hallux valgus in younger patients. The aim is to chisel off the bony prominence and to relocate and tighten individual toe muscles (adductor hallucis muscle) and the capsule. Follow-up treatment consists of elevation of the affected foot, local ice treatment, anti-inflammatory measures and thrombosis prophylaxis.

After about 6 weeks the ability to work is restored. Hallux valgus surgery after Keller-Brandes is used in older patients with a severe big toe malpositioning, advanced arthrosis in the metatarsophalangeal joint of the toe and lower stress demands on the forefoot in everyday life. A disadvantage of this surgical procedure is the shortening of the big toe, which is often cosmetically disturbing.Here the second toe overhangs the big toe in length.

The aim of the operation is to remove 1/3 of the base joint of the big toe and to chisel off the bony protrusion on the inner side of the metatarsal bone. It is a relatively easy to perform and fast surgical procedure. In individual cases it may be better to stiffen the metatarsophalangeal joint of the big toe (med.

arthrodesis). There are again various surgical procedures available for this. Screws are often used for this.

A recurrence of the complaints is extremely rare with this procedure of hallux valgus surgery. Prostheses are now also available for the metatarsophalangeal joint of the big toe. The material of these prostheses is usually durable silicone or ceramic.

The disadvantage of this method is the low load capacity and durability of the silicone prosthesis, so that a change operation, i.e. a second operation, must be expected very often. Scarring often results in poor mobility with ceramic prostheses. Aftercare consists of elevation of the affected foot, local ice treatment, anti-inflammatory measures and thrombosis prophylaxis.

After about 6 weeks the ability to work is restored. In severe forms of hallux valgus (angle of more than 50 degrees and intermetatarsal angle of more than 20 degrees), bone dissection and repositioning must be performed at the base of the 1st metatarsal. A small bone wedge is removed at the base, the 1st beam is swivelled and screwed back in the new position.

In comparison to Austin or Chevron surgery (see above), partial weight bearing in the bandage shoe forefoot relief shoe is approximately 2 weeks longer. As with all the above surgical procedures, heel loading is permitted from the 1st day after surgery. –> Continue to the topic Hallux valgus splint