Definition: what is a hallux valgus? at what age are you most at risk?
The big toe deviation protrude,in contrast, the bone located behind the first phalanx, the metatarsal. This “onion” is not always painful and embarrassing, but it can be. “In case of hallux valgus, the big toe can no longer play its propellant role. You should know that it supports, when walking, 20 times the weight of the body. Its deformation leads to a risk of instability, falling and deformation of the other toes “recalls Dr. Barbara Piclet, orthopedic surgeon.
This deformity occurs at any age in people predisposed morphologically (eg flat feet) and genetically. She may get worse over timeespecially when the footwear is not suitable ; this is why hallux valgus often affects women over 50, followers of narrow shoes with high heels (higher than 5 cm).
When should you have surgery?
Before considering surgery, different solutions can be suggested when hallux valgus appears: change shoes, wear Orthopedic soleto try a toe spreader which maintains the articulation in the axis.“We try 2 or 3 months. The effectiveness varies from person to person”, specifies Dr. Gamain, orthopedic surgeon.
If the pain and discomfort when walking are too great, surgery remains the best solution and can be performed as soon as growth stops, around 16-17 years of age.
Anesthesia, pain… how is the operation going?
The majority of interventions are carried out under locoregional anesthesia: only the foot is asleep. The surgery consists of a osteotomy of the first metatarsal: one or more bones are cut, then vis are placed.
Under X-ray control, an anesthetic product is injected around the sensory fibers of the nerve, without affecting the motor functions. “This type of anesthesia allowed us to make fantastic progress on pain. The effect of this very precise local anesthesia lasts 20 hours on average,” explains Dr. Piclet.
Surgery is usually done on an outpatient basis :the patient goes home a few hours following the operation. Some surgeons leave a catheter in place that continues to deliver anesthetic following returning home.
The relay is most often taken by oral painkillers: paracetamol, non-steroidal anti-inflammatory drugs…
Before / following: why is the operation of a hallux valgus less painful today?
Twenty years ago, surgery methods were quite invasive. The surgeon practiced large openings and management was less effective.
“Surgeons have specialized in hallux valgus, with some more suitable techniques “, says Dr. Régis Gamain, orthopedic surgeon. The instruments intended to ream the bone are introduced either by making incisions of 2 to 4 cm (minimally invasive technique), or by small holes in the skin (percutaneous technique).
Fewer openings mean less pain. In addition, anesthetic techniques have made immense progress.
Recovery, walking, shoes… how is the post-surgery going?
During the first 24 hours following surgery, the patient has no more sensitivity in the foot, which does not prevent him from to walk with crutches.
The first week following surgery, you should try to walk as little as possible. The days following the surgery and for 3 to 6 weeks, the patientshould wear a special hard-soled shoe. “The purpose of this shoe is to protect the support. In this sense, it has a painkiller effect”, specifies the surgeon. A edema is often present.
Opinions are divided on the interest of physiotherapy :
- Dr. Piclet recommends physiotherapy sessions following 3 weeks – one month “to learn to walk once more with this new morphology.
- Dr. Gamain believes that it is not not indispensable to go to a physiotherapist: “A self-rehabilitation with massages of the sole of the foot and the scar, and mobilization of the big toe may suffice. »
As with any operation, complications are possible: lack of correction (i.e. a risk of recurrence), infection or delayed healing (especially in smokers).
