Patients with hallux valgus (bunion) usually think about surgery when there is great pain at the level of what we know as "exostosis" (the lump), accompanied by difficulties with footwear. And almost more often when they come to the consultation for the consequences that the bunion causes in the rest of the forefoot, be it hammertoes , metatarsalgia (pain in the sole of the foot) or even Morton's neuromas (very painful inflammation of the a nerve of the sole of the foot).
If a forefoot presents multiple deformities and between them is the bunion, it must always be operated and, if possible, at the same time as the rest of the forefoot, since the big toe acts as a real post that prevents the rest from collapsing and misshapen. We must remember that if we correct a few fingers in a hammer and we do not do it with the hallux valgus, these fingers will deform in all likelihood. Only in patients of advanced age and with a bad state of health we can skip this rule.
Not only do you have to remove the lump
Only removing the lump is one of the most frequent and serious errors. In most cases this would lead to a reduction absolutely insufficient, if not null, since the origin of the deformity comes from two elements: the deviation of the metatarsal and the finger, on the cusp of the two we find the " exostosis ", the lump. That is to correct the hallux valgus we must cut the metatarsal (osteotomy) and the first phalanx of the big toe, varying its position until it is fully straightened.. Finally, obviously the so-called bulk must also be eliminated.
Another frequent error is to think about interfering both feet at the same time (if the patient suffers from both feet). In most cases I recommend doing one foot, usually the most painful, so recovery is faster because the other foot can be used normally. In general, the recovery time can be extended to more than double. Formerly they were both done at the same time because foot surgery was an extremely painful experience, and that was a way for the patient to suffer only once.. Nowadays, the minimally invasive techniques that we use, such as percutaneous surgery , allow this suffering to be infinitely less.
Nowadays, foot surgery is almost painless thanks to the use of non-aggressive surgical techniques such as percutaneous surgery and the good work of our anesthetists who use nervous "blocking" techniques that achieve a long duration of anesthesia . for the use of long-term anesthetic drugs. For this reason, most of our patients can go to their home on the same day of surgery.
Current percutaneous surgery allows us to correct approximately 90% of hallux valgus , while the rest requires open surgery. These evolved techniques allow us to use screws, for example, in the most severe cases without having to "open", and with this we can achieve results that are absolutely comparable to open surgery, with the advantage that the scars are minimal, the postoperative most pleasant , no income, pain is minimal and, what is very important, the degree of mobility of the big toe is very good, which greatly favors rapid recovery and the use of very early normal footwear, even with a heel high.