Hallux Valgus Correction (Bunion Correction)

OVERVIEW

Commonly known as a bunion, hallux valgus (HV) is a bony bump that forms on the joint at the base of your big toe, caused by sideways drifting and angulation of the big toe. This affected foot can become inflamed and swollen, causing foot pain over time. Among all age groups, the prevalence of hallux valgus is greater in women than men, with increasing prevalence as age increases.

Without appropriate treatment, a bunion can cause pain and difficulty with shoe wear and result in functional disability. So, it is recommended that you see an orthopedic specialist to assess the severity of the condition to find the best solution.

SYMPTOMS AND CAUSES OF HALLUX VALGUS

If you have hallux valgus, you may experience some of the following signs or symptoms:

  1. A bulging bump on the outside of the base of your big toe
  2. Swelling, redness or soreness around your big toe joint
  3. Corns or calluses — these often develop where the first and second toes rub against each other
  4. Ongoing pain or pain that comes and goes
  5. Limited movement of your big toe

Hallux valgus causes likely include:

  1. Hereditary foot type
  2. Foot stress or injuries
  3. Deformities present at birth
  4. High heels - wearing high heels forces your toes into the front of your shoes, often crowding your toes.
  5. Ill-fitting shoes - wearing shoes that are too tight, too narrow or too pointed
  6. Rheumatoid arthritis
  7. Flat arches (flat feet or fallen arches).

If you suspect hallux valgus, see an orthopedic specialist for proper evaluation of the severity. Your orthopedic specialist should prescribe necessary physical examinations to ensure the highest level of diagnostic precision and accuracy. At WIH International Hospital, Orthopedic and Sports Medicine team provides comprehensive examinations to personalize the best treatment solution possible for you, which typically include: 

  • X-ray

X-rays should be ordered to identify the condition severity, detect the possibility of a broken bone in foot (a broken bone can cause similar symptoms of pain and swelling), and also examine other bony issues (i.e. Bony impingement, cartilage injury and/or other suspicious conditions) since hallux valgus might be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis.

  • Computed tomography (CT) image 

Computed tomography (CT) image analysis or CT scan is ordered for preoperative planning of surgery or postoperative evaluation of fractures.

SOLUTIONS OF HALLUX VALGUS CORRECTION 

Our experienced team of board-certified foot and ankle orthopedic and sports medicine specialists provide 24-hour care to deliver a prompt and personalized holistic consultation. We are ready to expertly offer all aspects of services that help restore or correct a complex valgus deformity from non-surgical to specialized surgical options with arthroscopic-assisted and minimal-invasive techniques that answer each individual’s conditions with sustainable and satisfactory outcomes.

1.   Personalized Physiotherapy and Rehabilitation Program

In case your hallux valgus is diagnosed with mild and minimal conditions, the physiotherapy and rehabilitation program can be your effective non-surgical solution with shoe modifications individualized just for you. WIH physiatrist and physiotherapist will help you reduce your pain, enhance the function of the big toe, improve muscle strength and restore walking ability. Bone and joint themselves can take anywhere from 6 weeks - 6 months to heal, varying in each individual healing. 

In case of progressive deformity and difficulty with shoe wear after a certain period of the physiotherapy and rehabilitation program, or presence of the moderate to severe condition that interfere with routine life work and physical activities, surgery should be taken into consideration. 

2.   Minimally Invasive Surgery (MIS)

Whilst traditional surgical methods require large open incisions to expose the affected bone and joint to repair it, which leave large-sized wounds, more pain, more stiffness and a long downtime, MIS approaches allow internal bone correction by using a specialized microscope (arthroscopy) and advanced surgical equipment via only 2 - 3  minimal incisions (usually 1–3 cm long each), offering the advantage of smaller wound size, less pain, more cosmetic outcome, fewer complications, faster recovery, and quicker resumption of work and sports activity.

To confirm overall life quality with both functional and aesthetic outcomes that break through physical limitations as desired, WIH foot and ankle orthopedic and sports medicine specialists successfully utilize pioneering orthopedic MIS techniques, including:

Distal Linear Metatarsal Osteotomy (DLMO)    

Those with angles of intermetatarsal angle (IMA) <20° and hallux valgus <40° (mild-to-moderate hallux valgus) may be candidates for distal linear metatarsal osteotomy. Also called modified Bösch osteotomy, distal linear metatarsal osteotomy is minimally invasive correctional osteotomy for hallux valgus with semirigid fixation using only a single Kirschner wire to improve alignment. 

Minimally Invasive Chevron and Akin Osteotomy (MICA) 

The minimally invasive Chevron and Akin osteotomy is a third-generation MIS technique pioneered for candidates who have severe deformities with or without metatarsalgia. This involves screw fixation of a distal metatarsal osteotomy site, resulting in greater stability than is provided by previous generations of the technique with a low rate of symptomatic recurrence.

Arthroscopic Lapidus Procedure

The arthroscopic Lapidus procedure, also called arthroscopic Lapidus arthrodesis is the most common procedure as a method to reduce the intermetatarsal angle (IMA) in the setting of hypermobility or arthritis of the first metatarso-cuneiform joint. 

Superior to the traditional Lapidus arthrodesis open approach, such an arthroscopic approach provides the advantage of more thorough preparation of the fusion site with minimal bone removal and better control of the arthrodesis position and with less chance of malunion.

If arthritis of the metatarsophalangeal joint (hallux rigidus) is already present due to the hallux valgus deformity, this minimally invasive procedure can no longer be used. In this case, the procedure must include treating the metatarsophalangeal joint.

DETAILS OF HALLUX VALGUS SURGERY

Type of Anesthesia:  General anesthesia administered by anesthesiologist to ensure safety

Operation Time:        1 - 3 hours (depending on the bunion severity and technique to be performed) 

Length of Stay:         2 days 1 night 

Recovery Time:         3 - 6 weeks (depending on each person’s healing and post-op rehabilitation)

HALLUX VALGUS CORRECTION AFTERCARE

  1. After surgery, remain at home and keep your foot elevated to the level of your heart for 2 weeks.
  2. The special forefoot decompression shoes must be worn for 4 - 6 weeks.
  3. Use a cold compress (cooling gel) for 72 hours after surgery to reduce bruising and swelling.
  4. Pain is well-managed by prescribed medications.
  5. You will be advised to avoid exposing your wound to water and maintain wound care and hygiene by using the antiseptic solution.
  6. The stitches will be removed 10 - 14 days after surgery.
  7. A radiography examination provides accurate information on the condition of the treated joint and bone during the follow-up appointment, about 4 weeks after surgery. The more severe the misalignment, the longer rehabilitation will take.
  8. A rehabilitation program will be ordered for your motion enhancement of the treated foot.
  9. For functional follow-up treatment, you will be advised to bear weight on the treated foot as tolerated.
  10. After all, a holistic physiotherapeutic program will be ordered and personalized for muscular balance, and to stabilize and strengthen the foot.