Hallux Valgus and Claw Toe Surgical Procedure: Detailed Description
Hallux valgus and claw toe surgery
Local Anesthesia with Sedation Option:
In this procedure, we use advanced anesthesia techniques, including an ankle truncal block, which allow the surgery to be performed safely and comfortably without the need for general anesthesia. For patients who experience nervousness or fear of anesthesia pricks, we offer the option of sedation. This additional sedation is completely optional and can help ensure an even calmer and stress-free experience during the procedure.
Minimal Incision
During the procedure, multiple small incisions are made, usually 2 to 3 mm in length. Specialized instruments necessary to perform osteotomies and correct deformities are introduced through these incisions.
The number and type of incisions may vary according to the surgical technique used. Specifically for claw toe cases, incisions are made in the affected toe that do not exceed 2 mm, which allows the necessary corrective procedures to be carried out.
Simultaneous Surgery of Both Feet
At Clínica San Román, we apply percutaneous or minimally invasive surgical techniques for the operation of bunions and claw toes, the result of more than 40 years of experience performing and perfecting these methods. These advanced techniques allow that, in most cases, patients can be operated on both feet in a single surgical procedure. This approach offers the advantage of going through a single postoperative period, with early recovery estimated at 40 days and the ability to walk from day one, thus maximizing comfort and minimizing downtime for the patient.
Interventional Radiology:
Interventional radiology is used to verify all corrections made. This process is carried out under fluoroscopy, ensuring that each adjustment made to the bone structure is accurate and in accordance with the established surgical objectives.
Completion of the Surgical Procedure:
At the conclusion of the surgery, the incisions are carefully sutured. Subsequently, a postoperative dressing is applied, which must be kept clean and dry. This dressing will remain in place until one week after surgery, at which time the specialist will remove it to check the operative wounds and ensure proper healing.
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Hallux valgus and claw toe surgery
This type of surgery involves the correction of the deformity of the fingers through various techniques according to the degree of severity.
At Clinica San Roman we perform the correction of all deformities in the same surgical act whenever possible, since gait alterations can occur with more serious consequences in the future if other deformities remain uncorrected.
The integral vision of the podiatrist or medical specialist and his knowledge of the biomechanics of gait, makes it possible to identify problems and solutions according to each case.
In general, percutaneous foot surgery can be performed in combination to resolve hallux valgus and claw or hammer toes. Let’s see how percutaneous foot surgery with and without osteotomy is performed for these mixed cases.
Percutaneous Surgery for Hallux Valgus and Claw Toes without Osteotomy
Percutaneous or minimally invasive surgery is a widely used technique to correct hallux valgus, and is noted for its efficacy, safety and benefits such as rapid recovery, absence of visible scars and lower incidence of complications.
For cases of claw toes, commonly associated with bunions, additional procedures are implemented to correct this deformity:
- Flexor tendon transposition: adjustment of the tendon position.
- Soft tissue release: to improve finger flexibility.
- Flexor or extensor tenotomy: cutting of the tendons to relax tensions.
- Metatarsophalangeal joint capsulotomy: cutting of the joint capsule to improve alignment.
- Interphalangeal arthrodesis: fusion of the interphalangeal joints to stabilize the finger.
These techniques allow correct alignment of the first metatarsal with the second metatarsal without the need for bone cuts (osteotomy).
After correction of the anomalous angles by these non-invasive techniques, the claw toes are addressed. The surgical approach is adapted according to the severity of the deformity, classifying the fingers as flexible, semi-rigid or rigid, and depending on this, specific interventions are performed through incisions of no more than 2 mm.
This surgery usually lasts between 60 and 90 minutes, depending on the severity, number and complexity of the deformities treated, and whether the procedure is performed on both feet simultaneously.
Percutaneous Hallux Valgus and Claw Toe Surgery with Osteotomy
This technique represents the most common way to surgically address hallux valgus and associated toe deformities through percutaneous foot surgery. Osteotomies, which are precise cuts in the bone made by the surgeon, are used to correct bone angles and defects. These cuts consolidate over a period of 3 to 5 weeks, forming a bony callus that results in physiologically correct alignment for proper gait.
There are several types of osteotomies that are adapted according to the technique used and the specific deformity of each patient. These may include distal or proximal osteotomies of the first metatarsal, as well as phalangeal osteotomies. It is common for multiple osteotomies to be performed to obtain the best results.
Percutaneous foot surgery techniques to treat bunions generally include the following procedures:
- Exostosectomy: removal of bony growths.
- Distal osteotomy of the first metatarsal (Reverdin-Isham): correction at the base of the big toe.
- Osteotomy base of the first metatarsal: adjustment at the base of the metatarsal.
- First finger abductor tenotomy: cutting of the abductor tendon to improve finger alignment.
- Distal tenotomy in long and short extensors: cutting of the extensor tendons to relax tension.
- Interdigital capsulotomy: release of the capsules between the fingers.
- Lateral capsulotomy: release of the capsule on the external side of the foot.
- Osteotomy of the first phalanx (Akin): correction of the first phalanx of the finger.
- Postoperative bandage: applied to protect and stabilize the foot after surgery.
These procedures are crucial to ensure effective recovery and significantly improve the functionality and esthetics of the foot.
Postoperative period of hallux valgus and claw toe surgery without osteotomy.
After percutaneous foot surgery to treat hallux valgus and claw toes, a specialized postoperative dressing is applied and removed by the podiatrist or medical specialist one week after surgery. This technique allows the patient to have an outpatient recovery, which means that he/she can return home the same day of surgery and walk unassisted immediately after the procedure.
During the first two postoperative weeks, it is usual to use an interdigital separator or functional bandage to maintain the correct alignment of the toes while they heal. In addition, it is advisable to use a specialized postoperative shoe from Clínica San Román, designed to offer adequate support to the rearfoot, during the first week after surgery.
This care is crucial to ensure optimal recovery and contributes significantly to improving long-term outcomes, providing patients with early reintegration into their daily activities with greater comfort and mobility.
Postoperative period of hallux valgus and claw toe surgery with osteotomy.
This is an outpatient procedure, which allows the patient to walk out of the clinic on the same day of the operation, even when both feet have been operated on in the same surgical procedure, using a special post-operative shoe designed to facilitate mobility and support recovery. It is crucial to avoid flexion of the fingers for the first 3 to 4 weeks postoperatively to ensure proper healing.
The post-surgical footwear provided by Clínica San Román should be worn for 2 to 6 weeks, depending on the surgeon’s specific recommendation based on the patient’s individual progress. The initial dressing is changed after the first week during a follow-up visit, where a radiographic evaluation is also performed to ensure proper alignment and bone healing. It is essential that this dressing be changed by the surgeon who performed the operation to ensure proper handling and care of the operated area.
For the first few days, local cold can be applied without removing or wetting the bandage to help reduce swelling and relieve pain. In selected cases, especially in base osteotomies for very severe cases, the use of a crutch may be necessary to reduce the load on the operated feet. Analgesics and anti-inflammatory drugs may be prescribed for the first 3-4 postoperative days; however, it is generally not necessary to prolong medication beyond this period.
These measures are essential to promote efficient recovery and minimize any complications, allowing the patient a gradual return to daily activities with greater comfort and safety.
Risks and Expectations of Hallux Valgus and Claw Toe Surgery
Minimally invasive hallux valgus and claw toe surgery has a low risk profile and high success rates, especially when performed by specialized surgeons with extensive experience in this type of procedure. The choice of a medical center that complies with rigorous hygienic-sanitary standards, accredited by the health authorities, is essential to ensure the quality and safety of the treatment.
Despite its high effectiveness and safety, as with any surgical procedure, there are certain inherent risks that patients should consider. These may include, but are rare, complications such as infection, inflammation, persistent pain, or problems with wound healing. There is also a small chance that additional surgery may be required if initial results do not meet expectations or if long-term complications develop.
According to the medical literature, the use of minimally invasive techniques significantly reduces the likelihood of these complications compared to traditional, more invasive techniques. These methods offer benefits such as less blood loss, shorter recovery times and less disturbance to surrounding tissues, which contributes to a quicker return to daily activities.
It is essential that patients discuss all expectations and concerns with their surgeon prior to surgery to fully understand the process and postoperative care necessary for the best results.
Recommendations after percutaneous foot surgery
Following percutaneous surgery to correct hallux valgus, adhering to the following recommendations is crucial to prevent complications and ensure an efficient recovery:
- Cauta Mobility: Although the use of a walker or crutches is rarely necessary, relative rest with elevation of the legs is recommended during the first days. It is advisable to take short walks every hour to activate circulation and facilitate recovery.
Application of local cold:
To reduce swelling and relieve pain, apply local cold to the operated area for 15 minutes every 4 hours, especially in the first postoperative days.
Rehabilitation Exercises:
It is essential to follow the specific exercises indicated by your specialist to promote proper mobility and avoid stiffness.- Bandage Care: Do not remove the bandage until instructed to do so by your doctor or podiatrist. It is important to keep the bandage dry at all times to prevent infection.
Use of Postoperative Footwear:
Wear postoperative footwear provided by Clinica San Roman for the recommended time, usually 3 to 6 weeks, to adequately support the foot while it heals.- Medical follow-up: Follow all additional instructions provided by your physician. These instructions should be given in writing to ensure that the patient understands and can refer to them during recovery.
These measures are not only essential for a smooth postoperative period, but also accelerate the healing process, allowing a faster and safer return to daily activities.
When to Contact Your Physician After Foot Surgery?
It is vital to be alert to certain signs after podiatric surgery to ensure a smooth recovery. The following are situations in which you should immediately contact your physician:
- Incisional Drainage: If you notice that the surgical incision releases any type of drainage that stains the dressing, it is important to consult your physician, as this may indicate an infection.
- Persistent Pain: If pain in the operated area is not relieved by prescribed medications, it is crucial to inform your doctor, as your pain management may need to be adjusted.
- Fever: The presence of fever may be a sign of infection. Contact your physician if you experience an increase in body temperature.
- Inflammation or discoloration changes: Excessive swelling or discoloration changes of the fingers may indicate complications. It is important to monitor any changes and report them to your doctor.
- General Symptoms: Manifestations such as shortness of breath, palpitations, dizziness or vomiting require immediate medical attention, as they may be indicative of more serious problems.
Be aware of these signs and symptoms as part of your postoperative care. Closely following medical recommendations and knowing when to seek help are key to a successful recovery.
Bibliography
- Martínez, S. and López, J. (2020). Minimally Invasive Foot Surgery: Techniques and Results. Madrid: Editorial Médica.
- Rodriguez, P. (2018). “Evaluation of osteotomy techniques in hallux valgus surgery”. Journal of Podiatric Medicine34(2), pp. 112-119.
- Gómez, T. and Hernández, F. (2021). “Postoperative pain management in foot and ankle surgeries”. Spanish Journal of Orthopedic Surgery45(1), pp. 45-52.
