Hallux valgus and claw toe surgery: step by step

Local anesthesia

A type of anesthesia called truncal block is performed, which allows the surgeon to work without the need for general anesthesia and the patient’s recovery is immediate.

Incisions

At least 3 incisions of 2 – 3 mm in length are made, through which special instruments are introduced to perform the ostomies and correct the deformities. The number and type of incisions vary according to the technique. In the case of claw toes, incisions are made in the affected toe no larger than 2 mm, in order to perform the corresponding procedures.

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.

It is important to correct all deformities in the same surgical act whenever possible, since gait alterations may occur with more serious consequences in the future if small alterations are left unattended or 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 toe. Let’s see how percutaneous foot surgery with and without osteotomy is performed for these mixed cases.

Percutaneous surgery of hallux valgus and claw toes without osteotomy

Percutaneous or minimally invasive foot surgery is one of the most widely used techniques to correct hallux valgus due to its advantages in patient recovery, less scarring and lower complication rate.

In the case of claw toe, techniques are added to correct this deformity often associated with bunions.

  • Flexor tendon transposition.
  • Release of soft parts.
  • Flexor or extensor tenotomy.
  • Capsulotomy of the metatarsophalangeal joint.
  • Arthroplasty of the distal condyle of the proximal phalanx.
  • Interphalangeal arthrodesis.
  • Metatarsal head resection.

The hallux valgus correction techniques without performing osteotomies, involve the placement of means of fixation of the first metatarsal with the second metatarsal, in a normal or physiological aligned form, without the need to make cuts to the bone.

There are several devices created for this purpose, the principle of which is based on anchoring the deformed bone on adjacent and normal anatomical structures.

After correction of the anomalous angles without osteotomies, the claw toes are corrected. The surgical technique used varies according to the severity or degree of the digital lesion. The claw toe can be flexible if it can be reduced or stretched manually, semi-rigid or rigid, according to which cuts are made in the tendons and joint capsules through a small incision, no larger than 2 mm.

This surgical procedure usually lasts less than 60 minutes, depending on the degree of severity and complexity of the deformities.

Percutaneous hallux valgus and claw toe surgery with osteotomy

It is the most common form of percutaneous foot surgery for hallux valgus associated with toe deformities. Osteotomies are cuts in the bone, performed by the surgeon to correct bone angles and defects. After 3-5 weeks, these osteotomies consolidate generating a bony callus in an aligned and physiological position for a correct gait.

There are several types of osteotomies that are performed according to the technique to be applied and the specific deformity of each patient. They can be distal or proximal osteotomies of the first metatarsal, as well as phalangeal osteotomies. Many techniques contemplate multiple osteotomies.

In general, almost all percutaneous foot surgery techniques for bunions include:

  • Exostosectomy
  • Distal first metatarsal osteotomy
  • First finger abductor tenotomy
  • Distal tenotomy in long and short extensors
  • Interdigital capsulotomy
  • Lateral capsulotomy
  • Osteotomy of the first phalanx
  • Postoperative bandage

Postoperative period of hallux valgus and claw toe surgery without osteotomy.

  • As with all percutaneous foot surgery, a postoperative bandage is applied, which is removed by the podiatrist or specialist a week after the operation.
  • The patient is ambulatory, i.e. he returns home the same day after correction of both deformities.
  • A separator is generally used between the first and second toes, when there is a double correction of bunions and claw toes.
  • The special Clínica San Román postoperative shoe with rearfoot support should be worn for 5 weeks.
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Postoperative period of hallux valgus and claw toe surgery with osteotomy.

  • It is an outpatient procedure where the patient walks out with a special postoperative shoe on the same day of the operation.
  • Avoid finger flexion in the first weeks after surgery.
  • Postoperative footwear with rearfoot support should be worn for 2 to 6 weeks.
  • The dressing is changed after the first week. It is recommended that this dressing be changed by the surgeon who performed the procedure.
  • Local cold can be used for the first 48 hours without removing or wetting the bandage.
  • In selected cases, analgesics and anti-inflammatory drugs may be used for 72 hours, after which time no further medication is usually necessary.

What are the risks of hallux valgus and claw toe surgery?

In this type of minimally invasive surgery, the risks are very low and the chances of success are very high, especially if an experienced surgeon is properly chosen in a center with the appropriate hygienic and sanitary measures that is accredited by health and of course with experience in this type of surgery.

Recommendations after percutaneous foot surgery

After percutaneous hallux valgus surgery, it is very important to follow the recommendations to avoid complications and promote a quick recovery:

  • The use of a walker or crutches may be useful in some isolated cases but are generally not necessary.
  • Relative rest with legs up for the first few days, taking short walks every hour to activate circulation.
  • Application of local cold for 15 minutes every 4 hours the first day after surgery.
  • Perform the exercises indicated by your foot specialist.
  • Never remove the bandage until the doctor or podiatrist indicates it, keeping it dry at all times.
  • Wear the Clínica San Román postoperative footwear for the indicated time, usually 3 to 6 weeks.
  • Comply with any other specific medical indications during the corresponding explanations after surgery. These should always be given in writing to the patient.

When to call a doctor?

  • The surgical incision produces some type of secretion that stains the dressing.
  • The pain does not stop with the prescribed medications.
  • If there is fever.
  • A lot of swelling in the fingers or color changes.
  • Any general manifestations such as shortness of breath, palpitations, dizziness or vomiting.