The bunions or medically referred to as hallux valgus are the most common most common deformity of the forefoot and a reason to consult podiatrists around the world. This deformity has been described in medicine since the 16th century, and for more than 100 years more than 130 different techniques have been developed for the surgical resolution of this condition.
It is a common pathology but it is no less complex and therefore, it needs evaluation and treatment in the hands of expert specialists in the area. evaluation and treatment in the hands of expert specialists in the area.
What is
hallux valgus
?
It is a complex deformity that affects the front part of the foot (forefoot). (forefoot) and mainly involves the first metatarsal but also affected are: the first toe, the metatarsophalangeal joint and the small sesamoid bones of the first toe.
The most relevant and visible clinical manifestation is the outward deviation of the first metatarsal head. outward deviation of the head of the first metatarsal.. This deformity is accompanied by deviation of the first toe away from the midline and inward rotation. Simultaneously, the first metatarsal also undergoes rotation. As a whole, these abnormal deviations and rotations affect both the joint capsule and the ligaments and muscles of the forefoot, altering the biomechanics of gait and generating pain.
Although it is the most common and well known, not every forefoot deformity involving the first toe is
hallux valgus
. There are some medical and radiological criteria that must be accurately established to avoid misdiagnosis and ensure a surgical decision tailored to the deformity.
Between the angles of the deformities that should be taken into account for the diagnosis are:
– Angle of
hallux valgus
(HVA), normal less than 15º.
-The intermetatarsal angle (IMA), normal less than 9º.
– Articular angle of the head of the first metatarsal (PASA), normal figures are between 0º and 8º.
– Articular angle of the base of the proximal phalanx (DASA), normal between 0º and 6º.
From these important measurements made by your specialist, the classification of
hallux valgus
according to the severity: mild, moderate or severe.
What are the main causes of bunions?
There are a number of individual and external factors involved in the development of hallux valgus:
Extrinsic factors:
- FootwearFootwear has been shown to be one of the most important factors in the development of hallux valgus. Particularly with the use of narrow, high-heeled shoes.
- OverloadObesity seems to have an influence, but less than footwear, on bunions.
Intrinsic factors:
- Genetic factorsThere is a hereditary component to hallux valgus. It has been determined that more than 90% have a family history of the same deformity. Particularly when the deformity appears in adolescence or young adulthood.
- Sexmore frequent in women.
- Agebetween 40 and 60 years of age and the deformity increases progressively with age.
- Flat feetincrease the progression of the deformity.
- Egyptian footfirst longest toe.
- Achilles tendon retractiondue to the increased load on the forefoot during walking.
- Ligament laxity and joint hypermobility have been proposed as risk factors, but data defining their relationship to hallux valgus are still lacking.
What is percutaneous bunion surgery like?
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Surgery for bunions or
hallux valgus
is the most effective way to correct this deformity, particularly in moderate and severe cases.
There are different techniques of open surgery, described for many decades, however since 30 years ago, minimally invasive foot surgery or better known as percutaneous foot surgery has been introduced, which has offered a possibility of surgical treatment with fewer complications and rapid recovery.
Although it is a technique that offers several comparative advantages over open techniques, the education and training of specialized personnel is fundamental when choosing this procedure.
Steps of percutaneous bunion surgery bunions or
hallux valgus
Local anesthesia
Anesthesia is administered in the operating room. In the case of percutaneous foot surgery, the procedure is performed under a type of local anesthesia called a truncal block, which allows the surgeon to work in the surgical area without the need for general anesthesia. The effect of this type of anesthesia is short-lasting and the patient does not suffer the classic consequences of general anesthetic drugs.
Incisions
A total of 3 small or minimal incisions are made through which the instruments designed for this purpose are introduced to allow bone and joint corrections. The procedure is performed under radiology (fluoroscopy). This allows to guide and orient the doctor or specialist podiatrist during the surgery, to be able to visualize the movements and corrections made on bones and joints.
First incision
It is about 3-5 mm. is performed in the neck of the first metatarsal, below the joint capsule.
Second incision
It is a punctiform incision made at the distal end of the finger. Although there are varieties in the techniques. A third incision is usually made. Through these 3 incisions, the necessary osteotomies can be made to correct the deformity and the angles.
Completion of surgery
The surgery is completed with the radiological verification, after which the 3 small incisions are sutured and the special postoperative bandage is placed, which will be removed one week after the operation.
Duration
The entire procedure lasts approximately 60 minutes, depending on the degree of foot deformity or associated injuries.
Postoperative
Since the anesthesia is local and the incisions are minimal, the surgery is ambulatory and does not require any type of hospitalization. He can also walk unaided with special footwear supplied at the San Roman ClinicThe shoe is a postoperative shoe, which has the virtue of exerting foot pressure only on the back of the foot or heel, removing all pressure on the forefoot until the ostomy heals. This special shoe should be worn for 5 weeks or as directed by your doctor or podiatrist.
Advantages of percutaneous foot surgery
- The millimeter incisions reduce complications and postoperative pain.
- It does not require hospitalization of the patient, but is always performed on an outpatient basis.
- Less use of anti-inflammatory drugs and analgesics.
- The scars are barely noticeable.
- There is a rapid incorporation to their daily activities, with much more independence. Only with the limitations that take place due to the special footwear. The patient does not have to lie down and can carry out many of his usual activities without any inconvenience.
Article prepared by Clínica San Román
Date of Publication 11-1-2019
Date of revision: 11-02-2020
