Hallux valgus correction

Hallux valgus surgery is used to straighten the big toe and to reduce the pain in individuals with a bunion (hallux valgus).

A bunion is an abnormality that causes the big toe to bend sideways (towards the smaller toes), resulting in a bony lump on the side of the base of the big toe. This condition can be caused by genetic factors or joint problems such as rheumatoid arthritis or osteoarthritis. It is predominantly seen in women, probably due to footwears that squeeze the big toe. Shoes with excessively high heels also tend to increase the risk of bunions in women prone to the condition. Bunions are managed initially by wearing the right size footwear, using bunion pads to protect the feet from the pressure of the shoes, and taking certain medications. Surgery is recommended when the bunion becomes very painful and does not respond to conventional treatments.

The surgery involves removal of the bony lump and possibly some portions of bones from the big toe. In addition, the tendons (tissues that connect muscle to bone) and ligaments (tissues that connect bone to bone) around the big toe will be cut and realigned, and extra tissues (if present) will be removed.

Hallux valgus correction surgery is recommended to treat bunions that do not respond to other treatments. Symptoms of a hallux valgus that warrant a surgery are:

• Severe foot pain (even while wearing comfortable, flat shoes)
• Inability to straighten/bend the big toe
• Persistent inflammation and swelling in the big toe unresponsive to medications or rest

This surgery is not recommended in individuals who have arterial occlusive disease (narrowing or blockage of arteries usually in legs).

You will need to visit the hospital a few days prior to the surgery for a preoperative assessment wherein your surgeon will ask you to share the following details:

• Any medical condition (past and current) that you may have
• History of anaesthesia
• If you have any allergies
• Pregnancy status
• A list of medicines that you take including herbs and over-the-counter medications

Your doctor will conduct a physical examination and will order the following tests:

• Blood tests
• Urine tests
• Pregnancy test
• X-ray

In addition, your surgeon will provide you with the following instructions to prepare for the surgery:

• Stop taking aspirin, warfarin, ibuprofen, or other blood-thinning medications a few days prior to the surgery.
• Inform the surgeon if you have flu, cold, or fever on the days leading to the surgery. In such a case, your surgery may be postponed.
• If you are a regular smoker, the surgeon will ask you to stop smoking.
• Arrange for a friend, family member, or responsible adult to drive you home after discharge from the hospital.
• Take a shower and remove all body piercings, nail polish, and make-up before arriving at the hospital on the scheduled day of the surgery.
• Fasting for a few hours before the surgery will be recommended based on the type of anaesthesia used.
• All the details regarding the procedure and the risks associated with the surgery will be shared with you.
• The hospital staff will ask you to sign a consent form that gives your approval for the surgery.

After you arrive at the hospital, the hospital staff will ask you to undress and wear a hospital gown. They will also insert an intravenous (IV) line in your arm to provide you with essential medicines and fluids during the surgery. Sedatives will be given before the surgery to help you relax. The surgery involves the following steps:

• The surgeon will clean your skin above the bunion using an antiseptic solution.
• You will be given local or general anaesthesia. The former numbs the area of operation, and you will be awake during the procedure, while the latter will put you in a deep sleep.
• The surgeon will make an incision (cut) over the bunion and cut the tight ligaments and tendons around the hallux valgus.
• He/she will use a bone saw (cutter) to remove the bony lump and shorten the bone of the big toe and straighten it.
• The surgeon will use a plate, screw, or pin to hold the straightened big toe in a fixed position. 
• He/she will modify the ligaments and tendons in the area, depending on the severity of the bunion and remove any extra tissues around the big toe.
• Finally, the surgeon will stitch the cut and cover the area with a sterile dressing or bandage.

The surgery lasts for an hour. The medical staff will shift you to the recovery ward after the surgery for observation where your vital signs, sensation and blood circulation in the operated foot will be regularly monitored. You will also receive medicines for pain relief.

If the surgery is conducted with general anaesthesia, you will feel tired, restless, and groggy when you regain consciousness. You may also experience dry mouth and sore throat. These are side effects of anaesthesia that usually fade within a few hours.

Once your condition and vital signs are stable, you will be allowed to go home. You can expect to be discharged on the same day. However, you may need to wear a surgical shoe, cast, or brace to protect your operated foot.

You will be given the following instructions to care for the operated foot at home:

• Take all your medicines as recommended by the surgeon.
• Place the operated leg on one to two pillows for at least two days after the surgery to reduce swelling and pain.
• Keep the bandage on the operated foot dry and clean. Cover the area with a plastic cover while showering. Alternatively, you can opt for a sponge bath.
• You may need to minimise pressure on the operated area for a few days after the surgery. Use a crutch, walker, or cane for support during this period.
• The operated foot may require support from dressing or brace for about six to eight weeks after the surgery.
• Avoid driving for a minimum of one week following the procedure.
• Do not wear high heels for at least six months after the surgery.
• Consult the surgeon before resuming sports and other activities.

You may need to perform exercises, undergo physical therapy and other treatments after the surgery to regain mobility and strength in the operated foot. The surgery does not improve how your feet look; instead, it focuses on reducing the pain and correcting the deformity as much as possible.

When to see the doctor?

Contact the surgeon/hospital if you develop any of the following symptoms after discharge from the hospital:

• Fever with body temperature over 100^oF (38^oC)
• Increased pain around the operated area or pain that does not resolve with medicines
• Persistent loss of sensation in the operated feet
• Bluish colouration of toes
• Trouble breathing
• Chest pain
• Bleeding and/or foul-smelling discharge from the incision site
• Persistent swelling

The potential complications/risks associated with the surgery include:

• Infection 
• Delayed healing
• Breaking of fixation pins or plates
• A sensitivity that persists for months
• No relief in foot pain following the procedure
• Nerve damage
• Recurrence of the bunion
• Risks of general anaesthesia such as lung infection, confusion, heart attack, etc.

You will need to revisit the hospital two weeks after the surgery to get the stitches removed.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.