Hallux valgus

Hallux valgus is the commonest disease of the musculoskeletal system affecting mainly women. It usually appears in the middle age but even earlier sometimes. It is widely believed by many people that use of tight and high-heel shoes is correlated with the deformity but there is weak scientific evidence for that. High incidence of the deformity is noted in some families.

The frequent complaint is the cosmetic appearance of the foot. Pain at the first metatarsophalangeal (MTP) joint may exist. The deformity may remain unchanged for years but in the majority of cases it deteriorates. It may be associated with metatarsalgia (pain at the metatarsal heads) which requires a more sophisticated approach. There are some slings on the market that can somehow alleviate discomfort but are unable to halt the development of the deformity.

Surgery is indicated when the patient feels considerable discomfort and / or is concerned about appearance. Numerous techniques have been described for surgical correction. It depends on the surgeon to decide according to the degree of deformity and his/her experience. Almost all techniques include some kind of osteotomy of the great toe and osteosynthesis with small screws or plates or pins. Screws are buried beneath the skin and are not removed unless they cause irritation. Pins are left proud and removed some weeks postoperatively.

Surgery for hallux valgus is done under general, spinal or regional anaesthesia. Some injections around the ankle are required for the latter. Although surgery for hallux valgus is not grave it demands special skills and expertise. The patient can postoperatively bear the foot partially and leaves the hospital the 2nd or 3rd day. Special shoes are not necessary. Stitches are usually removed 2 weeks postoperatively. Return to preoperative activities is possible after some weeks. Recurrence cannot be excluded.

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