Hallux Valgus Bordeaux

"Understanding your pathology is a step

crucial to any treatment".

Doctor Becquet, specialist in foot and hand surgery

Hallux Valgus Bordeaux

Foot surgery in Nice

On the site the doctor Eddy BECQUET and his team is
entirely dedicated to the foot surgery (Hallux valgus surgery, the surgery minimally invasive and percutaneous surgery...) and the hand (Sprains, wounds...), this site aims to provide information as complete and fair as possible. Information at
Tel : 04 93 169 169

By answering your questions and providing practical information, this site will allow you to better prepare for a possible consultation, foot surgery or to extend it with a clear head. It is not intended to replace the consultation, and even less to shorten the direct relationship between the patient and his doctor, this website serves as an effective communication tool and source of information at the service of the patient.

Foot surgery in Nice ? Hallux valgus surgery ? Mini-invasive and percutaneous ?
Pain management ? Patient follow-up ?

Hallux Valgus Bordeaux

Your foot and hand surgery center

Center of excellence for foot surgery

The management of foot surgery patients requires a mastery of surgical techniques and an anesthesia management adapted to this type of surgery. Foot surgery is handled by our best collaborators

Pain Management in Foot Surgery

During and after foot surgery (percutaneous or minimally invasive surgery) Pain management is an essential component of quality care. Pain management remains a central concern for us,

Minimally invasive percutaneous foot surgery

The progress of minimally invasive surgery and percutaneous surgery in Nice over the last few years has made it almost unavoidable in the therapeutic proposals for the correction of hallux valgus...

Hallux Valgus Bordeaux

INFORMATION BOOKLET FOOT SURGERY NICE

Prior information about foot surgery is essential and necessary. Experience shows that oral explanations given by the foot surgeon are better assimilated by the patient when he or she has specific documentation written for him or her, which he or she can consult calmly in an environment outside the office: this is the reason why this manual has been written.

By answering the questions most often asked about the various foot pathologies (hallux valgus or bunion, claw toes, morton's neuroma, ingrown toenails, etc.), this book provides the surgeon with a written support that can help him or her to integrate the information provided by the physician regarding the specific modalities of the proposed surgery.

MAKE AN APPOINTMENT

You can make an appointment for a foot surgery consultation with Dr. Becquet using the doctolib.fr service by clicking on the following link:

CONTACT

Use our form to send us a direct message about foot surgery, leave a comment or ask a question, we will answer it as soon as possible.

Hallux Valgus Bordeaux

DR EDDY BECQUET
CURRICULUM VITAE

  • Former intern of the hospitals of Lille 1997
  • Former chief of clinic of the hospitals of Lille 2002
  • Appointed Specialist in Hand and Foot Surgery 2002
  • Inter-university diploma in surgical pathology of the hand 2002
  • University Diploma in Vascular and Nerve Microsurgery 2000
  • University Diploma in Legal Compensation for Personal Injury 2004
  • Inter-university diploma in arthroscopy 2002
  • Lecturer for the National Diploma of Orthopaedic and Traumatological Surgery 2003
  • Lecturer in Anatomy of the Hand and Foot 2002
  • Associate member of the French Society of Hand Surgery
  • Member of the French Association of Foot Surgery

Hallux Valgus Bordeaux

OUR TEAM

Dr T. BENSLIMAN

Anaesthesiologist resuscitator

Dr. J-P BENISTAND

Anaesthesiologist resuscitator

Dr. D. LUGRIN

Anaesthesiologist resuscitator

Mrs. J. MERIGEAU

medical secretary

Mrs. C. GUGLIELMI

Surgical Assistant

Hallux Valgus Bordeaux

SITUATIONS:

Located within the Saint George Clinic,
the office is easily accessible thanks to transportation
by public transport (bus number 15, 22 or 36)

Car : Parking of the Saint George clinic

CONSULTATION HOURS

Monday: 09:00 - 18:00
Tuesday: 09:00 - 18:00
Wednesday: 09:00 - 12:00
Thursday: 09:00 - 18:00
Friday: 09:00 - 12:00

Hallux Valgus Bordeaux

The Saint-George Clinic

The patient in the heart and
excellence in mind

The care offer

The clinic was founded in 1969. Successive extensions and modernization work have enabled it to position itself both technically and in terms of hotel facilities.
The clinic holds the following licenses:

Surgery : 157 beds and places including :

  • 8 surgical resuscitation beds
  • 35 surgical beds with particularly expensive care
  • Outpatient surgery: 21 places

Medicine : 115 beds and places including :

  • 4 medical resuscitation beds
  • 8 medical beds with particularly expensive care.
  • Outpatient chemotherapy: 49 places

Obstetrics and gynecology : 55 beds

Structure of the emergency room 23,478 visits in 2007 with an average of 64 patients per day.

Medical assistance in procreation

Oncology with a Cancer Coordination Center (3C) and an outpatient chemotherapy service

Palliative Care: 3 undifferentiated beds...

Surgical activity

The clinic is a multi-purpose surgical center performing more than 27,000 operations per year in many specialties. It provides emergency or scheduled surgery. It provides :

 

  • eight blocks of 25 operating rooms (15 hyperaseptic rooms, five aseptic rooms, five endoscopy rooms), with state-of-the-art equipment offering optimal safety for highly technical multidisciplinary surgery;
  • On-site central sterilization;
  • 10 induction rooms ;
  • five post-interventional surveillance rooms with 34 stations;
  • 149 traditional hospitalization beds ;
  • 8 beds of continuous surveillance of surgery.

The clinic has seven surgical hospitalization departments.
The rooms are very spacious and are all equipped with a bathroom with shower, individual television (headphones for double rooms) and telephone. Many single rooms are available.
The practitioners have, on the spot, an important medical imaging center including, in particular, a 64-bar scanner and an MRI.

The commitments of the Saint-George clinic

1. To offer the patient a wide range of quality care
2. To provide the patient with quality and personalized care
3. To offer the patient a modern and diversified technical platform
4. To provide the patient with quality hotel services
5. Abolish city/clinic boundaries

Hallux Valgus Bordeaux

The Saint-Antoine Clinic

Founded in 1925, the clinic, located in the center of Nice, became part of the Saint GEORGE Group in 1993. This medico-surgical clinic has 129 beds and places (104 surgical beds including 6 intensive care beds, 6 ambulatory surgical places and 15 medical beds).

Successive extensions and regular modernization work have enabled the clinic to position itself at the best level both in terms of hospitalization and technical aspects. Surgery and medicine are the two main activities of the clinic.
The respect of the patient's rights is one of the major axes of the establishment. This is reflected in a personalized welcome that respects confidentiality from the admissions office to the care services.

The computerization of patient records, and in particular the medication circuit, has been underway since 2007.
The organization of the operating room is functional, associates the various professionals and allows an optimal and secure care of the patient.
The CLIN, represented by the operational hygiene team, is involved in all the clinic's sectors of activity. Risk control is achieved through the effective implementation of correlated vigilances within the vigilance and risk management committee, which meets weekly.

Medical and surgical activity

It is organized around the following specialties:

 

  • surgical specialties: orthopedic, digestive, vascular, ophthalmologic surgery...
  • medical and surgical specialties: urology, ENT, gynecology, etc.
  • plastic and reconstructive surgery
  • medical specialties: gerontology, gastroenterology, dermatology, oncology...

Patients benefit from physiotherapy actions according to their needs, 7 days a week. In case of specific needs, a psychologist can be called in.

The hotel and comfort

There are two types of rooms, the twin room and the single room.

All rooms are equipped with :

  • Shower room and WC
  • Caregiver call system
  • Television
  • Telephone with direct line
  • Individual safe.
  • Air conditioning.

An accompanying bed can be provided in a single room for an additional fee
hotelier

Equipment
  • Hospitalization Services:
    • 3 surgical departments
    • 1 medicine department
    • 1 department with six post-operative monitoring stations

     

  • Two operating theatres with 7 operating rooms:
    • 4 aseptic operating rooms, equipped with a laminar flow system and a preanesthesia box
    • 1 septic operating room, equipped with a laminar flow with a preanesthesia box
    • 2 operating rooms for outpatient surgery equipped with a laminar flow with pre-anesthesia box
    • 1 post-interventional surveillance room with 12 stations
    • 1 central sterilization service

     

  • Endoscopy Department:
    • 1 examination room
    • 1 endoscope processing room

     

  • Radiology Department:
    • 2 rooms equipped with a remote-controlled table and an ampli of brilliance
    • 1 ultrasound room

     

  • Other premises :
    • 1 outpatient department with 6 places and 1 post-interventional surveillance room
    • 1 outpatient department (3 small surgery rooms and outpatient care...)

Hallux Valgus Bordeaux

Hallux Valgus | Nice

Hallux valgus is the most common foot condition. This progressive deformity manifests itself by an exaggerated deviation of the big toe towards the outside of the foot and by the appearance of a bump (or exostosis, commonly called "bunion") at the joint.

Hallux Valgus Bordeaux

Foot Surgery | Hallux Valgus | Nice

WHAT ARE THE CAUSES OF THE APPEARANCE OF HALLUX VALGUS

Women are more prone tohallux valgus They represent more than 90% of cases. The damage is greatest around the age of 50, when hormonal changes due to the menopause lead to hyperlaxity, which favors deformity.

In addition, wearing narrow shoes with pointed toes and/or high heels also strongly contributes to the deformity. Heredity: in 30% of the cases we find a family factor. Excess weight. Egyptian feet They represent 75% of cases. The excess length of the big toe in relation to the other toes forces it to fold down into the shoeespecially when it is narrow and sharp.

HOW DOES HALLUX VALGUS EVOLVE?

Hallux valgus is a progressive deformity. It is accompanied by increasing pain when walking and putting on shoes, sometimes associated with a sensation of numbness in the big toe. At the beginning, Hallux Valgus results in an isolated deformation of the big toeassociated with pain in the exostosis (bunion). Insert an image ofhallux valgus not very evolved An inflammatory bursitis can appear at the level of the exostosis: the bunion is swollen red and painful. It may ulcerate and lead to an infection. Insert image of inflammatory bursitis.

When Hallux Valgus continues to evolve, the big toe continues to deviate, thus "pushing" on the 2nd toe. In order to find room for its turn, the 2nd toe will then curl up into a claw: this is called the 2nd ray syndrome Insert an image ofhallux valgus with 2nd toe in claw The deformation will then progressively spread to the whole foot, deforming the other toes in claw. The retracted toes will come into conflict with the shoe, resulting in painful corns (accumulation of skin) on the toes.

At the same time, under the effect of the claw of the 2nd toe, the big toe will subluxate or even dislocate, giving rise to metatarsalgia (pain when leaning on the forefoot) Insert an image of subluxation + image of metatarsalgia More theHallux valgus is corrected earlier, the better the results. It is therefore recommended not to wait until the deformity is too important to consult.

WHEN SHOULD I SEE A FOOT SURGEON?

The appearance of pain when walking and difficulties when putting on shoes.

WHAT ARE THE TREATMENTS FOR HALLUX VALGUS ? In Nice ?

Whatever the evolution of hallux valgusIn order to avoid the conflict of the exostosis (bunion) against the shoe, it is recommended to wear wide or even open shoes. When hallux valgus is at the beginning, not very painful and reducible: an orthoplasty (prescribed by a podiatrist) can be sufficient to correct the deformity. When the deformity is fixed, the orthoplasty will not be of any use.

When hallux valgus is evolved, only surgery can correct the deformity and stop its evolution. Wearing orthopedic inserts and orthoplastics can, however, limit the pain until the operation can be performed.

WHAT IS THE SURGICAL TREATMENT?

Surgical treatment aims to re-align the big toe. It is performed in 2 steps, the first one aims to realign the metatarsal, the second to realign the phalanx. Metatarsal re-alignment: The surgeon will make a cut (osteotomy) in the shape of a lightning bolt in the bone, in order to translate the two bony parts one on the other, and straighten the metatarsal.

Reaxation of the 1st phalanx : The surgeon will make a bevelled cut (osteotomy) on the phalanx, in order to reax it, and if necessary shorten it. This procedure will also correct a possible rotation disorder of the big toe. In case of claws on the other toes, and/or metatarsalgia, other gestures will be necessary to correct these deformities.

WHAT IS PERCUTANEOUS OR MINIMALLY INVASIVE SURGERY?

Percutaneous forefoot surgery began 30 years ago in the United States and was recently introduced in France via Spain. This method consists of operating on the foot by introducing instruments through very short incisions. The bone procedures (osteotomies) are not performed "open" but through a small incision or even through the skin. This technique responds to the evolution of current surgery.

It limits the aggression to a strict minimum, thus allowing a strong reduction in postoperative pain, a reduction in the duration of incapacity and a virtual absence of scarring. However, it cannot be applied to all deformities or pathologies of the forefoot. Its use must be decided by the surgeon according to precise clinical and radiological criteria. It is increasingly common on the lateral toes to treat toe claws and metatarsalgia (plantar calluses), but is only reserved for the treatment of certain hallux valgus for the big toe. In fact, the combination of the "open sky" (classical technique) and minimally invasive is common to effectively treat a forefoot.

Hallux Valgus Bordeaux

Surgical advances: Minimally invasive surgery for hallux valgus | Nice

Reducing the incision, limiting skin aggression, and simplifying the postoperative period have always been an obsession in surgery, particularly in orthopedics. Thanks to technological advances (cameras and arthroscopic optics, for example), the development of specific instruments and the improvement of surgical practices, minimally invasive surgery has become possible for many procedures. (hand, shoulder, knee surgery...)

Foot surgery, like other surgical specialties, is constantly taking advantage of the latest technological innovations to enrich itself and progress towards a minimal approach, especially since this surgery has a significant aesthetic component to take into consideration.

 

Hallux Valgus Bordeaux

Principles of treatment of hallux valgus | Nice


Hallux Valgus Bordeaux

SCARF" osteotomy of the first metatarsal


Hallux Valgus Bordeaux

All about Foot Surgery in Nice


Foot surgery is a part of medicine where treatment requires physical intervention on the body, most often through surgery. It can be manual or instrumental. There are several types of surgery as it is possible to have several ailments that require surgical intervention.

These include foot surgery, visceral surgery, neurosurgery, etc. Of course, each surgical specialty mentioned above concerns one or more parts of the body. For example, foot surgery may involve the arms, feet, etc. This surgical specialty treats skeletal-related disorders, the feet being generally one of the parts of the body most exposed to orthopedic pain.

One of the most common foot deformities is hallux valgus or bunion. In most cases, this foot deformity requires surgery. However, some people have recourse to surgery for aesthetic reasons.

 

 

Curing hallux valgus with foot surgery


Hallux valgus is a condition that continually evolves. Therefore, surgery is preferable for an isolated hallux valgus rather than an advanced hallux valgus that has led to other problems such as claw toes. If the above-mentioned methods fail, surgery may become necessary. The goal of surgery is to realign the big toe by reducing the gap between the first and second metatarsals. Several surgical techniques are available. There are percutaneous and minimally invasive techniques.

- Percutaneous surgery is performed through a 2 mm skin incision. It requires specific interventions allowing the surgeon to better perform the operation. It has the advantage of being performed on an outpatient basis, thus avoiding hospitalization.

- Minimally invasive surgery allows for minimal skin incisions (2 cm) while using the techniques of conventional surgery. It is a sort of fusion of conventional and percutaneous surgery.

From mild deformities in the beginning, hallux valgus can become a serious ailment. When this condition appears, it is important to adopt certain rules to reduce the pain. However, surgery may become necessary if the condition progresses.

Hallux Valgus Bordeaux

The day before the intervention

A protocol for skin preparation will be given to you at the surgeon's office when you make your surgical appointment (Protocol of the Committee for the Fight against Nosocomial Infections). You must comply with it, especially for foot surgery. Wash your foot vigorously for five minutes and then dry with a clean cloth to remove all the corneal layer. Cut and clean your nails.

All the instructions concerning your food and medication will be explained to you by the anaesthetist during the consultation. Do not hesitate to share your questions with him or her and to bring up any subject that comes to mind concerning your operation.

 

Hallux Valgus Bordeaux

Course of the hospitalization

On an outpatient basis

Most of the time, the operation is performed as an outpatient surgery (the patient is admitted, operated and discharged the same day)

It is preferable to come to the clinic with loose clothing, easy to put on and take off, as well as the specific shoes (prescribed by the surgeon in consultation) which will allow you to leave with the dressing.

You will arrive in the clinic's waiting room, and once you are admitted, you will be accompanied to the outpatient department where final preparations will be made for your procedure.

The duration of the hospitalization in ambulatory cannot be inferior to 6 hours, after your intervention, your surgeon will see you again, the schedule of your exit being fixed with the anaesthetist according to the type of anaesthesia and your postoperative state.

If your companion is not at the clinic, he or she can find out the time of departure by calling the ambulatory service. As your foot will be asleep for several hours after the operation, it is advisable to use crutches for the return home. You will not be able to walk again until your foot is awake.

Inpatient

More rarely, the procedure may require a few days of hospitalization,

You will be asked to make your admission either the day before (if you are having surgery in the morning) or in the morning (if you are having surgery in the afternoon).

Once you have been admitted, you will be accompanied to your room in the department. Please make sure that you do not bring any jewelry or valuables with you; a hospitalization booklet will be given to you to explain and detail your stay.

For a hospitalization of a few days, your surgeon will see you again after the operation to redo the first dressing and he will decide the date of your discharge.

Hallux Valgus Bordeaux

Clinic Fees:

The SAINT GEORGE and SAINT ANTOINE clinics are under agreement. Please come with your current social security card, and the clinic fees will be paid immediately. If you are insured outside the ALPES MARITIMES, or if you have an independent social status (please provide a deposit check), contact our secretariat to organize your treatment.

Anesthesia fees:

You will pay the anesthesiologist's fees on the day of your discharge from the clinic in accordance with the estimate given to you and the administrative and conventional regulations in force.

Surgical Fees:

You will pay the surgeon's fees on the day of your discharge from the clinic in accordance with the estimate given to you and the administrative and conventional regulations in force.

You can get more details about your hospitalization by visiting the websites of the clinics
SAINT GEORGE and SAINT ANTOINE

Hallux Valgus Bordeaux

The complete document of the hospitalized person's charter is available on the website:

 

Hallux Valgus Bordeaux

Hallux Valgus Bordeaux

Frequently asked questions about Hallux Valgus

Hallux valgus is the most common foot condition. This progressive deformity manifests itself by an exaggerated deviation of the big toe towards the outside of the foot and by the appearance of a bump (or exostosis, commonly called "bunion") at the joint.

Hallux Valgus Bordeaux

Questions about Foot Surgery | Hallux Valgus | Nice

When should I have surgery?

The pain, but especially the degree of this pain is the key word. For the same forefoot deformity, it will differ from one patient to another. The consequences of this pain, i.e. difficulties in walking and in putting on shoes, will lead to an indication for surgery.
It is important to point out to the patient that a hallux valgus will always evolve spontaneously towards self-aggravation, and that it is preferable to intervene surgically on an isolated hallux valgus rather than on an advanced hallux valgus that has caused the appearance of claw toes on the lateral radii by its deformation.
In the latter case, the surgery will be more difficult, the recovery longer and the risk of recurrence increased.

Is there an age limit for hallux valgus surgery?

Apart from the anaesthetic contraindications, there is no maximum age limit. Osteoporosis does not constitute a contraindication to surgery.
However, there is a minimum age corresponding to the end of puberty, to which we add a six-month delay for safety reasons. Thus, in the case of a congenital hallux valgus, which by definition appeared before the age of 15, the surgery can only be performed when the growth plates of the metatarsals and phalanges have completely disappeared in order not to endanger the growth potential.

Can I have both feet operated on in the same session?

Technically, both feet can be operated on at the same time. This is mainly of economic interest (only one surgical act, only one anesthesia, only one hospitalization, only one work stoppage).
If we place ourselves on the patient's side, we must explain to him or her precisely what the constraints of a bilateral operation are going to be (difficulties and possible instability when walking due to the wearing of two specific shoes during the first four weeks post-op).

What type of anesthesia will be used?

Loco-regional anesthesia has become the reference anesthesia. For Hallux Valgus surgery, a popliteal block is performed (putting the leg and foot to sleep). This loco-regional anesthesia has the advantage of being both an anesthesia allowing the realization of the intervention, but also a treatment against the postoperative pain thus realizing an analgesic block during the first 12 postoperative hours.
Combined with minimally invasive surgical techniques, locoregional anesthesia has made it possible to perform Hallux Valgus surgery on an outpatient basis.

How long will I have to stay in hospital?

Forefoot surgery, particularly hallux valgus surgery, is now performed on an outpatient basis thanks to the advent of :
- Minimally invasive surgery, which by reducing incisions, reduces the aggressiveness of the surgical act.
- loco-regional anesthesia, a much lighter anesthesia than general anesthesia
- Intravenous analgesia performed at home by a specialized network of liberal nurses Until recently, this intravenous analgesia implied a hospitalization to allow the use of a specific and bulky material ("an electric syringe"). Thanks to the analgesic diffuser (single-use, miniaturized intravenous device), this analgesia can be performed on an outpatient basis for greater patient comfort:
- Sleeping and eating at home
- Avoiding noise pollution in a health care facility
- To be surrounded by your own.

Will I suffer a lot?

Foot surgery still has a bad reputation when it comes to post-operative pain. Fortunately, there is now a very effective arsenal of therapies available for the treatment of this pain.
Thus, this management is based on a systematic prescription from the surgeon and/or the anaesthetist, but also on the patient's compliance with the instructions given during the preoperative consultation:
Chronologically, the management of postoperative pain begins with the creation of an analgesic block to ensure that the foot is completely asleep within 24 hours of the operation. This treatment alone requires monitoring and multi-daily injections of the local anesthetic through the catheter left in place on the operated limb, and therefore justifies the need for hospitalization. This procedure ensures the most complete indolence during the most painful postoperative phase, and thus reduces stress and anxiety, which most often contribute to the feeling of pain.
Once the patient has left the clinic, the relay is taken by painkillers prescribed by mouth. It is important that these be taken systematically in order to anticipate the onset of pain.
The patient must be aware that pain-relieving treatments are meaningless if they are not accompanied by scrupulous respect of the instructions given before the operation: all forefoot surgery requires the elevation of the operated limb as soon as the patient is in the chair or in bed, thus ensuring the best possible drainage after the operation (edema being a pain generator). As a guideline, "the feet should be placed above the heart". The fight against edema is imperative, since it is not only the cause of pain, but also slows down the healing process: indeed, any excessive edema can lead to skin disruption of the surgical wound which is no longer permeable, exposing the foot to infection. Raising the foot is not enough; it must be systematically combined with icing of the operated area: ice has anti-pain, anti-oedema and anti-inflammatory virtues, without any associated side effects, thus allowing for multi-day use.
Re-education and self-education, begun early on postoperative day 10-15, play a role in the treatment of pain thanks to the edema-draining function of massage therapy and passive mobilization of the foot.
Finally, the proper follow-up of the protocol for resuming support is also important in the treatment of pain. Indeed, the patient must know that any excessive resumption of this support in the four weeks following the operation is synonymous with oedema and therefore pain. Furthermore, support must be limited to its strict minimum during the first week post-op, or even, if necessary, be non-existent by using an English cane in case of displacement. Beyond the first week and until the end of the fourth postoperative week, support is always done with the help of a specific shoe, not exceeding two hours per day initially and then gradually increased.
In conclusion, the immediate postoperative analgesic block, which ensures that the foot is put to sleep during the most painful postoperative phase, and above all the instructions given to the patient concerning the treatment of edema and pain, make it possible to obtain comfortable postoperative results. All of this must not make us forget that the individual reaction to pain is different from one patient to another; moreover, any surgery, whatever it may be, causes pain, and the important thing is to ensure the best possible management of it in the interest of the patient.

Will my foot stay swollen for long?

Edema is the rule in foot surgery for several reasons: it is a surgery on a limb exposed to blood flow in the standing position; moreover, the typical patient requiring foot surgery (45/50 year old woman) often has venous insufficiency.
In the postoperative period, raising the foot above the level of the heart in the chair and in bed is imperative and promotes healing by limiting excessive traction on the sutured tissues.
Edema generally persists until the end of the fourth month postoperatively, but this is only an average value that can be revised upwards or downwards, depending on the patient's compliance, the degree of initial deformity of the foot, and the existence of an associated venous insufficiency.
The shoes must be adapted to the volume of the feet, until they have returned to a normal size.

After how long will I be able to walk and resume my activities?

The resumption of support is authorized immediately under cover of a specific shoe allowing the complete loading of the operated foot: it will be kept for four weeks.
To limit postoperative pain and edema as much as possible, it is recommended to limit any movement during the first postoperative week to a strict minimum, by not hesitating to use an English cane to allow complete relief of the operated foot.
Beyond this period, the cumulative daily walking time should be limited to two hours, in 15 to 20 minute increments, with an emphasis on short distances. The walking time will be gradually increased. In case of bilateral surgery, walking is possible with the help of English canes.
At the end of the four weeks of specific shoes, a soft flat shoe is put in place until the end of the 4th month.
The length of time off work depends on the professional activity. There is no problem with returning to work after two or three weeks, if the patient's professional situation does not require prolonged standing or walking. However, elevation of the foot, including at the workplace, should remain the rule. On average, patients benefit from one month's leave from work.

What about dressings?

The first dressing will be done postoperatively just before leaving the clinic, thus ensuring that the scar is progressing well and that there are no infectious processes.
Dressings are done every two days by a nurse at home until complete healing. The removal of the sutures is scheduled at D 15 post-op.
The foot may be washed the day after the wires are removed, unless otherwise instructed.

Can I take a shower or a bath?

Showering is allowed as long as the dressing is protected by a plastic bag. At present, there are waterproof devices on the market that allow bathing.

Is rehabilitation necessary?

Rehabilitation is essential and indispensable. It must be started early between D 10 and D 15 post-op. It must aim to maintain joint mobility by mobilizing the toes, which must be passive during the first four weeks. This mobilization will have a draining effect on the edema, as will the associated massage therapy.
At one month post-operatively, work on pulp support on the ground must be undertaken; standing on tiptoes cannot be considered before the third month post-operatively.
This re-education must necessarily be associated with self-education, at a rate of three times a day for the first two months post-op. It helps the patient to become aware of his operated foot, and must be limited to passive mobilization according to a technique shown by the surgeon in consultation. The first sessions can be done with the help of a physiotherapist.

When should I contact my surgeon before a scheduled consultation?

In case of fever, significant local pain, redness, or discharge from the wound, it is essential to contact your surgeon. The same applies if pain appears in the leg or calf with abnormal swelling of the foot.

Do I need to be under anesthesia to remove the metal hardware?

Screws and metal pins are used in foot surgery. In the case of hallux valgus surgery, this material is buried in the bone and is therefore left in place permanently.
In the case of claw toe surgery, a temporary pinning of four weeks is sometimes necessary, the pins come out of the skin, their removal requires neither anesthesia nor hospitalization; it will be performed in consultation.

Can I wear high heels again?

It is essential to avoid wearing shoes with high heels and/or pointed toes, only those not exceeding 4 cm are tolerated. In the opposite case, the patient is exposed to a recurrence.

Are there any specific risks associated with forefoot surgery?

Any operation involves short or long term risks; those most often encountered are :
* Healing problems due to poor management of postoperative edema resulting in traction on the sutured tissue.
* Infection, which is most often limited to a superficial infection limited to the skin, the origin of which can be linked to a delay in healing or to the general state (diabetes). Exceptionally, it can be deep with a picture of osteitis which is often problematic. Treatment involves local care that may be associated with appropriate antibiotic therapy.
* Algo neurodystrophy is most often limited to a spontaneously resolving pain syndrome, with, in its most severe form, inflammatory signs, hypersudation and diffuse demineralization of the bone, in response to the local aggression of the procedure; but this is usually only seen in the most anxious patients.
* Recurrence exists as in any surgical intervention: it is quantified at 6% and can occur in the short, medium and long term. In general, the results of forefoot operations are good and the quality of life is improved. The causes of recurrence are diverse:
- excessive laxity of the toe
- lack of compliance by the patient who has excessively reproduced in the postoperative period the causes of the initial deformity: very often the wearing of rigid shoes with pointed toes and/or high heels.
- technical error of the surgeon
- use of old surgical techniques, which should be abandoned, and which have contributed to giving forefoot surgery a bad reputation, particularly because of recurrences, but also because of the persistence of iatrogenic pain. The surgical technique currently recommended has been reliable for more than 10 years.
* Thromboembolic complications justifying postoperative antithrombotic prophylaxis.

- BONE COMPLICATIONS:
The osteotomy (fracture performed by the surgeon) may present a delay in consolidation which will have few consequences other than the persistence of pain until complete consolidation. Delayed consolidation is sometimes observed for up to a year.
Pseudoarthrosis is a lack of bone consolidation six months after the operation, which may require a new operation to heal the bone in case of pain.
Bone necrosis (death of bone that is no longer vascularized around the osteotomy area) is rare (<2%).
These bone complications are favored by smoking, obesity, alcohol, osteoporosis, vitamin D deficiency, diabetes, corticosteroid treatments...
- JOINT STIFFNESS:
Any joint movement can lead to a temporary or permanent stiffening of the joint. This stiffness may require re-education or re-operation.
- RESIDUAL PAIN:
The risk of residual pain, particularly in the joints, is inherent to all types of surgery. Although hallux valgus surgery regularly results in the disappearance of the pain syndrome related to the causal deformity, it is nevertheless true that in some cases joint pain may persist, raising the question of moderate osteoarthritis, particularly in the metatarsal-tesamoid space, even if the standard radiological workup is considered normal.
- MIGRATION AND BREAKAGE OF EQUIPMENT :
Surgical management involves the mobilization of bone segments, requiring the placement of surgical hardware. Like any material

Surgical implants can be responsible for complications, due to their own fragility (material breakage) or migration due to excessive mechanical stress on the bone structures where they are implanted (resumption of intensive walking too early, obesity, standing on tiptoe before three months post-op...). Thus, this surgical material may sometimes need to be reoperated in order to remove it.
Finally, and at a distance from the operation, once the postoperative period has passed and the pathology has healed, this material can also be removed when it is responsible for local discomfort or conflict.

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