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.
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 contributes strongly 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.
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.
Principles of treatment for hallux valgus | Nice
SCARF" osteotomy of the first metatarsal