Minimally invasive surgery is the optimal treatment option for hallux valgus deformity. According to orthopaedic surgeons, “older surgical methods often lead to the deformity recurring.


16. 03. 2022 Orthopaedics

Wearing elegant high heels, unfortunately, comes at a high price that takes the form of a deformity called hallux valgus, more commonly known as bunions. Thankfully, this common foot deformity can be fixed by a relatively simple procedure, and a visit to a specialist shouldn’t be put off for long. Dr Rastislav Hromádka PhD, Chief Physician of Orthopaedics and Chief Physician of Surgery at Canadian Medical tells us more about the modern treatment options and the subsequent healing period.

How can a patient tell that they have hallux valgus and when should they seek medical advice?

Most patients only realize that they should see their doctor only when they start to experience pain in the forefoot area. If the pain is associated with a change in the position of the thumb or a reduction in its mobility, then it is appropriate to visit an orthopaedic clinic. X-rays then reveal the degree of the deformity. Very often I meet patients who say that their forefoot doesn’t hurt as much because they reduced the amount of physical activity they do. However, this approach is not really advisable, because physical activity is important for your overall wellbeing, and if the foot isn’t actively used, the hallux valgus often tends to get worse.

Is the procedure suitable even for patients who have just a slight deformity, when they don’t want to devote a lot of time to more conservative treatment methods?

The surgery is most often performed only when the patient is experiencing pain. Mild hallux valgus deformities do not have to be operated on if the body is able to adapt to the deformity. It is also important to realize that if the patient has a bunion on the inside of the foot, they very often overload the outside of their foot and toes. Often, it is not the bunion that actually hurts, but rather the toes or the entire forefoot. This is especially typical for middle-aged patients. In these cases, improving the function of the big toe can lead to pain relief.

What does surgical correction of hallux valgus deformity involve? Are there different methods?

There are a number of ways to perform foot surgery. They are most often based on corrective osteotomies of the first instep bone. The term osteotomy in the name means the intersection of bones and the correction indicates the mutual displacement of bones inside the leg. By moving the bones in the foot relative to each other, different mechanical conditions are set between the joints of the forefoot, and this leads to the straightening of the big toe. The essence of modern surgical approaches is to influence the forefoot to achieve an appropriate position of the large toe, while also resolving the cause of the deformity. Older surgical techniques only remove the bone growths around the basic joint of the big toe which often leads to the re-development of the deformity within a few years after the operation.

What are the benefits of minimally invasive surgical methods?

Modern surgical techniques are advantageous in that they do less damage to the soft tissue surrounding the operated area. The vascular supply is very important for bone healing and also affects postoperative swelling of the forefoot. Modern and especially mini-invasive approaches cause as little as possible damage to soft tissues and have been shown to cause less swelling.

Are there any benefits to minimally invasive surgery in terms of healing? 

Minimally invasive approaches use rotary cutters in osteotomies of the first instep bone, which are introduced into the patient's body only from small skin lesions. Of course, these procedures do cause some postoperative swelling, however, it is marginally less than what is expected after more invasive surgeries. The healing process is also a lot faster, and patients generally tend to tolerate these surgeries more. Specialists believe that the bone fragments in minimally invasive surgeries tend to heal together more rapidly, but there is no clear evidence. Also, as previously mentioned, modern surgical techniques are associated with a substantially lower risk of recurrence of the deformity.

Why are minimally invasive techniques not the standard at all medical facilities?

This mostly comes down to the available equipment. Modern approaches require an X-ray machine inside the operating room and a device for driving a rotary cutter, and this isn’t a common part of day-surgery orthopaedic rooms. The second reason is due to the lack of experience surgeons have with these techniques. Modern and minimally invasive approaches are more technically demanding and require the doctor performing these procedures to be specialised. So far, there are only a few facilities in the Czech Republic with doctors specialising in foot surgery.

What does the healing process look like in terms of rehabilitation or restrictions on what the patient can do, etc.?

After the operation, the healing limb needs to be relieved from any strain and postoperative flat shoes and crutches are used for this purpose. With the help of these aids, it is possible to gradually put more pressure on the foot, thus optimizing the healing of both the soft tissue and the bones. Modern procedures are also advantageous from a recovery point of view, because they allow for an earlier start in rehabilitation, especially exercises that involve moving the base of the big toe. Early and appropriate rehabilitation improves postoperative results.

How long does it take for everything to heal?

That really depends on a number of factors, but usually, I tell my patients that the foot should be able to bear the full weight after about 6 weeks, but the swelling should go down in about 3 months following the surgery.

Does one have to wear any special shoes following the procedure?

Postoperative footwear isn’t a necessary part of postoperative care, however, as already mentioned, early and adequate strain on the foot helps improve recovery time. I always recommend a post-operative recovery shoe to my patients.

After recovery, is one allowed to wear high heeled, narrow shoes?

Hallux valgus deformity procedures are performed with the intention that the foot will in due time be fully capable of bearing the normal weight. If during the procedure, it is possible to reconstruct the patient’s forefoot in a way that will allow for full weight-bearing, then it is absolutely possible for the patient to once again wear elegant high-heeled shoes of their liking, without a problem. Unfortunately, many women come to the orthopaedic clinic at the stage when the cartilage on the joints has been affected. Unfortunately, even after the corrective procedure, this still causes pain in the big-toe in shoes with a narrow front.

Is there any reasonable, or in other words, healthy way to wear high-heels? I mean, for example, limiting the number of hours per day or per week you wear them, so it doesn’t cause lasting damage.

This really depends on the dispositions of the foot. Not every foot is made to be able to wear narrow high-heeled shoes.  However, even if you have feet that aren’t exactly suited for the high-fashion life, there are ways to prepare your feet for the increased burden. Stretching the Achilles tendon and massaging the base joint of the big toe makes a big difference in achieving painless shoe wear. In my opinion, foot care has been lacking in the Czech Republic for a long time.

Can the pinky-toe also get deformed when chronically wearing tight shoes?

I mentioned at the beginning that the deformity of the big toe often leads to the overloading of all the other toes. Long-term overloading of the forefoot leads to a change in its shape, expansion and bruising on the soles. This is also associated with a change in the position of the fifth toe, which can twist and change its position. In the worst cases, it can bend all the way over the other fingers and create a painful bruise.

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