 | ||||||
 | ||||||
Surgical Treatment
|
|
Watch your feet! How many legends are heard on
this big toe affliction! “It hurts like
crazy, it comes back, they stick a wire into it and then rip it out at the
clinic”. And then this: “When you have had an operation on one foot, you
won’t go back for the other!” In fact, things are way better than that! For one thing, it is not a bump which grows and becomes sensitive. It rather is a progressive disformation of the joint between the foot and the big toe. And this disformation is called "Hallux Valgus" (Latin words for "big toe" and "askew").
Is Hallux Valgus due to osteoarthritis?NO. In most cases, there is no presence of osteoarthritis (cartilage wear). There are cases when the malformation occurs as soon as childhood or during the teen years, especially if it runs in the family.Does this mean it is a hereditary disease? Not strictly speaking, but in 75% of the patients, there are antecedents in the next of kin. As to childhood Hallux Valgus, it usually comes from the mother, with a variable penetrance of 72%. Although this family tendency is an important factor, the wearing of (tight) shoes and high heels will eventually accentuate the malformation. There are also other Hallux Valgus factors an individual can be born with: the laxity of ligaments, the especially round nature of the metatarsal bone head, the incline of that head, and so forth. These are obviously more prevalent than a Hallux Valgus caused by some form of osteoarthritis. Is there any way to prevent Hallux Valgus?No, but here is what you can do to delay the deterioration: Avoid pointy shoes and heels that are too high. If you have flat feet, wearing an insole with an arch support may also delay the progression of Hallux Valgus. To ease the rubbing of the bulge inside the shoe, wear something made with somewhat elastic material which will also have enough room for your toes. As to the different sorts of spacers (to separate the big toe from the next one), those can alleviate the pain coming out of the stretching of the capsule to some degree, but they won’t have any impact on the progression of the malformation.Is it not better to wait as late as possible before one seeks treatment ? The answer is definitely « NO ! ». But there are several “operative” choices to
look into. In many Hallux Valgus cases, dislocation has started between the metatarsal
and the phalange. This will of course go
from bad to worse and so the more one waits to seek treatment, the greater will
the secondary malformations be: Sagging
of the 2nd metatarsal, hammer-toe, etc. Therefore, the more one delays surgery, the
more complex it might become and its results will never be as good as if it had
been done in time.What is that “best time”?One has to have symptoms. To willingly undergo such surgery, you need to be motivated. And since there are so many varieties of Hallux Valgus, only a good physical examination and X-rays will determine what the ideal treatment will be. (Be wary of any surgeon who will decide on a surgery procedure without any reference to X-rays!)Are there any new treatments?YES ! For instance, instead of using metal wires which will need to be taken out later, I use a dissolving wire (which, over time, disappears inside the foot). This minimizes further the risk of infection. Sometimes I use a micro-screw which will stay put inside the bone for the rest of your life. No more casts after those operations! And not only one can walk right on your operated foot the same day one was operated, but this is done under local aenesthesia! (Careful, though! You should keep your foot up as often as possible that first week.)Is it true that your feet hurt a long time?No. 95% of patients are in pain 2 to 3 days after surgery, but a good choice of pain-killers will help them through. 90% of the pain disappears later on. What takes time after surgery is for the swelling and the stiffness to abate. Patients need to wear the post-surgery sandal for 4 to 5 weeks, then a wide running shoe for four weeks more. Therefore one can rarely go back to wearing regular shoes before 8 weeks. This is why the length of sick leave will depend on the patient’s occupation demands (work standing up, need to wear normal shoes, and so forth).You do not have to be in pain for years. Do not wait for your feet to become completely misshapen or have someone ask: “How are your bunions?”
- So-called “mini-incisions”, which will be frequently at the source of recurrences.
| ||||
| ||||||
 © Dr André Perreault Phone: 514-387-3871 Email: | ||||||
