𧿹Does hallux valgus surgery require osteotomy? What are the advantages of minimally invasive surgery?

Author: Xu Yingpeng, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Reviewer: Zhang Zhihai, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Hallux valgus is a common foot deformity. There are various surgical treatments for it, but up to now there is still no method that can completely solve the problem. This is a problem worldwide.

1. What are the commonly used surgical methods for hallux valgus?

Hallux valgus is usually caused by inversion of the first metatarsal. The current mainstream surgical method includes osteotomy at different parts of the metatarsal, such as distal, shaft and root osteotomy, to correct the inversion tendency of the first metatarsal. If the patient also has phalangeal deformity, corresponding osteotomy correction is required on the phalanges.

Figure 1 Original copyright image, no permission to reprint

When these methods are not enough to solve the problem, you may need to consider fusion surgery, which is to remove the original movable joint surface and fix it together to form a fixed joint, including distal fusion and metatarsal arthrodesis. For some patients, artificial joint replacement may be needed, which is to remove the metatarsophalangeal joint and implant an artificial joint.

However, these traditional surgical methods generally have challenges such as large trauma, long recovery period and significant potential impact on joint function, which affect the surgical results.

Nowadays, minimally invasive surgery for hallux valgus has become an effective treatment method. This procedure has been successfully used in many patients, and the vast majority of hallux valgus cases can achieve significant therapeutic effects through minimally invasive treatment.

2. How is minimally invasive surgery performed to treat hallux valgus?

After anesthesia, the toe is first released so that it can be easily moved into the inversion position. Next, the skin is incised transversely at the base of the proximal metatarsal, and once the bone is reached, a special periosteal elevator is used to completely peel the joint capsule away from the metatarsal head. The bone spur is then smoothed with a burr, and another incision is made in the metatarsal neck, which is penetrated and then the osteotomy is performed. After the osteotomy, the metatarsal head is manually pushed outward and pressed downward, while the toe is placed in a relatively inversion position and fixed with a bandage.

A pressure pad was placed between the first and second toe webs to maintain the inversion of the toe, and then bandaged. The outside was covered and fixed with adhesive plaster, and the operation was successfully completed.

Figure 2 Original copyright image, no permission to reprint

Most patients with hallux valgus can achieve satisfactory results through minimally invasive osteotomy. However, for more severe cases, it is difficult to achieve ideal correction. If the deformity still exists, the symptoms may be aggravated due to further collapse of the arch and the bowstring mechanism. In addition, the reduction of the metatarsophalangeal joint after surgery is crucial. If it is not completely reduced, it may also cause recurrence.

3. What are the advantages of minimally invasive surgery for hallux valgus compared with traditional large incision surgery?

First, the operation is quicker. Minimally invasive surgery can be performed on a foot in less than five minutes, and can be completed under local anesthesia; traditional large incision surgery may take more than an hour, and may require spinal anesthesia, and some may even require general anesthesia.

Second, the incision is very small. Minimally invasive surgery usually involves two incisions, the longest of which is no more than 1 cm, and the smallest is about 0.5 cm. Traditional large incision surgery requires at least two to three centimeters of incision.

Third, no sutures are needed. The incision of minimally invasive surgery is a horizontal incision. When bandaging, the toe will be bent inward to keep it in an inverted state. At this time, the skin on both sides is tightly pressed together, which can keep the two incisions completely aligned, and no sutures are needed. Traditional large incision surgery requires sutures.

Fourth, no internal fixation materials are needed. Minimally invasive surgery for hallux valgus does not require nails or steel plates. Through bandages and pressure pads, the fixation effect can be achieved, saving a lot of consumables and the cost is much lower. Traditional large incision surgery may require some internal fixation materials, such as nails, steel plates, or Kirschner wires.

Fifth, recovery is relatively fast. Generally speaking, patients cannot walk much for about two to three months after minimally invasive surgery. After two to three months, they can basically resume normal walking. Of course, they may still be unable to exercise, but normal walking is generally no problem. After traditional large incision surgery, patients may only be able to walk after two to three months.

In terms of functional recovery, minimally invasive surgery is also faster. Two or three months after surgery, the joint function has recovered quite well, and can recover to about 60% to 70% or 70% to 80% of the normal toe movement function. Traditional large incision surgery may not be able to achieve this.

In general, minimally invasive hallux valgus surgery has a simple procedure, less trauma, and a relatively quick recovery.