Category: Chirurgie

Hallux Valgus (Bunions): Myths and reality

Posted on by cdp.admin

Author: Adrien Ray

1. “THE HALLUX VALGUS IS DUE TO HIGH HEELS”

Hallux valgus, also known as bunion is a complex deformity whose origin is not yet fully understood. Bone architecture, genetic character, hyperlaxity and many other factors are recognized as contributing to its development. To date, however, no study has proven the role of high heels in the genesis of this pathology. However. by causing a displacement of the center of gravity previously, they increase the symptomatology and the pains, as the narrowness of these shoes. They therefore represent an aggravating factor in a context of hallux valgus already installed.

2. “IT IS NECESSARY TO WAIT UNTIL THE PAIN BECOMES VERY IMPORTANT BEFORE CONSULTING”

The surgical treatment of bunions has shown a great evolution since about twenty years. At the time, surgery was often complicated by recurrence, pain or development of other problems then little understood. Caution was necessary and patients were advised to wait until the symptoms were well advanced to discuss a correction. Currently, hallux valgus pathology is better understood, surgical bunion corrections are controlled and it is advisable to consult as soon as the discomfort or pain is established. It is also known that other problems, such as osteoarthritis, may arise if the deformity is left for years without correction.

3. “THE CORRECTION SURGERY OF A BUNION IS VERY PAINFUL”

If you ask a woman who has had a bunion (hallux valgus) surgery 20 years ago, there is a good chance she describes the experience as a real trauma, often compared to the pain of childbirth! Again, this vision is not at all short today. With the development of surgical and anesthetic techniques, micro-invasive surgery or improvement in follow-up,  pain is clearly no longer a problem. Naturally, each person perceives the pain differently, but it is transitory, well managed by the drugs and one quickly describes a discomfort more than a true pain.

4. “WE CAN CORRECT THE BUNIONS WITH LASER”

How many time did I heard this? FAKE NEWS!! There is currently NO technique of laser correction of bunions. Minimally invasive surgery, or percutaneous, allows to perform this surgery with one or more incisions of one millimeter. However, the bone movements made by these incisions are made by milling cutters at high speed and absolutely not laser.

 

5. “WHAT EVER WE DO, MY BUNION WILL EVENTUALLY COME BACK”

Recurrence is indeed the main complication of bunion correction. Nevertheless, scientific literature and studies show a 7% recurrence rate which means a 93% chance of permanent correction. Of course, this rate may be modified by the severity of the deformity to correct, the surgical procedure quality, or other very technical issues. Still, a well chosen and performed correction leads to a long standing correction. 

To know more about hallux valgus and bunions …

Or micro-invasive(percutaneous) foot surgery…

 

 

Recurrence after hallux valgus surgery

Posted on by cdp.admin

Author: Dr. Adrien Ray

1. WHAT IS THE FREQUENCY OF RECURRENCE OF FOOT SURGERY?

It depends primarily on the type of intervention chosen and the age of the patient.

In adults, the recorded rate of recidivism and 2 to 4% (Mann et al.). This is usually the risk encountered during a modern foot surgery where a cut in the bone is performed, moved, and then fixed to realign the big toe. This rate can rise up to 50% in surgeries where only excision of the hump has been performed. It is for this reason that the hallux valgus are practically systematically corrected by a bone cut, because the former surgeries, lighter, show disappointing results.

In adolescents, it can be elevated and, according to published studies, can range from 10 to 40%.It is often explained by a bad analysis of the cause of the deformation which is often different from the hallux valgus developed in the adult. Therefore, a 14-year-old girl is not necessarily treated as a 50-year-old woman.

2. WHAT ARE THE CAUSES?

Understanding the cause of the deformity is paramount in surgical planning. Each foot is different and there is no foot surgery correcting all hallux valgus . For a long time, the causes of these deformities were not really understood, which explains the high rate of recurrence in patients operated many years ago.

The anatomical scientific studies and the studies of operated patients made it possible to classify the hallux valgus according to their form, their degree and sometimes their causes. All possible surgeries (there are more than 200) are now specific to certain forms of hallux valgus and should only be offered under these conditions. For example, an elderly patient, simply suffering from a lump in a context of mild hallux valgus and osteoarthritis, is a very good candidate for a simple excision of the hump or for another light surgery. The consequences will be simple and the pains clearly diminished. The same surgery in a young patient could give good results for a few months, but the deformity progressing, it will appear 6 months later for a disabling recurrence. It is therefore necessary to offer him from the outset surgery a little heavier but definitive.

3. HOW TO CHOOSE THE RIGHT SURGERY?

This is obviously the question that every patient and every surgeon asks himself. There is no exact answer and it depends on many factors. It is here the role of the surgeon to explain to the patient his problem, his cause if it exists, and the means to correct it. The personal experience of the operator is one of the key factors. Each surgeon must know several interventions to correct a hallux valgus and his personal experience will allow him to choose the appropriate gesture. There are many possible options for correcting a deformity and there is no exact consensus that such hallux valgus requires such intervention. It is necessary to know how to appreciate the age of the patient, his requests and goals as well as the type of deformation to offer the most specific gesture possible.

4. WHAT TO DO IN CASE OF RECIDIVISM?

Above all, do not give up. Recidivism exists and does not mean that it is definitive. There is usually a way to correct them. 
The first question to ask: Does this new distortion really bother me? Beyond the aesthetic character, a slight recurrence can be perfectly painless and in this case, it is better to think clearly about the need for a new intervention. 
If the pain or discomfort reappears, it is advisable to consult a specialist. Changes in shoes or soles can sometimes be enough to significantly reduce the discomfort. As a last resort, surgery may be considered.

5. WHAT ARE THE OPTIONS?

Foot surgery will depend on the deformity and its cause. 
Recurrence is often noted if there is insufficient or inadequate correction during the first surgery.In this case, we will make a new correction, this time, sufficient. 
Sometimes, only a small lump sign recurrence without deviation of the big toe. We can then discuss a simple excision of this hump, by open or percutaneous surgery. 
Finally, some people unfortunately show significant damage to the joint accompanying this recurrence, and in this case the option of choice remains the arthrodesis, ie the final blockage of the joint.

In any case, it is important to understand that revision surgery is always more technically complex than first-line surgery.

To learn more about the treatment and causes of hallux valgus …