Foot surgery

The foot is a part of the skeleton that influences the whole posture, especially the knees, hips, pelvis, spine. Many types of back pain are often caused by poor foot support as well as certain types of knee pain are due to poor plantar posture. Therefore surgery, when recommended by the specialist, must be performed not only to correct defects of the foot itself but also to prevent conditions that could affect other osteo-articular districts. Foot surgery can be very painful however, with the advent of minimally invasive techniques, this problem has been largely overcome.

MediClinic Foot Surgery service adopts advanced minimally invasive surgery techniques for the treatment of many foot conditions such as hallux valgus, hammer toes, metatarsalgia, Morton’s neuromas, calcaneal spurs.

Who could benefit from this service?

The service is aimed at all patients suffering from the above-mentioned foot conditions, such as:

• Hallux valgus
• Hammer toes
• Metatarsalgia
• Hallux rigid
• Morton’s neuroma

Minimally invasive surgical treatment of hallux valgus

Hallux valgus is the medial displacement of the first metatarsal ray, with a lateral deviation of the first toe. This modification of the bone position creates an angle that determines the condition (hyperostosis). The purpose of any type of hallux valgus surgery is to restore the correct alignment of the first ray (first toe and metatarsal bone).

Hallux valgus is a disease that mainly affects women (9 to 1 ratio), often occurring between 40 and 60 years of age however it might also affect young patients. There are various causes that can lead to the development of hallux valgus: congenital (i.e. present from birth) or acquired for laxity, inflammatory conditions, genetic predisposition, hollow foot structure, incorrect posture that creates deviations in the structure of the foot. When the support changes, the foot adapts to find a new stability and a new balance but, in doing so, it causes the condition. When the hallux valgus is associated with pain, especially during the gait, it becomes appropriate to contact the specialist to evaluate possible surgery.

Surgery must be performed in patients older than 18-20 years of age to allow the complete formation of the affected bones and it can be performed throughout the lifespan therefore also in patients of advanced age.

The symptoms are:

• pain in the area of the first metatarsal bone
• diffuse pain in the forefoot
• pain while wearing shoes
• pain when walking

The method is effective, fast and at the same time complex and requires a long learning curve by the specialist. In fact, the Italian Orthopedic Society suggests the use of the described technique only to particularly expert surgeons who have many years of experience and adequate case studies.

Surgery is performed via small incisions and without using screws, plates, wires or nails. Post-operative pain is practically absent in 95% of cases. It is possible to start walking 1 hour after surgery, with a suitable shoe. The minimally invasive technique involves a local-regional anesthesia. The length of surgery is on average 12-15 minutes.

A bandage needs to be worn for about 40 days after surgery and it is sufficient to maintain the alignment of the metatarsal bone. This effectiveness of this minimally-invasive technique is internationally recognized.

The principle of minimally invasive surgery is to create microfractures to favour, while walking, the new alignment and repositioning of the bones, according to the shape of the foot.

Surgery

The complexity of the surgery lies in the method of intervention that requires working in a “closed sky” environment with the support of a fluoroscope and a monitor. The lower visibility must therefore be compensated by the high experience and sensitivity of the operating surgeon, combined with perfect knowledge of the anatomy of the foot. Traditional surgery to treat hallux valgus lasts on average 1 hour, followed by a long recovery that severely limits patient mobility, causing fairly significant postoperative pain.

Bosch’s minimally invasive technique for treating hallux valgus, already in use in the United States, has been further refined with important changes and is preferred over other techniques. The method used at MediClinic is particularly innovative because it does not involve the use of synthetic fixation devices, reducing the patient’s recovery times, decreasing the risk of infection, reducing pain in the postoperative phase which in most cases does not require the administration of specific medications.

The surgical procedure, aimed at solving functional and aesthetic problem of the foot, is divided into the following phases:

• a small incision is performed under the area containing the bony protrusion, allowing the entry of the micro-drill
• guided by the fluoroscope, the procedure is followed step by step, “filing” the protruding part of the metatarsal bone
• using the previous access point, the metatarsal osteotomy is performed through a second helical mini-drill
• the tenotomy, i.e. the section of the adductor tendon of the first toe is then performed, which drags the toe outwards, elasticizing it
• a second microfracture is performed on the first phalanx of the first toe
• through an appropriate movement made by the specialist, the metatarsal bone is repositioned and realigned
• a taping bandage follows and an elastic bandage is placed to keep the first ray aligned. The patient can leave the clinic about two hours after surgery. For the first 2/3 days after surgery it is advisable to rest and walk at home, keeping the foot elevated as much as possible. Later the patient can leave the house avoiding to get tired.

Physical therapy

At the end of the whole surgical procedure, the patient has the opportunity to take advantage of the modern MediClinic rehabilitation service. The medical-surgical staff and the rehabilitation professionals constantly collaborate to provide the patient with complete assistance and favor a prompt return to everyday life in the shortest time and with the least discomfort possible.

Frequently asked questions about hallux valgus surgery

How does hallux valgus form?

The hallux valgus can be congenital, i.e. present since birth, or acquired, i.e. it forms during lifetime due to a series of intrinsic and extrinsic factors.

What are the intrinsic and extrinsic factors?

Intrinsic factors are those as laxity of foot ligaments, postural attitude, metabolic diseases present in the individual. By extrinsic factors we mean the use of footwear.

So shoes or heels are not responsible for this pathology?

Absolutely not! Footwear and high heels, only if worn excessively, can aggravate the situation and in any case it is important to emphasize that they are absolutely not the cause of hallux valgus.

Is it a condition that can be avoided?

It is difficult to intervene to change the course of the disease. If there is a tendency to develop hallux valgus, sooner or later this deformity will occur and all those practices that try to cancel the condition are worthless. Of course, the use of an insole can help slow down the course of the condition but it certainly does not eliminate it.

When should I refer to the surgeon?

After trying and experimenting with the various orthoses, insoles and anything else, if the foot starts to hurt and wearing a shoe becomes a torture then the time has come to consult the surgeon.

What does the hallux valgus correction surgery consist of?

Eliminating hallux valgus means removing the bony protrusion and straightening the first toe. This is achieved through the execution of fractures of the affected bones and their subsequent realignment.

Are there more than one technique to correct hallux valgus?

Yes, there are:

the so-called “traditional” techniques involve more or less large wounds to perform the above fractures and the final use of fixation devices (screws, wires, plates, etc) to keep the fractures aligned
techniques where small incisions are made and metal wires are used to keep the fractures in place
the so-called “percutaneous” techniques where surgery is performed through small incisions in the skin, with special small drills and without the final use of screws, metal wires, plates, etc.

Other conditions

The minimally invasive technique, previously described, allows the specialist to solve other foot conditions such as hammer toes, metatarsalgia, Morton’s neuromas, etc.

Why choose MediClinic?

MediClinic, thanks to the high professionalism of the specialists, is able to offer minimally invasive surgical procedures for the treatment of foot conditions. The operating rooms are equipped with all medical and technological devices that allow the surgeon to operate in maximum safety.

The constant support of the anesthesiologist throughout surgery allows the surgeon to work with maximum effectiveness and allows the patient to face the surgery and the post-surgery phase with maximum serenity.