- The purpose of surgical treatment of hallux valgus deformity
- What type of doctor performs hallux valgus surgery?
- How effective is surgical treatment of hallux valgus?
- Preparing for surgery
- How is surgical treatment of hallux valgus performed?
- What type of anesthesia does the patient receive for thumb surgery?
- Will my foot hurt after hallux valgus surgery?
- Conditions of accommodation at the Gelenk Clinic
- What to pay attention to after surgery
- How much does surgical treatment of hallux valgus cost?
- Who is suitable for such surgical treatment of hallux valgus deformity?
- How can a foreign patient make an appointment and the operation itself?
Surgery for hallux valgus pathology - a bunion or bunion - is the correction of a deformity of the big toe with a noticeable deviation towards the outer edge of the foot.
@joint-surgeon Valgus pathology of the first toe (curvature, “bump” or “bone”) is a fairly common disease, primarily among the female population. Hallux valgus pathology is characterized by a noticeable deviation of the big toe towards the outer edge of the foot, which can cause curvature of the remaining toes. All this creates a rather unaesthetic picture. As a rule, women most often experience hallux valgus and notice that their usual size shoes no longer fit them. At the progressive stage of the disease, the overload of the first metatarsophalangeal joint increases every day. Over time, other fingers also undergo deformation, namely, they take on the shape of a hammer. Sometimes signs of a hooked finger are also observed. A bunion on the foot with increasing transverse flatfoot severely deforms the metatarsophalangeal joint of the forefoot. Its sole becomes denser and protrudes in the center; in the same place painful exostoses (bone growths) and inflammations form, further aggravating the problem with shoes. Excessive stress on the foot can cause arthrosis of the first metatarsophalangeal joint (hallux rigidus). Often, experts also note the cosmetic aspect of the operation, which is called “Cinderella” or “Cinderella”. However, improving function, relieving chronic pain, and correcting foot deformity pathologies are also important components of comprehensive treatment. Doctors at the specialized medical center for foot and ankle surgery at the Gelenk Clinic, near Freiburg, provide highly professional, gentle treatment for deformation pathologies of the big toe. The clinic's experienced surgeons are true professionals in their field. In their work, they use exclusively high-tech equipment that facilitates painless, minimally invasive interventions. After the operation at the Gelenk Clinic in Freiburg, the patient will be left with no scars. Thus, the healing process and rehabilitation period are reduced to a minimum, which avoids visible scars on the foot.
The severity of hallux valgus deformity determines the complexity and course of surgery. The more complex the operation, the longer the postoperative treatment. That is why people suffering from hallux valgus (Hallux Valgus) need to consult a doctor in a timely manner and discuss treatment in advance, as well as all possibilities for correcting the disease.
Treatment of hallux valgus at the Gelenk Clinic returns patients to their previous mobility in the shortest possible time. In addition, the goal of our specialists is to achieve the best cosmetic result without scars or other visible consequences.
What type of doctor performs hallux valgus surgery?
The specialist clinic Gelenk-Klinik in Freiburg is distinguished by a special relationship between doctors and patients. This means that your attending physician will monitor you from taking your medical history until the operation itself. This way, you have a competent contact person who understands your situation and can answer all your questions at any time. Dr. Thomas Schneider and Dr. Martin Rinio are among the leading experts in the field of foot and ankle surgery. In addition, Dr. Schneider and Dr. Rinio are experienced, certified surgeons who treat hallux valgus and ankle deformities at the highest level, are audited annually by independent German medical associations, and constantly improve their qualifications. This is why the orthopedic Gelenk-Klinik in Freiburg has been given the official name “Center for Foot and Ankle Surgery”.
Current trends in foot surgery:
Foot surgery is currently developing rapidly. Gone are plaster casts, crutches and long bed rest. Modern foot surgery offers simple and beautiful solutions! The patient begins to walk on the day of surgery. Rehabilitation is quick and painless. The result of the operation is reliable and stable. If you are concerned about a bunion in your foot, feel free to contact our specialists. One operation is enough to restore the natural shape of the foot, regardless of the stage of the disease!
How effective is surgical treatment of hallux valgus?
The effectiveness of the operation does not depend on the severity of the hallux valgus deformity. However, the severity of the hallux valgus disease determines the surgical procedure. Treatment of hallux valgus has certain features that are explained by the structure of the metatarsophalangeal joint of the big toe, which in turn differs from others by the presence of sesamoid bones and muscles responsible for its stabilization and the strength of the first ray of the foot. The use of stabilizing metal implants is typical for patients with pronounced valgus deformity. In such cases, patients should be prepared for long-term treatment and a longer recovery process. Sometimes these metal structures are removed after 6-12 months. And even with a very pronounced bunion, accompanied by arthrosis of the first metatarsophalangeal joint, the orthopedic specialists at the Gelenk Clinic in Freiburg are able to achieve a similar result.
Before each operation, experienced surgeons of the Gelnk Clinic conduct a conversation with the patient, during which they discuss all the possible advantages and complications of the surgical intervention. According to the results of international studies, almost 80% of patients feel very well after surgery. Another 10-15% of those operated on feel even better than before surgery. And only about 5% of patients did not feel any improvement. How effectively the surgical treatment of hallux valgus will be successful depends on the qualifications and experience of the operating surgeon.
Based on many years of experience and cooperation with exclusively experienced and knowledgeable specialists, we recommend regular home exercises to each patient. We believe that with special exercises, surgical treatment of hallux valgus will be more effective. A detailed description of gymnastic exercises is provided by the specialized center of the Gelenk Clinic for the treatment of foot diseases in Freiburg.
Possible complications of the procedure
Complications from using laser equipment for surgery are rare. They are associated with violation of recommendations for caring for the affected area and infection of the wound. Therefore, a course of antibiotic therapy is prescribed.
The most unpleasant consequence is the recurrence of a bunion on the operated leg. The reasons are due to failure to comply with the requirements of the orthopedist to stop wearing narrow high-heeled shoes, obesity, additional foot injuries, and heavy lifting.
Preparing for surgery
First, the doctor prescribes a comprehensive clinical examination and imaging diagnostics. First of all, a conversation is carried out with the patient and then a physical examination and an x-ray in the “standing” position, that is, under load. By measuring the intermetatarsal angle (the angle between the 1st and 2nd metatarsal bones), the degree of hallux valgus is determined. Based on the result of this procedure, the doctor and the patient make a decision regarding the technique of the upcoming operation.
After assessing the patient’s physical condition, the surgeon conducts an explanatory conversation with him, during which he discusses the course of the operation, as well as possible complications. In addition, before surgery, an anesthesiologist meets with the patient, who once again carefully checks the patient’s health before anesthesia. As a rule, the operation is performed the next day.
How is surgical treatment of hallux valgus performed?
Hallux valgus: A noticeable deviation of the big toe toward the outside of the foot and misalignment of other joints.
Asymmetry of the sesamoid bones. © joint-surgeon Surgical treatment of hallux valgus helps to straighten the curved position of the bony axis of the big toe. In addition, surgical treatment helps to normalize tendon-muscle tone. Otherwise, the thumb deviates more and more to the side. A very important point during the operation is careful treatment and minimal trauma to the muscles and tendons surrounding the first toe. Also, surgical treatment of hallux valgus deformity contributes to long-term improvement of finger pronation.
Surgical treatment of hallux valgus also involves monitoring the condition of the sesamoid bones. Os sesamoideum or sesamoid bone is located in the thickness of the tendons and is responsible for maintaining the required distance to the bone, preserving the original functions of the tendon apparatus. During the operation, the surgeon must monitor the position and condition of the sesamoid bones. When this component of the flexor apparatus of the foot takes part in pathological processes, the patient experiences severe pain, which significantly worsens the quality of his life.
The duration of the operation is about one hour. Typically, surgeons use minimally invasive surgical techniques that involve small incisions. This operating principle significantly reduces the risk of infection. After this surgery, patients may experience minimal scarring. In most cases, surgical treatment of hallux valgus is combined with the following techniques:
- Corrective osteotomy: This intervention is aimed at correcting the crooked position of the foot.
- Soft tissue correction (lateral release): Treatment of the joint capsule and straightening of hallux valgus.
- Surgical treatment of tendons: Correction of tendon length to avoid hallux valgus.
- During surgery for hallux valgus pathology, the surgeon may also perform a joint-preserving cheilectomy (removal of bone spurs). In case of severe arthrosis (hallux rigidus), arthrodesis is performed (immobilization of the first metatarsophalangeal joint). In this way, the patient is relieved of severe foot pain and quickly returns to previous activities. Fortunately, this procedure is performed quite rarely.
Types of laser treatment
The laser therapy method is used in complex physiotherapeutic treatment in conjunction with electrophoresis, massage, and baths to relieve inflammation of the metatarsophalangeal joint before surgery. It is recommended to remove foot deformities using laser surgery in one of three ways:
- exostectomy;
- osteotomy;
- resection arthroplasty.
The use of a laser beam in surgery requires the establishment of certain parameters in terms of wavelength and pulse frequency. The depth of impact and power depend on this.
Exostectomy
The operation is used more often as a cosmetic procedure if patients do not have impaired joint function. The laser beam successively evaporates excess bone tissue on the head of the metatarsal bone. The process is called grinding. The bone is removed layer by layer until the desired leveling is achieved.
The surrounding tissues are quickly restored. Joint mobility is preserved.
Osteotomy
It involves partial removal of the phalanx of the thumb. The beam's ability to destroy bone by microexplosions when the temperature reaches 100 degrees or more is used (crater formation in the tissue). The finger is shortened, which is considered the only possible way to eliminate advanced deformity.
Mobility in the joints cannot be completely restored. After surgery, patients need to wear orthopedic shoes.
Resection arthroplasty
It is carried out to radically correct a deformed joint. First, excess bone tissue is excised, then the joint is removed and replaced with a prosthesis made of biomaterial, metal, or fiberglass.
What type of anesthesia does the patient receive for thumb surgery?
As a rule, surgical treatment of hallux valgus deformity is performed under general anesthesia. However, if the patient wishes, this operation can be performed under local anesthesia. To do this, the anesthesiologist injects an anesthetic into the spinal canal of the lumbar spine. During such an operation, the patient is fully conscious. What type of anesthesia is suitable for the patient is determined individually, during a conversation with the anesthesiologist. At the same time, our specialists take into account all available indicators, as well as the physical condition of the patient. The practicing anesthesiologists of the Gelenk Clinic in Freiburg are professionals in both of the above-mentioned methods.
Conditions of accommodation at the Gelenk Clinic
Private ward at the Gelenk Clinic in Gundelfingen, Germany.
As a rule, during an inpatient stay at the clinic, you are in a separate room with a shower and toilet. In addition, we provide you with towels, a robe and slippers. You can also use the minibar and safe. Each room has a window. You only need to bring your own medications, comfortable clothes and nightwear. After hallux valgus surgery, we provide 24-hour care from qualified nursing staff and experienced physiotherapists. Generally, the hospital stay after surgery is two days. Your family members can stay at a hotel that is a few steps away from the clinic. We will be happy to take care of your hotel room reservation.
What should you pay attention to after surgery?#
Immediately after hallux valgus surgery, the foot should be cooled and kept elevated. In this way, swelling and pain are prevented. A special dressing technique stabilizes the thumb in the first few days. After approximately 12 days, the stitches are removed. After this you can take a shower again.
In addition, for four weeks it is necessary to wear special shoes that relieve stress on the forefoot. The total body weight is transferred to the heel. If you need to walk a somewhat long distance, we also recommend using elbow-supported crutches. Prevention of thrombosis during periods of inability to perform full exercise is mandatory. In addition, treatment of hallux valgus in our clinic involves physical therapy and lymphatic drainage to minimize the likelihood of swelling and prevent muscle loss. Often the duration of swelling depends on the age of the patient.
- Inpatient treatment: 2 days
- Recommended time of stay in the clinic: 5 days
- When is a return flight possible: 5 days after surgery
- Recommendations regarding return flight: 7 days after surgery
- When can you shower: after 12 days
- Recommended duration of sick leave: 4 weeks (depending on professional activity)
- When the stitches are removed: after 12 days
- When can you drive again: after 4 weeks
Are the heels to blame?
One of the most common problems with which patients turn to orthopedists is hallux valgus (foot deformity at the metatarsophalangeal joint). In simple terms, it’s a lump on the big toe. This bump itself and crooked toes not only look ugly, but also cause a lot of problems: pain when walking, heavier gait, the inability to choose not only beautiful and fashionable, but even just comfortable shoes.
– Bagavdin Gadzhievich, what is the main reason for the appearance of bunions on the foot? Is it only in the notorious narrow high-heeled shoes?
- No, this is a misconception. After all, this form of foot deformation is often found in men, and they do without high heels. According to statistics, every third patient with hallux valgus (30%) is a member of the stronger sex.
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Hallux valgus is the result of congenital or acquired flat feet. In a person with this problem, when walking, the center of gravity in the foot shifts to the front part, as a result the joint is deformed, and the toes move to the side. Not always, but in about 80% of cases with flat feet, such a problem develops. This usually happens after 40 years, when the ligamentous apparatus of the foot loses its elasticity. Excess weight can also trigger the onset of the disease. There is also a hereditary predisposition: as a rule, in a family, grandmothers, mothers, and daughters have this foot feature. As for high heels, they only stimulate and accelerate the process of foot deformation in people who already have either flat feet or poor heredity.
– Phew, calmed down. So, we continue to wear stiletto heels!
– Wear them if you really can’t live without them, but not often and not for long. In general, orthopedic surgeons have a special attitude towards heels: we consider them to be the culprit of many problems with the spine and strictly recommend wearing high-heeled shoes no more than 2 hours a day.
Women who wear such shoes for some reason think that it decorates them. In the doctor's opinion, the opposite is true. When a person stands on high heels, the biomechanics of the ankle, knee, hip joints, lumbar spine and cervical region are disrupted. That is, the knees, back, and neck are forced to bend at the same time. Is this beautiful? Very doubtful. Plus it's inconvenient. And most importantly - very harmful!
Where to point your feet. Is it possible to cure flat feet? More details
– Okay, let's not abuse it. In everyday life - only ballet shoes!
- Wrong again. When a person stands straight, the load on the heel of the foot is 65%, and on the forefoot - 35%. But if you wear shoes with a heel of 1.5–2 cm, the load between the heel and the forefoot is distributed equally - 50 to 50. And when the heel is higher, each centimeter redistributes the load from the heel to the toe by 10%. As a result, the ligamentous apparatus gets tired and wears out. Against this background, that same bump appears - exostosis - and curvature of the fingers occurs. Therefore, the right shoes should have a heel, but not a high one.
How much does surgical treatment of hallux valgus cost?
In addition to the cost of the operation, it is also necessary to take into account the additional costs of diagnostics, conversation with a doctor and elbow crutches. If you plan to stay in Germany after surgery for physiotherapy treatment, we will be happy to make appointments with renowned physiotherapists and provide you with a preliminary cost estimate.
Information regarding the cost of hotel accommodation and possible additional rehabilitation treatment can be found on the service provider’s website.
Who is suitable for surgical treatment of hallux valgus?
In order to accurately assess the condition of the foot and determine the degree of hallux valgus, we will need recent x-rays, as well as an MRI. Based on these images, your doctor will be able to tell if surgery is right for you. Good blood circulation is the key to a quick recovery after metatarsal surgery. The foot is the most distant organ of movement from the heart. The soft tissue coverings on an overloaded foot are very thin, and the mechanical loads, on the contrary, are high. That is why all diseases that reduce already poor blood circulation negatively affect the healing process after surgery. The following pathologies prevent successful correction of hallux valgus or complicate this process:
- obliterating atherosclerosis of peripheral arteries
- diabetic foot
- the initial stage of polyneuropathy (a nervous disease often caused by diabetes)
- venous insufficiency
If the above diseases are present, before performing surgical treatment of hallux valgus, our specialists should consult with a phlebologist.
Polyarthritis and rheumatoid diseases do not prevent foot surgery. However, in this case, it is necessary to pay special attention to the surgical technique used to treat hallux valgus. The surgeon needs to be especially careful if the patient has already had hallux valgus surgery, since this fact only complicates repeated corrective treatment.
Poor circulation is always a contraindication: Obliterating atherosclerosis of the peripheral arteries or diabetic foot syndrome prevent or complicate the wound healing process after surgical treatment of hallux valgus. © Viewmedica
Contraindications to laser treatment
Contraindications are absolute and relative. It is strictly forbidden to use a laser in operations in the presence or suspicion of a malignant tumor process in the patient’s body.
Relative contraindications imply the possibility of surgical treatment after the elimination of acute symptoms and compensation for concomitant diseases. These include:
- benign tumors;
- diabetes;
- severe inflammation in the joints;
- low blood clotting;
- fungal and other skin diseases in the area of the proposed operation;
- high activity of collagenosis, systemic connective tissue diseases.
Low blood clotting is a contraindication to the procedure
The decision on the advisability of surgery is made after a complete examination of the patient.
How to make an appointment and the operation itself for a foreign patient
In order to establish the condition of the first metatarsophalangeal joint, specialists in the treatment of hallux valgus in Germany require current MRI and X-ray images, which you can download on our website. After viewing the sent images, within 1-2 business days you will receive all the necessary information, a treatment proposal, as well as an estimate of the cost of treating hallux valgus.
Foreign patients can make an appointment with a Gelenk Clinic specialist in a short time frame that suits their plans.
We will be happy to assist you with obtaining a visa after the advance payment indicated in the cost estimate has been received into our account. If your visa application is refused, we will refund your advance payment in full. For foreign patients, we try to reduce the time interval between the preliminary examination and surgical treatment of hallux valgus to a minimum. This way you will not need to come to the clinic several times. During your outpatient and inpatient stay at the Gelenk Clinic in Freiburg, our multilingual patient management staff (English, Russian, Spanish, Portuguese) will answer all your questions. In addition, we provide a translator (for example, into Arabic), which is paid for by the patient himself. Also, we will be happy to help you organize a transfer, find a hotel and tell you how to spend your free time in Germany for you and your relatives. Send request
Our advantages!
- Specialists who have undergone training and internship in leading European orthopedic hospitals, and with experience in foot surgery of 10 years.
- Modern equipment: dual-wave laser, Zimmer power equipment, Soring premium high-frequency electrosurgical device. It allows you to reduce the duration of the operation itself, minimize tissue trauma and blood loss.
- The latest European operating techniques : Weil, Chevron, Scarf, Bosch, Akin, Ludlof, Austin, Johnson, Keller, etc.
- Imported mini-implants, knitting needles from the world's best manufacturers: Integra (USA), Synthes (Switzerland), Sbi Autofix (USA), etc.
- No cast required , no crutches or long bed rest required
- Already on the day of surgery, the patient walks independently in postoperative shoes.