All doctors agree: at least half of the success of rehabilitation depends on how correctly the recovery was carried out after surgery to remove hallux valgus. Depending on the method of surgery and the general condition of the patient, rehabilitation may require from 4 months to a year.
The patient is usually discharged the day after surgery. But this does not mean that he is completely healthy and you can start doing your current affairs as usual. Discharge only means that the person does not require constant medical supervision. For the first 10-14 days after hallux valgus surgery, it is better not to do anything. And how complete this “nothing” turns out to be depends on how quickly the swelling goes away and how difficult the rehabilitation will be.
Recovery period
You can get up the next day after surgery to correct hallux valgus, but it is better to do this only to go to the toilet, walking in special orthopedic shoes. It is best to stay in bed as much as possible. The operated leg should be in an elevated position, above the level of the heart. This will help drain blood and lymph from the operated leg and reduce swelling.
Before removing the stitches, the bandage must not be exposed to water under any circumstances. Therefore, during hygienic procedures, the leg should be wrapped in polyethylene, and it is better to limit yourself to local ablutions at this time.
There are two fundamentally different medical approaches to control during this period. Some doctors believe that it is better to play it safe and invite patients for dressings, during which they look at the condition of the wound. Others believe that there is absolutely no need to force a person after surgery to get to the clinic to remove the bandage, look and apply a new one: most often, recovery after valgus surgery does not require intervention.
Walking
The patient leaves the hospital on crutches.
Crutches are used for 2 weeks. For the first three days after surgery, you cannot lean on the operated leg; it is recommended to lie down as much as possible and hold the operated leg above body level (for example, on three pillows stacked on top of each other); you can walk only if absolutely necessary. For 2 weeks after surgery, you need to walk as little as possible, and while sitting, you need to raise your operated leg (put it on a chair). Usually after surgery you are allowed to walk in special shoes that transfer the load from the operated area to the heel. Special shoes are worn only for walking for 6-8 weeks, depending on the operation; in a state of rest and during sleep, the shoes are removed. You can use public transport and drive a car, depending on the procedure, after 6-8 weeks after surgery. After the period of using special shoes ends, you can try cycling and swimming. Walking with poles, running, jumping and cross-country skiing are allowed after normal walking is restored approximately 16-24 weeks after surgery. When playing sports, the foot can be loaded until pain occurs. You can start wearing regular shoes 6-8 weeks after surgery. Until the swelling of the foot goes down and the operated area stops hurting, it is recommended to wear soft shoes slightly larger than the usual size. The ability to wear shoes that the patient likes may appear only 3-4 months after surgery.
Wound healing
Some bleeding after surgery is normal. There is no need to change a bandage with a small amount of blood, because the blood is sterile and does not interfere with healing. It is not recommended to remove the bandage until 48 hours after surgery, because this contributes to the occurrence of inflammation in the wound. Bandage a bandage with a small amount of blood yourself with non-sterile gauze pads or a bandage. If the bandage is very bloody or simply very dirty, contact a qualified healthcare professional to have it replaced as soon as possible. If wound healing is expected, leg dressings are performed once every seven days. Sutures are removed 17-21 days after surgery. With normal wound healing, surgical scars on the toes become barely noticeable. To prevent excessive scar tissue formation, Contractubex gel may be used for three months after suture removal. If you have problems with wound healing, consult your doctor before starting to wash your feet. Signs of complete healing of the wound: the edges of the wound have grown together, there is no discharge from the wound and the crusts have come off.
Finger position
After surgery, it is very important to keep your toes in the correct position, this will help the soft tissue surrounding the bones to heal favorably and thereby maintain the normal shape of the toes.
After operations, the big toe must be kept in the correct position around the clock for the first 6 weeks after surgery with an intertoe separator or a bandage. If the big toe is immobilized, its position does not need to be supported.
Thin metal pins are installed in the operated 2-5th toe to maintain position. The tip of the needles should be covered with a bandage around the clock to prevent inflammation. The needles are removed in the clinic; the procedure causes inconvenience rather than pain. After removing the wires, the operated 2-5th toe is supported with an adhesive plaster straight and bent downwards for 4 weeks, this is called taping.
When you need to see a doctor and have your wound examined
- The bandage was wet with wound discharge. This shouldn’t happen, and we need to figure out what happened.
- The patient developed a fever, malaise, and chills. These may be signs of an infectious complication, and a doctor's examination is necessary as soon as possible.
- Over time, the patient's condition does not improve. Soreness and malaise immediately after surgery to remove hallux valgus (as after any intervention) is normal. But every next day should be easier than the previous one. If relief does not occur, you need to look for the cause.
In 10-14 days
During this period, the sutures are removed, or, if the doctor used absorbable suture material, they disappear on their own. From this moment, you can begin to prevent pathological scarring. To ensure that the seam after surgery is thin, even and invisible, you can use silicone-based patches and gels: Kelo-Kot, Dermatix.
Since prolonged immobility contributes to venous thrombosis and thromboembolism, during this period the doctor may prescribe drugs that reduce blood clotting, such as Aspirin Cardio or Thrombo-Ass. It is better to wear compression stockings on your feet (there are models without socks and toes).
Gymnastics for the joint
From this moment it is time to begin to develop the operated joint. There is a set of special exercises. At first, gymnastics can be extremely unpleasant, but it is necessary. By the time the pain goes away, the joint will become immobile, and no set of exercises will be able to help. It is best to do exercises when treating foot deformities under the supervision of a rehabilitation physician and with his help (at least at first).
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Longitudinal-transverse flatfoot: who is suitable for surgical treatment?
The method of surgical treatment of longitudinal-transverse flatfoot depends on the stage of the disease. Indications for surgical treatment should be made quite discreetly, since this disease can be treated conservatively. Due to the dynamic situation in the arch of the foot, good results can be achieved through regular training and special exercises aimed at developing muscles.
Surgical treatment of longitudinal-transverse flatfoot is recommended only if the patient experiences severe pain for a longer period of time, and also if this pathology has a negative impact on the patient’s quality of life. Chronic tendon inflammation or rupture of the tibialis posterior tendon makes surgery inevitable. It will also be necessary to operate on spasmodic deformities of the hindfoot, accompanied by arthrosis of the ankle joints.
In 4 weeks
By the end of 4 weeks after surgery to correct hallux valgus, a control radiograph is taken. After this, with the doctor’s permission, you can change your orthopedic shoes to regular ones, but they must be comfortable and well-worn in. For now, you need to watch your gait, stepping on an even foot and not rolling over the big toe joint. You should not lean on the outer edge of the foot or “clubfoot” - this increases the load on the 4-5 metatarsal bones and metatarsophalangeal joints, which soon begin to hurt. Be sure to continue the set of recommended exercises. If swelling persists, you need to wear compression garments. Another two weeks will pass like this.
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.
After 7-8 weeks and beyond
Starting from the 7th week after hallux valgus surgery, you can no longer control your gait and move normally, with your foot rolling over the big toe joint.
At the end of the 8th week, X-ray control is recommended - a picture of the once valgus foot under load - and you can then live your normal life. Swelling during this period is normal; it can persist for more than six months, it all depends on the state of the patient’s venous and lymphatic systems.
You can play sports after six months. The load on the upper body can be given earlier - literally a month after the operation, but full-fledged sports involving the legs are possible only with the permission of the doctor and no earlier than 6 months after the operation.
After 6 weeks from surgery for Hallux Valgus.
After 6 weeks, control radiographs are taken; if everything is in order, then walking with a load on the forefoot is allowed. Also at this stage, it is advisable to perform exercise therapy and physiotherapeutic procedures aimed at further developing movements in the 1st metatarsophalangeal joint.
Slight swelling in the finger area persists for a long time, up to 6-12 months after the intervention. Sports activities are not recommended for 3 months after surgery. Appearance of the feet one year after surgery. By this time, postoperative scars become almost invisible, swelling completely disappears, and the range of motion in the metatarsophalangeal joints is completely restored.
At stage 3 of hallux valgus, metatarsalgia comes to the fore - pain in the projection of the heads of the 2-3 metatarsal bones. Further spreading of the transverse arch leads to an even greater increase in deformation. The intermetatarsal angle exceeds 15 degrees, the valgus angle of 1 toe exceeds 40 degrees. The heads of the 2-3 metatarsal bones descend even lower and take on most of the load when walking. Since such a load is not expected by nature, the ligamentous apparatus along the plantar surface of the 2-3 metatarsophalangeal joints is gradually frayed, which leads to the formation of hammertoe and claw-like deformities of the 2-3 fingers. At stage 3 hallux valgus, intervention is always individual, since the degree of deformation of different rays varies greatly. Most often, intervention is required on 3-4-5 rays simultaneously, with 8-10 osteotomies performed. Such interventions are accompanied by a difficult rehabilitation period.
Clinic K+31 specializes in performing surgical interventions for all degrees of hallux valgus. In our clinic, we use only modern equipment and implants for operations for hallux valgus.
Hallux Valgus is just the tip of the iceberg, the most obvious manifestation of transverse flatfoot. In addition to this deformation, transverse flatfoot causes a huge number of other problems such as overload metatarsalgia, hammertoe deformity of 2-3-4 toes, Morton's neuroma, damage to the plantar plate. Therefore, when treating Hallux Valgus, one should always strive to correct the transverse arch of the foot and not just correct the cosmetic deformity.
What shoes to wear after surgery
For the first month after correction surgery for hallux valgus, it is recommended to wear special shoes - Baruk boots. These are shoes with hard soles and thick heels, which allow you to unload the forefoot. You need to wear special boots for a month.
4 weeks after surgery to correct hallux valgus, the doctor allows you to use normal shoes. This doesn't mean you need to immediately put on your favorite dress shoes. By “regular” we mean comfortable shoes with a heel of about 2 centimeters (for example, sneakers), spacious and well-worn in. Many women in this situation temporarily borrow the shoes of male relatives. Moreover, the swelling usually still persists, and the pre-operative shoes become simply too small. After the swelling subsides, you can return to your usual shoes.
Wearing high heels is allowed no earlier than after 4 months, for a short time. But do not forget that narrow high-heeled shoes are considered one of the main causes of hallux valgus.
A set of exercises for the treatment of hallux valgus
The set of exercises for hallux valgus deformity is simple. It is necessary not only and not so much in order to strengthen weakened foot muscles with hallux valgus, but, first of all, to maintain joint mobility. Otherwise, you can get a beautiful, but completely immobile metatarsophalangeal joint of the big toe. Ideally, the exercises should be shown by a qualified physical therapy doctor or rehabilitation specialist, and the first few times they should be monitored for correct execution. But if this is not possible, you will have to do it yourself.
- Sit in a cross-legged position so that the ankle of your operated leg rests on your knee and your big toe can be easily reached with your hands. Grasp it as close to the operated joint as possible. Gently move your finger upward until you feel resistance and pain. Hold it in this position for 10 seconds, release it, allowing it to relax. Repeat 3 times.
- Similarly, holding the thumb as close to the operated joint as possible, tilt it down toward the foot until pain appears. Hold for 10 seconds, release. Repeat 3 times.
- Place a rubber ball with a diameter of 10-15 centimeters on the floor and place your foot on it. Slowly, while rolling over the ball, move your leg forward, try to pull your foot and fingers towards you. Roll back. Repeat 3 times.
This set of exercises for hallux valgus should be repeated 3 times a day for the first 3-4 weeks after surgery. At 5-6 weeks, the frequency of exercises increases to 7-8 per day. From week 7, a weight-bearing exercise is added, which helps strengthen the muscles of the operated foot.
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- Stand barefoot on the floor, rise on your toes, try to hold on for 10 seconds (if you don’t succeed, then as long as you can).
The number of repetitions of each exercise increases to 7-8, the complex itself should be repeated 5-6 times a day.
Postoperative physical therapy for hallux valgus helps speed up recovery and reduce swelling. In this regard, lymphatic drainage massage is very useful, which can be started 2 weeks after the intervention. Magnetic therapy, pressotherapy, electrophoresis with agents that normalize vascular tone improve microcirculation and lymph flow.
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
Probability of relapse
The likelihood of relapse after surgery depends not only on the intervention technique, but also on how carefully the patient follows the doctor’s recommendations. The characteristics of the body also matter: with general hypermobility of the joints (which is determined by the state of the connective tissue) and a hyperelastic foot with excessively mobile joints, the likelihood of relapses is higher; in these cases, doctors try to use special surgical techniques.
The statistics cited by domestic and foreign authors are contradictory. In adolescents, according to various sources, the relapse rate ranges from 10 to 61%, in adults from 2 to 41%.
Surgery is the only effective way to correct hallux valgus. For it to be successful, you must carefully follow the doctor’s recommendations during the rehabilitation period, do gymnastics and gradually increase the load on the operated leg.