Hallux valgus: what it is and how the surgery works
SmartHallux® Method
Smarthallux explains to you
All you need to know
on the hallux valgus
What does hallux valgus mean?
Hallux valgus is a fairly common condition. In fact, it's the leading cause of forefoot surgery in women and the second leading cause in men after hallux rigidus. It's characterized by the formation of bone (exostosis) on the medial aspect of the joint and the classic deviation of the proximal phalanx.
This is a pathology that often involves both feet (in about 80% or more of patients), although symptoms often involve the dominant limb first.
What causes hallux valgus?
The cause of hallux valgus, like that of hallux limitus, has not yet been determined, although several predisposing factors have been cited. These are multifactorial conditions, meaning they are caused by both genetic and environmental factors.
It's commonly believed that hallux valgus is primarily due to environmental factors. Recent studies have suggested a significant genetic contribution to this condition, but it remains unclear which genes are involved.
A recent study of 10 individuals from three independent families has highlighted specific mutations related to the pathogenesis of hallux valgus. These mutations demonstrate the hereditary nature of these mutations, which favor the onset of hallux valgus. This opens the way to early diagnosis and, perhaps in the future, to new drugs for the treatment and prevention of this condition.
From a biomechanical point of view, hallux valgus is often associated with hypermobility of the cuneo-metatarsal joint of the first ray which progressively tends to move away from the second ray and rotate.
Wearing shoes with narrow toes or heels is not associated with the onset of the deformity, but these types of footwear can simply worsen the symptoms. When suffering from hallux valgus, it is therefore recommended to wear comfortable shoes, reserving heels and narrow toes for dinner out or a special evening.
Hallux valgus: symptoms
Hallux valgus often becomes symptomatic due to inflammation of the medial exostosis and the bursa covering it. Sometimes, however, the deviation of the first toe toward the second can cause pain due to impingement between the two toes, which, in more severe cases, can even overlap. Hallux valgus may be associated with other conditions, particularly a biomechanical metatarsalgia, to the claw of the fingers and to the deformity of the fifth finger which are often the symptoms that push the patient to undergo a visit.
Hallux valgus becomes symptomatic, and therefore pathological, when the compensatory mechanisms fail, causing pain, swelling, and redness in the patient.
Diagnosis of hallux valgus
The specialist, simply by observing the patient walking barefoot, and noting the presence and distribution of hyperkeratosis (common calluses), is able to reach a diagnosis.
To decide the patient's therapeutic path, the doctor uses an x-ray of the weight-bearing foot.
This is an examination performed with the patient standing, because the foot works while standing and the pathology manifests itself while standing. Ultrasound, magnetic resonance imaging (MRI) and computerized tomography (CT) are second-level investigations, useful in certain situations, but which often provide the surgeon with less information than x-rays, as they are performed in a reclining position (lying down).
When do we talk about an operation?
Hallux valgus does not always require surgery. Hallux valgus correction surgery is useful when the patient experiences pain around the exostosis (the so-called bunion), a claw deformity of the toes, or pain around the metatarsal heads that limits normal daily activities, sports, or the use of standard footwear.
It's important to remember that hallux valgus tends to worsen and, if left untreated, can lead to local complications over time, particularly bursitis, which can lead to perforation of the skin and infection, dislocation of the metatarsophalangeal joint of the second toe, biomechanical metatarsalgia, and complications in the joints of the lower limbs, particularly the knee, as well as, according to some studies, back problems.
The specialist's task is also to distinguish hallux valgus from some conditions that can cause similar symptoms, in particular hallux rigidus and metatarsalgia, and to verify whether there are other deformities associated with hallux valgus such as flatfoot or the hollow foot.
Non-surgical treatments
Conservative management of symptomatic hallux valgus depends on the patient's symptoms and the extent of the condition. In the early stages, the use of an insole or special separators or spreaders can improve pain, particularly if the primary symptom is metatarsalgia.
However, even the insole is not free from complications, linked in particular to the thickness of the insole which can worsen the conflict of the medial exostosis and the toes in the prongs with the upper of the shoe.
Furthermore, it is widely demonstrated by the most important scientific journals that insoles and braces represent a temporary solution, therefore indicated only in elderly patients with low functional demands or with contraindications to surgery.
The use of painkillers and anti-inflammatory drugs can improve the pain symptoms, but chronic use of these drugs does not solve the problem and can lead to complications, particularly affecting the stomach, liver, and kidneys.
There are no effective methods to prevent hallux valgus (the classic "corrector" or spreader purchased on Amazon), at most drugs and physical therapies can limit the symptoms if the big toe is inflamed.
Do you suspect you have bunions?
If you suspect you have a bunion, see an orthopedic surgeon who specializes in foot and ankle surgery.
Through gait analysis and a thorough examination, the specialist can make a diagnosis. A weight-bearing foot X-ray can aid in the diagnosis and, more importantly, in planning the procedure.
Consulting a foot surgeon can help you choose the best and most innovative solution for your case.
Surgery: Hallux Valgus
In cases where an insole is not indicated, or the patient complains of pain despite using the insole, surgery represents a reliable solution.
There are many myths surrounding hallux valgus surgery that need to be dispelled. We often hear about laser surgery, non-invasive surgery, minimally invasive surgery, laparoscopy, and arthroscopy.
It's important to clarify. There are several surgical options for hallux valgus, but the most common are osteotomy, arthrodesis, and prosthetics.
Hallux valgus surgery can be performed in the traditional manner with an incision or with a minimally invasive or percutaneous technique.
More than 30 different types of osteotomies are currently in use for hallux valgus, some with excellent results, others fraught with complications. It's important to carefully choose not only the surgeon who will perform the procedure but also to have the type of osteotomy explained to them.
In cases where the deformity is severe or the joint is significantly degenerated, arthrodesis offers an excellent solution, with the significant limitation of eliminating movement of the big toe joint. This limitation should be taken into account if the patient needs to wear high-heeled shoes.
In these cases, a valid alternative is a prosthesis, which, however, carries the risk of requiring revision since this type of prosthesis does not last very long. Risks and complications associated with surgery are very rare, especially with non-invasive surgery.
These include bleeding, allergic reactions, infections, deep vein thrombosis, embolisms and skin complications, nerve damage with loss of sensation, persistent pain at the scar, delayed union, pseudoarthrosis, and joint stiffness.
Post-operative recovery
From the day after the operation, when sensitivity is completely recovered, the patient can walk with full support on his foot, wearing a very advanced post-operative shoe specific for this type of surgery, significantly different from the post-operative shoes commonly in use.
The only restriction remains driving vehicles for 7 days.
The first check-up is performed approximately 15 days after surgery. During this check-up, a second bandage is applied. A second check-up is performed approximately 4 weeks after surgery, during which all bandages are removed and the patient can return to weight-bearing without any aids, wearing a pair of comfortable shoes. Full recovery generally occurs 2-3 months after surgery.
The patient can return to contact sports after 3-4 months. Water walking rehabilitation, or hydrokinesitherapy, can help the patient recover more quickly.
It is essential to follow your doctor's instructions to avoid complications such as recurrence of the deformity, pseudoarthrosis (the failure of the bone to heal), and infectious complications.
The benefits of surgery
The hallux valgus correction techniques we use are extremely precise and minimally invasive. State-of-the-art percutaneous surgery allows us to correct all deformities without incisions and achieve a significant reduction in pain, improved foot function, and increased mobility of the forefoot joints.
All this translates into an improved quality of life for patients who can go back to wearing shoes they couldn't wear before and resume physical activity without pain.
The surgery can also prevent the onset of complications such as bursitis and metatarsalgia and improve the patient's posture, in addition to the indirect benefit related to the resumption of sports activities.
The goal of SmartHallux
SmartHallux's goal is to revolutionize the treatment of hallux valgus and all forefoot conditions. To achieve this goal, we adopt the best surgical options, orthopedic devices, instruments, and materials available on the market, and we learn, develop, and improve new techniques for hallux valgus correction.
This is why we propose ourselves as private healthcare at an accessible and financeable cost. Unfortunately, public and subsidized healthcare have spending limits that place limits on the use of materials, instruments and structures.
With SmartHallux you will have access to the best possible treatments, in excellent facilities and without having to wait for public health authorities.
SmartHallux®: Innovative Minimally Invasive Technique
Our surgical techniques
Anesthesia
Surgical techniques have undergone an important evolution compared to the past, starting from anesthesia and post-operative pain control.
The anesthesia that we use at SmartHallux does not involve painful ankle punctures or annoying spinal anesthesia or general anesthesia. With ultrasound guidance, our anesthetists are able to identify the nerves and with a single puncture behind the knee they are able to selectively "put to sleep" the nervous structures necessary and sufficient to perform the operation without pain, leaving the mobility of the legs and bladder control to the patient.
Sedation allows the patient to avoid anxiety and often wake up immediately after surgery. This type of anesthesia also allows for anesthesia to be prolonged for up to 24-48 hours, reducing or even eliminating postoperative pain, without any risks or contraindications.
Mixed technique, percutaneous and open minimally invasive
The surgical technique we use at SmartHallux is called MICA (minimally invasive Chevron Akin). Essentially, cuts are made in the bone (called "osteotomies") with a motorized drill, not through incisions but through three small "holes" that leave no scars. SmartHallux uses cutting-edge minimally invasive surgery, which, unlike other minimally invasive techniques, reduces the risk of recurrence, ensuring long-lasting correction, faster recovery, and less pain.
Disposable material
SmartHallux uses the highest quality disposable materials to guarantee maximum sterility and drastically reduces, compared to those who reuse the drills, the risk of transmission of infectious diseases and metallosis, i.e. the dispersion of metal debris in the tissues with the risk of chronic inflammation. Disposable materials also guarantee greater cutting precision and are environmentally friendly, as it is not necessary to resterilize them with consequent savings in water and electricity.
Greater accuracy
The osteotomies are fixed with a small titanium screw which allows for faster recovery, greater precision of the correction, a lower risk of recurrence and less post-operative swelling.
In fact, the popular techniques without fixation (WOS, PBS, SERI, PDO) are not able to adequately correct the translation of the metatarsal head and above all the rotation, which is much discussed in modern conferences dedicated to foot and ankle surgery .
The previous techniques, in fact, have a 61% rate of bone non-healing or vicious consolidation, as reported by the scientific literature.
A noble metal
Modern fixation devices are made of titanium, a "smart" metal. In addition to its biomechanical properties of high strength, toughness, and rigidity, titanium stands out for its "biocompatibility."
In practice, our body doesn't consider it a foreign body; it integrates perfectly with our tissues, which is why it has been widely used in dentistry for years. Furthermore, you won't have any problems if you need to undergo an MRI scan or metal detector screening, as titanium is a non-magnetic material.
Minimally invasive surgery with fixation is considered by the entire international scientific community as an evolution of previous techniques without fixation (PBS, WOS, SERI, PDO) which remain in use only due to their lower cost in terms of instruments and materials used.
Duration of the intervention
The operation is generally performed in day surgery. The patient enters the hospital in the morning and returns home the same evening.
The therapeutic path
The entire therapeutic process, from the visit to the operation to the post-operative recovery, is managed by a team of surgeons specialized in the treatment of foot and ankle pathologies and with considerable experience in this type of surgery.
Aesthetics beyond function
In addition to correcting the functionality of the foot, it is also possible to correct its aesthetics, improving the shape and length of the toes and decreasing their diameter in order to obtain a foot with a more pleasant appearance and which fits more easily with the desired shoes, even more tapered and with a high heel.
Why choose SmartHallux for surgery?
We at SmartHallux are so confident that we can solve your problem that, if we can't, we are ready to refund you the full amount and assist you free of charge throughout your recovery journey. We are able to offer you this guarantee as our treatment path is extremely safe, reliable and tested over time.
SmartHallux® Certified Clinics
Our offices
San Camillo Nursing Home - Via Mauro Macchi, 5, 20124 Milan MI
UPMC Salvator Mundi International Hospital V.le delle Mura Gianicolensi, 67, 00152 Rome RM
Ruesch SPA Clinic Viale Maria Cristina di Savoia, 39, 80122 Naples NA
Smarthallux Netherland - Statenplein 21 - 2582 EZ Den Haag
SmartHallux United Kingdom - Cromwell Hospital 164-178 Cromwell Rd, London SW5 0TU, United Kingdom
Smarthallux Madrid - Calle de Hermosilla 95 - 28006 – Madrid Spain
FAQ
Bunion surgery can vary depending on the technique used, the complexity of the case, and the healthcare facility where it's performed. Typically, the average cost is around €9-€10.000. At SmartHallux, thanks to the advanced technique used and our partnership with several clinics, you can get a more competitive price.
There are several options for booking a visit with Dr. Manzi
Dr. Manzi visits medical practices that collaborate with SmartHallux located in Rome, Milan and Naples
It is also possible to book a telemedicine visit.
Waiting times for bunion surgery through the National Health Service (NHS) can be very long, varying from region to region and from facility to facility. In some cases, the wait can be several months or even years. SmartHallux offers the opportunity to access the procedure more quickly, avoiding long waiting lists.