Review surgical procedures for hallux valgus, with step-by-step instruction of approaches, soft tissue handling, bony procedures and fixation options, and closure. The first ray is an inherently unstable axial array that relies on a fine balance between its static (capsule, ligaments, and plantar fascia) and dynamic stabilizers (peroneus longus and small muscles of the foot) to maintain its alignment.
A deviation of the disal portion of the great toe, at the metatarsophalangeal joint, toward the outer or lateral side of the foot. A deviation of the tip of the great toe, or main axis of the toe, toward the outer or lateral side of the foot. There are over 100 named surgical techniques for the correction of hallux abductovalgus, most of which are modifications of a number of principles of approach. The big toe tilts outwards, crowding the smaller toes, and a bony lump (called a bunion) appears on the inside of the foot. These are used to remove the bunion and to divide one or more of the bones of the front of the foot. Compared with standard (open) surgery, this procedure uses smaller cuts to the foot and X-rays or endoscopy to see inside the foot. Scar symptoms are a recognized complication of forefoot surgery. The tourniquet was released, and the skin was sutured.
I must caution you that the use of the TightRope for bunion correction is a relatively new concept but is very promising. The most common complication from this type of procedure has been fracturing of the second metatarsal bone which in all cases required further surgery to correct the fracture. The study mentions other possible causes for failure such as the fact that the drill holes through the second metatarsal bone will naturally weaken the bone. The next video demonstrates implant surgery for correction of a bunion. This procedure is sometimes performed in conjunction with an osteotomy procedure to realign the metatarsal and toe bones. Many patients ask me if you can have laser surgery on bunions. More importantly, lasers cannot remove bone, all they do is burn bone, so a laser could not be used to remove the large bump of a bunion deformity.
Associated deformities may include second digit hammertoes and flexible or rigid flat foot. Instability of the second digit may allow a more rapid progression of hallux valgus, as it is unable to act as an adequate lateral buttress. If surgery it to be contemplated it is imperative that peripheral blood flow be adequate for healing. Understand that bunions are progressive and that non-surgical treatments alleviate symptoms but do not limit progression. The most important indication for surgery is pain, not deformity, although there will often be concern about the appearance of the deformed joint. It is usually a combination of bone and soft tissue surgery.
Contributing factors, if present, include gastrocnemius or gastrocsoleus equinus, flexible or rigid pes plano valgus, rigid or flexible forefoot varus, dorsiflexed first ray, hypermobility, or short first metatarsal. During normal propulsion, Heel Pain approximately 65° of dorsiflexion is necessary at the first metatarsophalangeal joint, yet only 20-30° is available from hallux dorsiflexion. Note the greater deformity of the right foot (image left) versus the left foot (image right).