Hallux valgus as well as hammer toes, claw toes, hallux rigidus and Digitus quintus varus are common deformities of the foot or the toes (foot deformities, toe deformities). Different surgical procedures are used to treat these conditions.
Bunion is a misalignment of the big toe where the big toe is shifted inwards. It can appear together with splayfoot and deformation of the toes in the form of hammer toes or claw toes. Women are far more frequently affected than men. A genetic predisposition is considered the main cause behind the development of bunions.
Hallux rigidus refers to a form of osteoarthritis in the base joint of the big toe. Osteoarthritis can be caused by injury or overexertion.
The inwards misalignment of the little toe is referred to as Tailor’s bunion. This misalignment is attributed to wearing shoes that are too tight.
What preparations are carried out before the procedure?
Before the surgery, misalignments and deformities in the feet and toes are examined in detail with X-rays. Options for correction are then discussed with the patient and the surgical procedure set out. The type of anaesthesia is determined in consultation with the anaesthesiologist.
The usual examinations before surgery, such as blood tests, blood pressure measurements and an ECG are performed. The intervention requires the patient to have an empty stomach, meaning that they must refrain from eating or drinking 6 hours before the surgery.
How is the operation carried out?
Depending on the specific deformity and misalignment of the toes, different surgical treatments are used. In the case of bunions, misalignments of the metatarsal and toe bones are corrected. In osteoarthritis, the joint is ‘cleaned’ and stiffened as needed. Interventions on the foot are carried out either under general anaesthesia or under spinal anaesthesia.
Surgery for bunions, splay foot, hammer toes, claw toes
Surgical treatment of bunions is aimed at correcting the misalignment of the metatarsal bone and the toe bone. The affected foot bones are aligned and straightened with bone incisions and then fixed into the corrected position using small screws. Depending on the misalignment, the bones are shortened, lengthened or only have their axis corrected. Hammer toes or claw toes are also straightened and fixed.
In cases of osteoarthritis, the big toe joint sometimes has to be stiffened surgically.
Bunion surgery, osteoarthritis of the big toe joint
An incision is made before opening the joint. This allows bony growths, deposits and damaged joint material to be removed. In early osteoarthritis, this can help preserve the joint. If the joint is too severely damaged, a stiffening operation (arthrodesis) is performed. This involves removing the joint cartilage completely and connecting the two bones with screws.
Surgery in the event of small toe deformation, digitus quintus varus
As with bunion surgery, the bone is severed, straightened and fixed using small screws when the little toe is misaligned.
What is the success rate of this procedure?
With a surgery, the symptoms caused by deformities in the feet and toes can be treated and patients can go through life without any limping or pain. Before the surgery, the advantages and disadvantages of the different procedures have to be weighed up. Patients with a stiffened joint can walk normally without a limp again and take part in all kinds of sports.
What are the possible complications and risks of this procedure?
Surgery for deformities of the feet and toes is low-risk and generally takes place without any complications. As with all surgeries, infections, bleeding or blood clots may occasionally occur. The foot also remains swollen for a long time.
What happens after the operation?
After the surgery, the foot operated on is monitored temporarily, and needs to be elevated. It should also be kept elevated regularly in the first few weeks. Thanks to a post-operative shoe adapted to the individual, patients can usually leave the hospital after one or two days. This special shoe makes it possible to walk without heels and must be worn for 4–6 weeks, or 6–8 weeks if any stiffening has been performed. After this period, the bone is stable, while the capsule, tendons and ligaments often remain sensitive and swollen for 4–6 months.
