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Pre-operative medical visit
The person who qualifies the patient for surgery of the hallux valgus toe is an orthopedic doctor. This takes place at the Rehasport clinic during a scheduled pre-operative visit, which should be held two weeks before the scheduled surgery. During the visit, the doctor describes the hallux surgery to the patient and then fills out the medical records. If the patient agrees to the surgery, the procedure to prepare him for the hallux valgus surgery at the Rehasport clinic begins.
A further consultation is held with the patient's caregiver, who presents the procedure in preparation for surgery and informs the patient of the date, time and place of the procedure. The nurse interviews the patient about any comorbidities, drug allergies and dietary preferences during the hospital stay. The nurse informs what to purchase from the pharmacy to take care of the wound to avoid possible infection, instructs the Patient on the procedure to prevent thrombosis.
Laboratory tests
Approximately two weeks before the hallux surgery, the Patient should perform laboratory tests. These tests are performed at one of Rehasport's designated laboratory facilities, where blood will be drawn for testing (you must be fasting) and a nasal swab for staphylococcus.
Meeting with the anesthesiologist
Before the procedure, a consultation with the anesthesiologist is recommended, for which the results of laboratory tests are necessary, the results of the nasal swab are not necessary. Based on these, the anesthesiologist qualifies the patient for the valgus toe procedure.
On the day of surgery
The patient stays in the hospital for one night, so it is necessary to take the necessary personal belongings to the hospital - necessarily flip-flops and pajamas. In accordance with the doctor's recommendations, before the hallux valgus surgery, the Patient must get elbow crutches and a special shoe - orthosis, which can also be purchased at the Rehasport store, where a physiotherapist will adjust their length to the Patient's height on the spot.
Course of surgery for hallux valgus toe
Preparation for the procedure - The patient is laid on the operating table on his back, a pneumatic band is placed on the lower leg of the operated limb, after the blood is squeezed out of the limb, the band is tightened for the duration of the procedure - the procedure takes place in the ischemia of the limb.
The surgeon prepares for the procedure - surgical hand washing, disinfection.
The surgeon prepares for the procedure - dresses a sterile gown and surgical gloves.
Preparing the surgical field - the surgeon, together with the instrumentalist, disinfects the surgical field and protects it with a disposable sterile drape.
Skin incision - from the inside of the foot in the projection of the valgus deformity of the toe.
After reaching the metatarsophalangeal joint - the orthopedist evaluates the cartilage in the joint, the mobility of the joint and removes a fragment of the head of the 1st metatarsal bone with an oscillating saw.
X-ray - after each stage of the procedure, a control intraoperative X-ray is taken.
Under visual and X-ray guidance - a Kirschner wire is temporarily inserted to help determine the desired parameters for correction of hallux valgus (lengthening/shortening of the bone, elevation/lowering after correction).
After the Kirschner Wire is inserted in the desired position - a guide is applied to it for the saw with which the osteotomy of the 1st metatarsal bone will be performed, the guide shields the tissues from accidental tissue damage and facilitates the determination of the exact and desired length of the osteotomy (corrective cut of the bone).
Under X-ray guidance - the next stages of the osteotomy are performed, which resembles the letter 'N' or 'Z' in its shape.
After the osteotomy - the surgeon checks the mobility of the bone fragments and removes any bone bridges that prevent the translation of the bone fragments, in order to correct the valgus.
After obtaining the desired translation - (displacement of bony fragments of the metatarsal bones) in order to correct valgus toe, bone fragments that protrude and “interfere” with the new positioning of the bone become visible - such a fragment is cut off with a saw - it will be used to stabilize the proximal part of the osteotomy.
Excised bone fragment - is driven by the surgeon into the area of the proximal part of the osteotomy, its function resembles a peg - it stabilizes the bone fragments.
The distal part of the osteotomy - is stabilized with a screw or suture, depending on the quality of the bone and the stability of the osteotomy fragments, in this case a screw was used, in the picture you can see the reinserted temporary Kirschner wire serving as a guide for the screw.
After the insertion of the screw - a control X-ray in two planes is performed.
Depending on the need, a - corrective osteotomy of the proximal phalanx of the phalanx is also performed - after obtaining additional correction on this osteotomy, it too is stabilized with a screw.
After the surgery - a follow-up X-ray is performed to assess the effects of the correction of the valgus toe.
If the correction is correct - the surgeon sutures the wound in layers, starting with the joint capsule and suturing the skin.
After the procedure - a specialized sterile dressing is placed, which is replaced after about 10-14 days, the operation is completed. In the photo in the background - feet before surgery.
What is the anesthesia for hallux valgus surgery?
Before hallux valgus surgery, the patient receives subarachnoid anesthesia, plus nerve blocks to disable specific areas to be operated on. This is regional anesthesia - from the waist down.
How long does hallux valgus surgery take?
The duration of hallux surgery depends on whether only the hallux valgus deformity of the toe is operated on, or deformities in other joints (such as hammer toes), and ranges from 1 to 2 hours.
How long does one stay in the hospital?
The patient stays in the hospital for one day. He comes to the hospital in the morning on an empty stomach, is operated on the same day, has a discharge the next day and goes home.
The day after valgus toe surgery
In the morning there is the first medical consultation after surgery, where the orthopedist checks the patient's well-being, the condition of the limb after surgery and gives instructions for further treatment. The physiotherapist then gives the patient a post-operative exercise manual and demonstrates the performance of the first exercises.
How much release after hallux valgus surgery?
The length of the release after hallux surgery depends on what kind of work the Patient is doing. If he performs office work, the release is issued for a period of 2-6 weeks, most Patients even do not want to stay on leave longer. If the Patient has a typically physical job where he or she does a lot of walking, squatting or kneeling, then he or she is issued a release for 2-3 months.
Further treatment after hallux valgus surgery
In the package, the Patient receives two free post-operative visits to the Rehasport clinic. The first is two weeks after surgery, at which the stitches are removed, the doctor looks at the wound and gives further instructions for treatment. The second visit to the attending physician, takes place six weeks after surgery. Full rehabilitation begins after an orthopedic check-up with X-ray after 6 weeks. Receiving rehabilitation in the Rehasport clinic is very important, because at any time the physiotherapist, can consult the patient's medical case with the doctor and immediately get the consultation needed without an additional appointment.
How long on crutches?
The duration of use of elbow crutches also depends mainly on the quality of the patient's bone tissue and ranges from 2 to 6 weeks.
How long does rehabilitation last?
Rehabilitation after hallux valgus toe takes from 3 to 6 months.
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