Hallux Valgus and Maller Finger Correction

Hallux valgus is the most common disorder in the foot region and according to some estimations maybe the most common deformation of the musculoskeletal system in general.  It is prevalent in all populations and races and it is considered that wearing narrow shoes with a high heel is one of the most important etiological factors. Therefore, it is not weird that over 80% of cases occur in women, mostly in the fourth decade of life. A genetic component is important too and estimates say that 60% of patients with hallux valgus have a member of the family with the same deformation.

On the clinical side, pain dominates because of the pressure from the shoes on the pseudoexostosis and consequent inflammation of the bursa which occurs because of the irritation. Patient also complains on pain in the metatarsal region and in advanced cases, secondary deformations of the other toes occur. The most important diagnostic procedure is the x-ray image of both feet standing (so called bifocal image). By drawing a line in the middle of the first and second metatarsal bone and the proximal phalanx, we determine the angles with which we assess the degree of severity of the deformation and decide on treatment. Conservative (non-surgical) treatment of the hallux valgus is mostly symptomatic (orthopedic inserts and shoes that fit) and cannot resolve or stop the advance of the deformation. Surgery is indicated in case of severe pain and not being able to wear shoes. Over 200 different types of hallux valgus surgeries have been described, which tells us there is not a single procedure that is optimal.

Type of procedure is chosen on the basis of the degree of deformation. The aforementioned angles are of extreme importance when choosing the right surgery. For mild deformations we most commonly use the so-called chevron osteotomy, and for advanced ones the so-called scarf osteotomy. Post-operative rehabilitation includes walking on crutches in a postoperative shoe for 10 to 14 days. After that the stitches are removed and the patient can lean on the heel fully for the next 4 to 6 weeks during which the healing process takes place. Wearing normal footwear and returning completely to daily activities is expected 6 to 8 weeks after surgery.

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