Hallux Valgus Correction Patient Info

Left Foot Before Surgery

Left Foot Xray Before

Left Foot 5 weeks after X-ray

Left Foot Before Surgery

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Hallux Valgus

Correction

HALLUX VALGUS CORRECTION

The “bunion” is formed by a bone in the big toe moving out of place. The bone must be moved back into the right place and held in position with special screws until the bone heals. At the same time I may also release a tight muscle in the back of the leg, or straighten some of the other toes.

What can I expect on the day of surgery?

The surgery will normally be under a general anaesthetic.
Normally this is a day surgery case but some patients stay overnight.
I will numb the ankle with local anaesthetic so that you will be comfortable when you wake.
There will be a big bandage on your foot and ankle which you will keep dry and intact for 2 weeks
You will be given crutches and a post op shoe to wear

What are the risks and complications?

The vast majority of patients do extremely well. A small group of patients need extra physio due to swelling or stiffness. Rare complications include infection, DVT, nerve damage, fracture, non-union, stiffness, recurrence, deformity, flexor tendon injury, further surgery (ranging from removal of screws to repeat hallux valgus correction and extremely rarely fusion of the joint) and CRPS

Clear Advice About DVT

A DVT is a Deep Vein Thrombosis or a blood clot in the leg. A blood clot occurs after forefoot surgery for about 1 in every 400 patients. You can help prevent a blood clot by keeping your knee and ankle and toes moving. Keeping yourself hydrated is also helpful to prevent a DVT. Finally elevating your leg to the level of your heart will minimise the amount of swelling you have which will also help to prevent a DVT.

If you were the unlucky patient who developed a DVT you would likely have some symptoms:

The leg (above the dressing/foot) would become hard, heavy, swollen, painful and/or red
If you were to have any of the above symptoms you would have to have a scan to look for a blood clot and then be treated with blood thinners

If the blood clot were to move to the lungs you would have a pulmonary embolism which is a medical emergency

The symptoms of a pulmonary embolism are breathless & chest pain- Call 911

When can I drive?

The best guide that you are safe to return to driving is that you are able to walk well without crutches and without the surgical shoe. The usual time scale also depends on whether you had surgery on your right or left foot and whether you drive a manual or an automatic.

Right side surgery and all car types: 6 weeks
Left side surgery and manual car: 6 weeks
Left side surgery & automatic car: 2 weeks

How long will I need to off work?

The time you require off from work depends on what type of job you do. The first two weeks of healing are critical and so you must have this time off work. Many people are able to work from home and so if you avoid commuting in the first six weeks, you will find that your foot does better. If you work on your feet all day, do a manual job, or are required to wear dress shoes you may need 8 weeks before you are back at work.

What instructions will I have for the first 2 weeks after surgery?

Elevate leg level to heart (above if swollen)
Keep foot dry for 2 weeks
Keep dressing intact
Move Toes and Ankle
Flatfoot Weightbear in post-op shoe
Keep the big toe flat and don’t walk with the toe sticking up in the air
Please remember that standing and walking in the first 2 weeks puts pressure on the healing wound. The more you stay off your foot, the better your wound will heal.

SELF EXERCISES

Start immediately (Day 1) post op and repeat as often as you can.

(Please don’t remove your dressing these photos are just to illustrate clearly what you should do)

In your dressing wiggle your toes up and down as much as you are able to do
Grip the entire big toe and move the toe as far down as it will go and then as far up as it will go

Passive Dorsiflexion Passive Plantarflexion

What happens at 2 weeks in clinic?

You will attend my foot & ankle clinic to check your wound
If your wound has healed well you will be put into a hallux valgus splint and shown how to apply it
If you have K-wires in the toes they must stay dry
Continue with postop shoe for another 4 weeks whenever standing or walking

It is crucial that you learn how to do special exercises in this clinic appointment to teach the big toe to work normally (see below)
Reteach your big toe to rest on the floor (and not stick up in the air)

Sit in a chair no splint THEN:
Practice pushing your whole hallux down into the floor (Figure1)
Once you are doing this well, lift your heel and start to push up onto tip toes (Figure 2)

FIGURE 1 FIGURE 2

Physiotherapy and instructions for the period from 2 weeks to 6 weeks following surgery

You must use the post op shoe and splint whenever you are standing and walking
Gradually increase the amount of time you spend standing and walking
Continue to elevate your foot when it is swollen
Continue to do the exercises to move the toe up and down regularly
Now add in exercises (shown to you in clinic) which work on ensuring your big toe can push down into the floor and then lift your heel off the floor
You may do pilates exercises/ abdominals and core (but only those where you are laying on a floor mat and no standing exercises)
Also stretch gastrocs, & hamstrings with theraband or towel wrapped around foot
Contrast bathing in hot and cold bowls of water (If no K-wires)
If K-wires, clean foot with a moist flannel but do not wet the wires
Wound massage with Bio Oil

Clinic Appointment 6 weeks following surgery

You will have a set of weightbearing radiographs
If you have K-wires in any of your toes these will be removed
Once the K-wire site has had a day to heal over you will be able to start wetting the foot
Gradually increase the amount of time you spend standing and walking
Continue to elevate your foot when it is swollen
You will then be able to go into a roomy lace up shoe
Work on walking slowly, heel through to toe off so that you are using your foot well

Physiotherapy and instructions 6 weeks+ following surgery

‘SURREY STAGES’

The Surrey Stages is a Foot & Ankle Rehabilitation Program designed to continue to strengthen the healing tissues while preventing injury as healing takes place

BRONZE AWARD

DOUBLE HEEL RISES (DHR)
You can go up and down on tiptoes in sets of 3, slowly and 15 reps in each
You are working towards a normal gait (perhaps slightly slower to start)
All pilates exercises & gym equipment with foot plate (bike, rowing machine, X-trainer)
Note: If you and your physio are struggling to help you progress past the bronze award, start to wear a backpack and slowly increase the weight/ number of books in the back pack. Eventually you will be able to discard the back pack and progress to the Silver Award

SILVER AWARD

DOUBLE HEEL RISES WITH A LIFT
You go up on both feet but lift unoperated leg and lower slowly only on operated leg
3 sets, working to 15 reps in each
You can stand both feet on a wobble board
You can hold a solid DHR for 20 seconds
You can skip on the spot (low height) with both legs

GOLD AWARD

SINGLE HEEL RISES
3 sets, working to 15 reps in each
You can stand on one foot on wobble board
You can hold a solid DHR for 40+ seconds
Very gentle jogging

PLATINUM AWARD

Progress to hopping in all directions
Double and Triple Hops

How does the bone get put back in place?

The bone is split lengthwise with a "Z" Shaped cut. One half of the bone is attached to the toe and the other is attached to the rest of the foot. The toe is pushed back into place and held in place with screws.