Hallux valgus is a frequent deformity of the first metatarsal joint. It occurs particularly in women.

When you come to see Dr Gdalevitch, she will assess the following:

  • Pain
  • Functional capacity: limitations of daily sports, recreational activities, type of shoes that you wear
  • First toe alignment, presence of calluses on the foot, stability of the first toe and deformity or pain in other toes

Surgical indications:

  • Pain associated with mild to moderate hallux valgus deformity
  • Radiographs demonstrating a first intermetatarsal angle = 12 – 18 degrees.

Advantages of using a minimally invasive percutaneous approach for a distal metatarsal osteotomy:

  • Decreased surgery time (15-20 minutes);
  • Decreased surgical exposure;
  • Possibility of operating bilaterally with decreased probability of complications;
  • Earlier weight bearing (immediately post op).

Pre-operatively, you will undergo anteroposterior and lateral weight-bearing foot x-rays.

Surgical Technique:

1. A 2mm Kirschner wire/pin is inserted approximately 2-3mm from the medial corner of the nail of the great toe.

2. A 3-5mm skin incision is made right below the bunion.

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3. Fluoroscopy will be used during surgery for correct positionning.

4. A small bone-cutter is inserted and the osteotomy (the breaking of the bone) is performed.

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5. There is displacement as needed to correct the bunion. This displacement is done using a special instrument.

6. Stabilization of the bone is done by further inserting the 2 mm metal pin in the toe until the middle of the foot. This pin will remain in place for 4 weeks.

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7. Two small dissolvable stitches are placed at the skin incision.

 

8. Once the surgery is complete standard post operative bunion bandage is applied.

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9. You are encouraged to weight bear as tolerated with your flat rigid sole sandal as soon as you leave the hospital, and crutches are used for comfort and balance only.

10. Your dressing will be changed at your follow up appointment at 1 week after surgery.

11. You will return 4 weeks after surgery for removal of the metal pin. This is done in the clinic and is not painful.

12. Following removal of the metal pin you must do exercises to regain dorsiflexion of the first toe within the first 4-6 weeks after pin removal. This is of upmost importance and you will be given an instruction sheet demonstrating how to do these exercises correctly.

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13. You are only permitted to increase your walking endurance until 3 months postoperatively, at which point you may resume other activities, including sports.

Follow-up appointments with Dr Gdalevitch:

Your follow up appointements and repeat xrays will be at:

  • 1 week,
  • 4 weeks,
  • 3 months,
  • 9 months after surgery.

For a complete list of the risks and complications, please see Patient info.

Patients who will undergo this procedure should read the following sections in the Patient information tab.

1- Post-operative care

 

 

 

Source: Magnan, B. Pezze, L. Rossi, N. Bartolozzi, P. (2005). Percutaneous distal metatarsal osteotomy for correction of hallux valgus. The Journal of bone and joint surgery, 87-A (6), 1191-1199.