Medical treatment is not able to correct the deformity, it can only alleviate the pressure on the bunion and the toes next to the big toe.

The medical treatment is based on:

Zapatos bien sujetos

The use of shoes that are wide and suitable for walking.

Medicines

The use of shoes that are wide and suitable for walking.

ortesis, corrector juanete

Orthosis use (insoles).

surgery scalpel

Surgical treatment.

ejercicios de reeducación pie

Therapeutic exercices.

Pharmacological treatment (analgesic or anti-inflammatory) is used to treat the pain, and may be oral or topical, which is prescribed as required as a symptomatic treatment. This treatment does not improve the deformity or the majority of symptoms associated with poor support and excess of pressure.

There are numerous orthopaedic devices on the market:

  • Spacers or protectors. Alleviate the pressure on the prominent or deformed areas. The orthosis is generally made of materials that are able to reduce the pressure (silicones). These materials can be acquired prefabricated with pre-define forms, or they can be made to measure.
  • Correctors. Their aim is to delay the bunion progressing and to alleviate the symptoms. These orthopaedic devices can be useful in the developing stages, but not when the deformity is already significant.
  • Insoles. They alleviate the pain while walking and correct the disequilibrium of lack of support. They are unable to improve the position of the big toe.

In cases where conservative treatment does not alleviate the symptoms, there are numerous surgical techniques described for the treatment of hallux valgus. Each patient treatment is individualised and takes into account factors such as, the type and grade of the deformity, characteristics of the foot, previous illnesses, and age, among other things.

In the majority of cases the simple incision and scraping of the bunion is usually insufficient as it does not correct the deformity or means that it may reappear.

Nowadays, in almost all cases, ambulatory surgery is performed with a local anaesthetic, as such that the patient can normally go home the same day as the surgery.

It is important to clarify that the laser technique is not used, nor has it been used anywhere in the world to operate on hallux valgus. However, there is a false belief that there are surgical techniques that allow operating using small incisions, known as percutaneous or minimally invasive surgery. This technique, like any other, has its indications and limitations and must be well indicated, depending on the needs of each case.

Re-education is important as a post-operative treatment because using exercise techniques helps to recover the joint flexibility of the operated toe.

  • Self-re-education of the operated hallux valgus. It forms part of the cure process and prevents stiffness in the big toe. In general, it is started 15 days after the operation, following a well-defined protocol.
  • Movement exercises. After the operation and during the first four weeks, the toes must be moved in order to drain the fluid of the oedema and widen the joint range.
  • After one month. At first, a specialist helps the patient to walk without shoes and by walking on the heel. During this period the propulsive support of the big toe is reduced; manual massages are performed on the scars and lymphatic drains in order to reduce the swelling. In this stage it is essential not to walk on the outside edge of the foot, in order to prevent suffering the risk of deviating the big toe again.

Among the complications of the surgical treatment, may be those common to any surgery of the locomotor system. Among these, are highlighted:

  • infections, which, fortunately, have a low incidence;
  • problems in the healing of the bone (consolidation), and
  • re-appearance of the deformity, despite the improvement in the surgical techniques.
Substantiated information by:
Cristina CasalsNurse — Orthopedic Surgery and Traumatology DepartmentJordi FluviàPodiatrist — Orthopedic Surgery and Traumatology DepartmentJessica MartínezNurse — Orthopedic Surgery and Traumatology DepartmentDaniel PoggioTraumatologist — Orthopedic Surgery and Traumatology Department

Published: 20 February 2018
Updated: 20 February 2018

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