Minimally invasive hallux valgus surgery allows patients to walk again immediately with very little pain. However, like all joint surgery, it is essential to mobilise the joints quickly to prevent stiffness. The goal is twofold: to restore correct weight-bearing on the big toe (rather than on the outer edge of the foot) and to mobilise the metatarsophalangeal joint of the hallux (MTP1) as soon as possible.
With this in mind, Dr Bruno Lévy recommends that his patients begin self-rehabilitation from the 8th day after surgery, with several sessions per day of 5 to 10 minutes. Every day, four times a day, these exercises should be performed in a calm environment. If you are in pain, it is advisable to take pain relief medication before the session. If needed, you can also apply cryotherapy using the equipment prescribed by Dr Lévy prior to surgery, to carry out the session in better conditions. These exercises are simple and require no special equipment. Not only do they prepare the ground for subsequent physiotherapy sessions, they also play a decisive role in the quality of your recovery.
In this article, we detail 4 post-operative self-rehabilitation exercises for hallux valgus, along with the key principles to follow for an optimal recovery.
Why Is Rehabilitation Essential After Hallux Valgus Surgery?
The Risk of Joint Stiffness
Even when a minimally invasive percutaneous surgery is performed under the best conditions, the metatarsophalangeal joint of the big toe remains vulnerable to stiffening in the weeks following the procedure. This phenomenon, known as post-operative joint stiffness, occurs when the joint is not mobilised early enough. It can permanently limit the range of motion of the big toe and compromise the functional outcome of an otherwise technically successful operation.
Early mobilisation is therefore an absolute necessity: it prevents the formation of scar adhesions, maintains the suppleness of the tendons and ligaments, and allows the joint to gradually regain its full range of motion.
Restoring Correct Weight-Bearing
Another major challenge of rehabilitation after hallux valgus surgery is restoring correct weight-bearing on the big toe. Due to pre-existing pain and deformity, many patients have developed, often without realising it, a compensatory habit of shifting their body weight onto the outer edge of the foot or the heel. If this habit persists after surgery, it can lead to pain under the lateral metatarsals or the 5th metatarsal, and slow down functional recovery.
The self-rehabilitation exercises presented in this article are designed specifically to correct these compensations and retrain the foot to bear weight correctly across the entire forefoot, including the big toe.
When Should the Exercises Begin?
Self-rehabilitation exercises can be started from the 8th day after surgery, following the first dressing change, provided the wound is healing well. They should be performed four times a day, for 5 to 10 minutes, always respecting the fundamental rule: work within tolerable pain limits, never force. Intensity increases progressively, in line with the pace of recovery.
THE 4 SELF-REHABILITATION EXERCISES
Exercise 1: Plantar Flexion (Downward) of the Metatarsophalangeal Joint of the Hallux (MTP1)
Mobilisation of the MTP1 joint is the first exercise to master after hallux valgus surgery. It aims to quickly restore mobility in the big toe, prevent joint stiffness, and prepare for the resumption of correct weight-bearing during walking.
How to perform this exercise?
- Sit in a semi-reclined position, for example on your sofa, with your knee bent so you can easily reach your big toe. You can also perform this exercise sitting on a chair, with the operated leg resting on the other leg.
- Place one hand under the MTP1 joint and push upwards to create a counter-support and block movement in the midfoot joints.
- With the other hand, push the first phalanx of the big toe downwards to achieve plantar flexion of the MTP1 joint.
- Hold this position for 10 seconds, gradually increasing the pressure and seeking tension in the joint. This tension may be painful: it should feel similar to a muscular stretch after exercise. Breathe deeply and try to relax the muscles to facilitate the stretch.
- Release for 10 to 15 seconds to allow the joint to recover.
- Repeat the flexion 10 times in a row.
- After the exercise, apply 15 to 20 minutes of cryotherapy to limit pain and swelling that may appear following the session.
Why is this exercise important?
After hallux valgus surgery, the MTP1 joint can quickly lose its mobility due to lack of use, swelling, and progressive retraction of the articular capsule, the anatomical structure that surrounds and stabilises the joint. Early and regular mobilisation is therefore essential to maintain sufficient joint range of motion. Passive manual mobilisation helps combat stiffness and scar adhesion formation, and gradually restores effective plantar flexion of the big toe. This mobility is crucial for the big toe to resume correct ground contact and play its full role in the gait cycle and propulsion during walking.
Exercise 2: Weight Transfer — Relearning Balance and Correct Foot Loading
The weight transfer exercise is the second exercise to master after hallux valgus surgery. It aims to relearn how to load the forefoot correctly and restore symmetrical weight-bearing across both feet.
How to perform this exercise?
- Stand with your feet slightly apart, in line with your hips. If necessary, position yourself near a wall, a piece of furniture, or the back of a chair for support.
- Gradually transfer your body weight from one foot to the other. To truly load the operated foot, progressively shift your pelvis and centre of gravity over it.
- As you transfer your weight onto the operated foot, progressively raise the heel of the non-operated foot to shift the load towards the forefoot. Start by lifting the heel slightly, then increase the height with each repetition.
- Focus on maintaining weight across the full width of the operated forefoot, including under the big toe, without letting the foot roll outward.
- Actively push into the ground with the forefoot and the operated big toe. You should feel the work in your calf and the flexor muscles of the big toe.
- Your pelvis and navel should move towards the foot bearing the load. Keep your trunk upright: do not tilt your shoulders or lean your upper body sideways to compensate. The goal is to naturally bring your centre of gravity over the supporting foot.
- Alternate weight-bearing from right to left repeatedly, aiming for a progressively smoother movement. The objective is to automate the correct loading pattern so that placing weight on the operated foot during walking becomes natural and free of apprehension.
- Once the exercise feels comfortable, gradually increase the load until you can bear your full body weight on the operated foot for a few seconds, then return to both feet.
- As a progression, when this exercise is fully mastered, move towards single-leg standing on the operated foot, first for a few seconds, then for increasingly longer periods, to increase muscular and proprioceptive work.
Why is this exercise important?
After hallux valgus surgery, it is common to unconsciously protect the operated foot by shifting weight onto the other foot or the outer edge of the foot. This habit can persist even as pain decreases. The weight transfer exercise retrains the body to shift the centre of gravity over the operated foot and gradually rebuild confidence in loading it. Above all, it helps restore correct forefoot and big toe contact, which is essential for normal gait. Repeating this exercise progressively automates the correct loading pattern, so the patient can walk fluidly and symmetrically without having to think about how to place the foot.
Exercise 3: The Towel Grip — Strengthening the Intrinsic Muscles of the Foot
The towel grip is the third exercise to master after hallux valgus surgery. It aims to strengthen the foot muscles and the flexors of the big toe, improving toe control, forefoot stability, and supporting the recovery of active and effective big toe loading during walking.
How to perform this exercise?
- Place a tissue or small towel flat on the floor, then rest your operated foot on it while seated.
- Try to grip the towel with your big toe and the other toes, as if you were trying to pick it up.
- To do this, actively curl the toes downward, with particular emphasis on flexing the big toe. The goal is to crumple and then slightly lift the towel from the floor.
- Hold the contraction for a few seconds, then fully release the toes before repeating.
- Repeat the movement 10 times, progressively trying to increase the grip strength.
- It is perfectly normal not to be able to lift the towel at first, particularly in the early days after surgery. Do not force the full movement straight away.
- Even if the towel does not move, keep trying: the intention to curl the toes is already an exercise in itself. It activates the flexor muscles and progressively re-establishes the neuromuscular connection between the brain and the operated foot.
- Perform this exercise daily. With repetition, the movement will become progressively easier, stronger and more natural.
Why is this exercise important?
After hallux valgus surgery, the foot muscles, and in particular the flexors of the big toe, can quickly lose strength and effectiveness due to pain, swelling and reduced use. The towel grip reactivates and strengthens the foot and toe muscles, while specifically targeting the big toe’s ability to flex and push against the ground. Even when the movement is still difficult, repeated attempts awaken the neuromuscular connection between the brain and the operated foot. This work progressively contributes to restoring active and effective big toe loading, essential for forefoot stability and efficient propulsion during walking.
Exercise 4: The Forward Lean
The forward lean is the fourth exercise to master after hallux valgus surgery. It aims to actively reintegrate the big toe into ground contact by working plantar flexion of the MTP1 joint under load, soliciting the toe flexor muscles in a situation close to the demands of walking.
How to perform this exercise?
- Stand facing a wall or the back of a chair, close enough to catch yourself immediately if you lose balance, but without leaning on it. Feet are hip-width apart and remain flat on the ground.
- Keeping the body relatively upright, gradually lean forward by shifting your centre of gravity. The movement should come primarily from the ankles, never lifting the heels from the ground.
- The movement is similar to the one performed by Michael Jackson in Smooth Criminal, but with a much smaller amplitude, of course!
- As your centre of gravity shifts forward, you should feel your toes progressively gripping the ground to control the fall. Focus particularly on feeling the big toe actively pushing against the floor.
- Lean progressively until you reach the point just before losing balance, while keeping your heels on the ground. Hold this position for a few seconds.
- Slowly return to the starting position, rest for a few seconds, then repeat 10 times.
- It is essential not to go too far. If you feel you are losing balance, immediately take support on the wall or chair in front of you.
- Over successive sessions, gradually try to lean a little further forward, always keeping your heels on the ground and actively controlling your balance through the pressure of your toes.
Why is this exercise important?
After hallux valgus surgery, it is common to unconsciously protect the big toe when resuming walking and to shift the load towards the outer edge of the foot. Even when joint mobility returns, the hallux can remain insufficiently engaged. The forward lean actively reintegrates the big toe into plantar loading: as the centre of gravity shifts forward without the heels lifting, the toe flexor muscles must contract to stabilise the body and resist the fall, and the big toe then exerts active pressure against the ground. This exercise is a natural progression from the previous ones: after recovering passive plantar flexion of the MTP1 through manual mobilisation, and beginning to reactivate the flexor muscles with the towel grip, this exercise works active plantar flexion under load, in a situation closer to the real demands of walking. The final goal is to restore a big toe that fully participates in weight-bearing, balance and propulsion.
What About the Scar?
One often-overlooked aspect of post-operative hallux valgus rehabilitation is scar work. Once the wound is fully closed, which generally occurs between the 15th and 21st day depending on individual healing speed, it is both possible and recommended to mobilise the scar to release subcutaneous scar adhesions.
When left untreated, these adhesions can limit the gliding of tendons beneath the skin and cause persistent discomfort or pain during walking. Scar mobilisation involves gently moving the skin around the scar in several directions (horizontally, vertically, in rotation) to loosen the deeper tissues. Your physiotherapist will be able to teach you this technique during your first rehabilitation sessions.
Self-Rehabilitation and Physiotherapy: An Essential Partnership
The self-rehabilitation exercises presented in this article are designed to be performed independently at home, between physiotherapy appointments. They do not replace professional follow-up: they prepare for it and extend it.
Formal physiotherapy generally begins around three weeks after surgery, once healing is complete. Your physiotherapist will then take over with more advanced passive mobilisations, proprioceptive work and progressive muscle strengthening. The more consistently the self-rehabilitation exercises have been practised beforehand, the more effective the physiotherapy sessions will be and the faster the recovery.
Dr Bruno Lévy emphasises consistency as the key factor for success: short but daily sessions are far more effective than long, infrequent ones. Five to ten minutes several times a day is enough to keep the joint mobile and progress steadily towards a full recovery.
Rehabilitation after hallux valgus surgery is an essential step to make the most of the surgical procedure. These 4 self-rehabilitation exercises form a solid foundation for gradually restoring correct weight-bearing, satisfactory joint mobility and comfortable walking.
If you would like to find out more about the minimally invasive percutaneous technique practised by Dr Bruno Lévy, do not hesitate to book a consultation. He will guide you through every step, from diagnosis to your full return to activity.
FAQ: Hallux Valgus Rehabilitation
When should rehabilitation begin after hallux valgus surgery?
Self-rehabilitation exercises can begin from the 8th day after surgery, provided the wound is healing well. Formal physiotherapy generally starts approximately three weeks after the procedure.
How many times a day should the exercises be performed?
These exercises should be performed several times a day, ideally four times, for sessions of 5 to 10 minutes. Consistency matters more than intensity: short, frequent sessions produce better results than long, infrequent ones.
Are the exercises painful?
Some exercises may be uncomfortable or mildly painful, which is normal. The rule is to stay within tolerable pain limits and never force. Range of motion and comfort improve naturally over successive sessions.
Do I still need to see a physiotherapist?
Yes. Self-rehabilitation at home is an essential step, but it does not replace professional follow-up. A physiotherapist brings complementary expertise, particularly for deeper passive mobilisations, scar work and the adaptation of the programme to each patient’s progress.
Does Dr Bruno Lévy’s percutaneous surgery require as much rehabilitation as conventional surgery?
The minimally invasive percutaneous technique practised by Dr Lévy offers faster and less painful recovery than conventional open surgery. However, early mobilisation of the metatarsophalangeal joint remains essential to prevent stiffness and achieve the best possible functional outcome.
