Hallux valgus, more commonly known as a “bunion,” is a condition characterized by a foot deformity affecting the big toe, often accompanied by significant pain. Hallux valgus occurs when the big toe gradually deviates towards the other toes, creating a visible bony bump on the side of the foot. This condition can be caused by genetic factors in approximately 30% of cases, but it is most often triggered by prolonged wearing of tight shoes or biomechanical foot disorders, such as flat feet. Both painful and unsightly, hallux valgus generally requires surgery to eliminate pain and correct the deformity. When performed using a minimally invasive technique, the procedure is called halluxoplasty and is most often carried out on an outpatient basis. If you are suffering from hallux valgus and considering surgery, this article will guide you through the various stages of medical care, from surgical techniques to post-operative recovery.
What is Hallux Valgus and Why Does it Require Surgery?
Hallux valgus is a fairly common foot deformity that primarily affects the big toe. In France, approximately 70,000 hallux valgus surgeries are performed each year, with 90% of patients being women. This disparity is mainly explained by the frequent use of footwear that is unsuitable for foot health. High heels, for instance, shift body weight forward, which, over time, contributes to the deformity of the toe. Menopause can also be a triggering factor due to hormonal changes. These changes may cause a loosening of fibrous structures, leading to a widening of the forefoot which, when confined in tight shoes, becomes prone to deformation.
More broadly, hallux valgus is a condition that should not be underestimated, as it may worsen over time and lead to complications if left untreated.
Symptoms and Impact on Quality of Life
Beyond its unsightly appearance, hallux valgus can significantly interfere with daily life. The most common symptoms include localized pain at the affected joint, severe inflammation, and redness caused by shoe friction. These discomforts can make walking difficult and limit certain activities.
What Complications Can Arise from Untreated Hallux Valgus?
In more advanced cases, hallux valgus can cause secondary deformities of the other toes, such as hammer toes or claw toes, thereby increasing the risk of joint osteoarthritis. There is also the potential development of bursitis—an inflammation of the bursa (a fluid-filled sac that cushions joints)—which can occur at the site of the bump, leading to painful swelling and, in some cases, infection.
Changes in weight-bearing points can also lead to second ray syndrome (metatarsalgia), characterized by pain under the second toe, often described as a burning sensation or the feeling of “a pebble under the toe.”
When the pain becomes chronic and conservative treatments—such as orthopedic insoles or shoe modifications—are no longer effective, surgical intervention may be necessary to correct the deformity and restore optimal comfort.
How Does Hallux Valgus Surgery Work?
Surgery for hallux valgus aims to correct the deviation of the big toe and relieve the associated pain. It begins with a preoperative consultation during which the surgeon evaluates the severity of the deformity through a clinical examination and imaging tests. The entire foot structure is carefully analyzed, and the surgeon also checks whether any new pain has developed in the meantime.
This step is essential, as it helps determine the most appropriate surgical technique based on the degree of deviation and the condition of the joints.
The procedure itself can be performed using two main approaches: minimally invasive surgery, which involves small incisions and reduces tissue trauma, or traditional surgery, which uses larger incisions and involves the placement of screws.
In most cases, the surgeon performs the correction under local anesthesia by reshaping the bone and realigning the joints. The operation typically lasts between 30 minutes and one hour.
Dr. Lévy’s Percutaneous Technique for Hallux Valgus Surgery
The halluxoplasty technique performed by Dr. Bruno Lévy is a minimally invasive approach that avoids the use of screws and pins. This method significantly reduces post-operative pain and allows for a quicker recovery. Walking is possible the same day, provided the patient wears a pair of orthopedic shoes—without the need for crutches.
Halluxoplasty also results in a very fine, nearly invisible scar.
Consultation with the Anesthesiologist
Following the consultation with the surgeon, the patient will meet with an anesthesiologist who will oversee anesthesia management during the procedure. This consultation aims to prescribe any additional tests if necessary and to explain the anesthesia process to the patient.
It is extremely important to note that smoking is strictly prohibited for at least one month prior to the surgery. Nicotine intake has a significant impact on blood circulation, which severely compromises bone healing and increases post-operative pain. Smokers may manage nicotine withdrawal using slow-release nicotine patches.
Hallux valgus surgery is performed under local anesthesia. The anesthesiologist first administers anesthesia at the ankle and foot, after which the surgeon completes the process by injecting anesthetic directly around the affected toes. These injections ensure a numbness that lasts 10 to 12 hours, allowing the patient to return home pain-free. After this period, oral medication prescribed by the surgeon will take over to manage pain.
For a traditional surgical procedure, a period of rest and immobilization is required to ensure proper healing. Patients are usually allowed to walk with special orthopedic shoes within the first few days, but a full return to daily activities depends on strict adherence to post-operative recommendations and, if necessary, physical therapy sessions.
Dr. Lévy’s halluxoplasty technique allows immediate walking after surgery, as no muscles, tendons, or joint capsules are affected.
Post-Operative Follow-Up for Hallux Valgus
After the operation, the surgeon will prescribe orthopedic shoes, which will allow you to resume normal life at home immediately. These shoes must be worn for at least one month.
After 8 to 10 days, you will have a follow-up consultation with the surgeon to monitor the healing progress. At this time, a splint will be prescribed and applied. Its purpose is to keep the foot properly aligned and ensure correct bone consolidation.
After one month, the dressings and splint will be removed, and you will be allowed to wear shoes again—but only loose-fitting ones (such as sneakers or Converse-style shoes). Compression bandages will continue the work of the dressings and splint, while the surgeon will explain self-rehabilitation exercises. These exercises will help you regain full joint mobility in your toes.
Another appointment will be scheduled around the third month. This visit aims to monitor the evolution of the surgical outcome. Depending on your progress, additional advice and recommendations may be provided to complement the post-operative care.
Post-Operative Contraindications for Hallux Valgus Surgery
- Do not drive for at least one and a half months.
- Avoid prolonged walking for at least one and a half months.
- Immediately inform the surgeon in case of any infection.
- Some loss of sensation in a few toes may occur, but this usually recovers within the first year after surgery.
- Depending on the shape of the patient’s foot, the surgeon may prescribe orthopedic insoles to help redistribute weight evenly on the feet.
If you suffer from hallux valgus and wish to be treated using Dr. Lévy’s halluxoplasty technique, please contact our team to schedule an appointment.
