If conservative treatment methods have already been exhausted and the pain of hallux valgus can no longer be alleviated, the level of suffering in everyday life is often high. In most cases, hallux valgus surgery helps to finally be free of pain again. In this article you will learn everything about hallux valgus surgery, what you should know as a patient and how you yourself can contribute to a successful surgery. In addition, we will inform you about the time after the hallux valgus surgery, when you are allowed to drive again and how long you might be unable to work. You can find out everything about the causes (development), bandages, physiotherapy splints and risk groups here, in our online guide.
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Before and after images during hallux valgus surgery. These pictures show the surgical procedure of a mild hallux valgus, which was performed with a screw made of human bone.
When should a hallux valgus be operated on?
“Many patients try to relieve the pain caused by hallux valgus with conservative methods. However, this often only succeeds to a small extent. So whether a hallux valgus should be operated on or not always depends on the patient’s level of suffering,” says Dr. Klaus Pastl, hallux valgus expert from Linz, Austria. For surgeons, there are precise classifications here about the severity of hallux valgus. However, the severity or intermetatarsal (IM) angle tells only a limited amount about the patient’s pain. In mild to moderate malocclusions, the IM angle is 11°- 15° and one can often delay surgery. The angle can be accurately determined by X-ray examination. If the hallux valgus angle is over 15°, patients suffer from more severe pain in everyday life. In most cases, only surgery can help. When to have a hallux valgus surgery, however, must always be decided individually depending on the pain sensation.
Visit a hallux valgus specialist near you for a consultation. You do not know which doctor you should go to? Ask us, we will be happy to recommend a hallux valgus specialist in your area.
The severity of hallux valgus
“The goal of hallux valgus surgery is to relieve the patient’s pain as quickly as possible. A large hallux valgus angle is often also an indication of more severe pain. However, this does not have to be the case. Patients often have severe pain even though the intermetatarsal angle is still well below 15°,” says Dr. Pastl. The following table shows the severity levels of hallux valgus.
Hallux valgus Winkel (IM)
Intermetatarsalwinkel (IM) unter 15°
gelegentliche Schmerzen im Alltag, Rötungen und verdickte Haut möglich
Physiotherapie, Fußgymnastik, Operation nach Austin, Schienen, Einlagen
Intermetatarsalwinkel (IM) zwischen 15° und 20°
häufige Schmerzen im Alltag, Rötungen, Druckstellen am Ballen, Schmerzen beim Tragen von Schuhen
Optimiertes Schuhwerk, Operation nach Scarf, Fußgymnastik
Intermetatarsalwinkel (IM) über 20°
Schmerzen auch im Ruhezustand, sowie beim Gehen und Laufen
Operation nach Scarf oder Lapidus-Arthrodese, Fußgymnsatik
Hallux valgus pain is not always dependent on the severity of the hallux valgus angle. Pain in hallux valgus is always a purely subjective sensation and varies from patient to patient!
Materials used in hallux valgus surgery
“The majority of hallux valgus operations involve the use of screws or plates. I always discuss the various options with my patients and decide together with them on the best option in each case. As always, all systems have advantages and disadvantages,” says Dr. Klaus Pastl. Basically, screws made of human bone, screws and plates made of metal, and screws made of bioreactive plastics are available.
Screws from human bone
Screws made from human bone form a solid bone healing unit with the patient’s bone.1 “More and more of the body’s own cells migrate into the bone screw and eventually remodel it into its own bone tissue. So there is no metal removal after hallux surgery.” In addition, the surgeon can use these screws for mild, moderate and severe hallux deformities,” Dr. Klaus Pastl said. The Bone screws are sunk entirely into the patient’s bone. The surrounding tissue is therefore not irritated.
1Literatur: Elliot DS et al, (2016) Bone healing unit
Shark Screw® are screws made from human bone. Sie bilden eine stabile Knochenbrücke und dienen als Leitstruktur für alle Knochenzellen des Patientenknochens. It can be used for mild, moderate and severe hallux valgus deformities.
Metal screws and plates
Metal screws and plates have been in use for decades. Not only in hallux valgus surgery. These are tried and tested systems in orthopedics and trauma surgery. Unfortunately, however, screws and plates made of metal always bring with them a certain risk of metal removal that may be necessary. Depending on the severity of the deformity and depending on the study, the incidence of metal removal has been reported to range from 8.9% for Chevron (mild hallux valgus) to 32.3% for Lapidus arthrodesis (severe hallux valgus) within the first 21 months. Of the study participants who did not undergo metal removal, 18% considered future metal removal after the first 21 months.1
Metal plates are often used for severe hallux valgus deformities. These wear on and can cause pain when wearing shoes. You can find a hallux valgus surgery with a plate here. Attention in this video you can see real blood.
In order to counteract problems arising from the provision of metal implants, various resorbable osteosynthesis materials (screws for the fixation of bone) have been developed in recent decades. In the group of resorbable (dissolving) screws, according to the literature, side effects occur, due to the resorption processes, (dissolution processes). Aseptic inflammation, fluid formation, fistula formation, cysts, and sustained bone, cartilage, and soft tissue damage may occur. Mild side effects, such as diffuse pain, may occur in up to 47% of cases. Period 60 days – 9.5 years after surgery.2
A wide range of surgical materials are available to the surgeon and patient. Which is the best material for the patient is always on a mutual basis. Often, a second opinion from another specialist can also help.
Old and New Surgery Methods for Hallux valgus
If surgery is decided upon, it is important to clarify with the treating foot orthopedist how large the intermetatarsal angle (IM) is for hallux valgus and which surgical procedure offers the best chances of healing. The literature speaks of over 200 different surgical methods used in hallux valgus surgery. However, only a fraction of them are really practiced frequently.
The most common surgical methods for hallux valgus correction are: Austin hallux valgus correction, Scarf osteotomy, Akin, Lapidus arthrodesis (TMT I arthrodesis) Chevron osteotomy, modified Austin osteotomy, Keller Brandes surgery, minimally invasive hallux valgus surgery.
The goal of hallux surgery is to correct the misalignment of the big toe using a special hallux surgical procedure. There are approximately 200 hallux surgical procedures worldwide. The most common hallux valgus surgeries are:
- Hallux surgery according to Akin (additional correction)
- Hallux surgery according to Austin (mild hallux valgus)
- Hallux surgery after Scarf (Middle hallux valgus)
- Hallux surgery with lapidus arthrodesis (severe hallux valgus)
Hallux surgery with lapidus arthrodesis (severe hallux valgus)
A new surgical method for mild to severe hallux valgus deformities is surgery and fitting with screws made from human bone. The advantage for patients: The screws are converted into the patient’s own bone tissue and no longer need to be removed. This new surgical method has been used for hallux valgus since 2016. Learn more about screws made from human bone here.
1 Literatur: Ruden, J. (2019). Operative Korrektur des 1. Strahls am Fuß – Evaluation des verwendeten Implantats und des klinisch funktionellen Outcomes. Marburg: Philipps-Universität Marburg.
2 Literatur: Pisecky, D. L. (2020). Bioresorbierbare Implantate in der Vorfußchirurgie: Materialien, Möglichkeiten und Nachteile. Linz: JATROS Orthopädie & Traumatologie Rheumatologie.
3 Literatur: Literatur: Kajetan Klos et al. Foot Ankle Surg2013 Dec;19(4):239-44.doi: 10.1016/j.fas.2013.06.003. Epub 2013 Jul 3.
4 Literatur: Kajetan Klos et al. (2013). Modified Lapidus arthrodesis with plantar plate and compression screw for treatment of hallux valgus with hypermobility of the first ray: A preliminary report. Elsevier.