Hallux varus

• Medial deviation of the big toe
• Pain around the medial side of the big-toe metatarsophalangeal joint
• Friction against footwear
• Aesthetic concerns
• Instability of the big-toe metatarsophalangeal joint
• Reduced motor function
• Metatarsalgia

• Surgical treatment of hallux valgus deformity
• Incorrect postoperative management after hallux valgus surgery
• An injury damaging structures that stabilise the big-toe metatarsophalangeal joint, such as the sesamoid ligament apparatus or muscle attachments
• Rheumatoid arthritis and other arthropathies
• Removal of the lateral sesamoid bone
• Gout
• Avascular necrosis of the head of the first metatarsal bone
• Congenital deformity
• Neurological causes

Treatment depends on the size and cause of the deformity and on when it developed.

Conservative treatment of hallux varus

• Choosing appropriate footwear
• Corrective devices
• Correctly applied dressing after hallux valgus surgery
• Insoles that help correct other coexisting foot problems

Surgical treatment of hallux varus

Treatment depends on the cause and duration of the deformity.

For progressive or moderate-to-severe deformities, surgery should be performed as early as possible.

Diagnostic tests used before hallux varus surgery

• Radiographic examination in standard views

             It is extremely important that the images are taken under full weight-bearing.

• Haematological and biochemical tests
• Pedobarographic examination, still rarely used in Poland, which assesses pressure distribution on the soles while standing and walking and enables more precise planning of surgery.
• Ultrasound examination
• Computed tomography
• Magnetic resonance imaging

Surgical methods used to treat hallux varus: 

• Capsular plasty of the big-toe metatarsophalangeal joint
• Dynamic correction using a graft of 1/2 of the extensor hallucis longus tendon
• Passive correction using special repair systems, such as Mini Tight Rope Arthrex or Zip Tight Biomet
• Osteotomies of the first metatarsal bone
• Arthrodesis of the big-toe metatarsophalangeal joint

For postoperative treatment, we use special Postoperative footwear:

Patients begin walking in them on the first day after surgery and usually wear them for 4–5 weeks.
The operated foot is specially bandaged for approximately 10 weeks after surgery.

Rehabilitation is an important element supporting rapid recovery after hallux varus surgery. To be effective, it should be based on the following principles:

• the patient’s condition should be assessed
• Individual recommendations should be prepared for hallux varus treatment
• therapy should be adapted to the patient’s abilities

Individual exercises with the patient aim to:

• improve the range of motion in the joints of the operated lower limb
• improve proprioception
• improve neuromuscular coordination
• reduce swelling (soft-tissue work, lymphatic massage, kinesiotaping)
• correct gait and faulty movement habits
• physiotherapy

In foot surgery, ensuring a pain-free operation and minimising postoperative pain have always been major challenges.

It is commonly believed that recovery after foot surgery, especially hallux surgery, is very painful.

There are many options for anaesthesia during procedures on the foot.

Modern anaesthesiology aims, wherever possible, to use regional anaesthesia techniques – from central blocks such as spinal and epidural anaesthesia, commonly known as lumbar anaesthesia, to peripheral nerve blocks at various levels performed under ultrasound guidance, especially when operating on one foot.

The possibility of using a particular type of anaesthesia depends mainly on the extent of surgery and any coexisting conditions.

The final choice of anaesthesia is agreed with the patient during the preoperative assessment interview.

Using ultrasound in anaesthesiology to perform peripheral nerve blocks has enabled highly precise regional anaesthesia.

Our many years of experience have changed our perioperative approach, both to anaesthesia itself and to the postoperative period.

For foot surgery, peripheral nerve anaesthesia, known as an ankle block, means injecting a local anaesthetic around the nerves at the appropriate level.

These anaesthetics are highly precise because the nerves responsible for pain sensation are clearly visible on ultrasound and medication delivery is fully controlled.

This can substantially reduce or even eliminate the need for pain medication early after surgery.

For many patients, one of the most important advantages is that sensation above the knee is preserved in the operated leg and, most importantly, lumbar anaesthesia is avoided, which patients do not always accept.

Another important advantage is that walking can begin very soon after the procedure.

During the postoperative period, administering pain medication at regular intervals under ultrasound guidance around the nerves responsible for pain enables patients to pass through this period as comfortably and painlessly as possible.