Minimally invasive percutaneous surgical techniques with internal fixation for correcting hallux valgus

Hallux valgus (HV) is more commonly known as a bunion. The big toe is deviated towards the other toes resulting in a bony protrusion. This deviation occurs at the first metatarsal phalangeal joint. The small sesamoid bones found beneath the first metatarsal also become displaced as the first metatarsal bone drifts away from its normal position, weakening the big toe. Symptoms include damage to the skin over the bunion, pain and weakness of the forefoot when walking, cosmetic concerns, and difficulty with footwear.

In a small number of people, bunion development is associated with underlying genetic conditions affecting the structure of the foot (such as ligamentous laxity syndromes and certain neurological conditions). But in most people the aetiology is not clear. Chronic trivial injury to the joint (for example, caused by some types of footwear) may be the cause. The condition is most common in women and in middle and later life.

Current treatment options include exercises, orthoses (devices to support and align the foot), spacers between the toes to keep them in the correct position, shoe alterations and analgesics to relieve symptoms. Open surgery is considered as standard care when conservative treatments have failed, and severe pain and deformity cause functional impairment. Many different surgical operations are used for treating HV, depending on the nature and extent of the deformity. One commonly used open surgical procedure is distal first metatarsal osteotomy, which divides and repositions the bone of the great toe near to the joint to correct the deformity.

Surgical correction of HV using minimally invasive percutaneous surgical techniques with internal fixation is done as a day case under local or general anaesthesia and in supine position. Low-dose X-ray monitoring or endoscopic images are used. One or more small incisions are made close to the hallux metatarsophalangeal joint of the affected toe. The bunion is then removed and the metatarsal is divided surgically (osteotomy). Motorised high torque low speed burrs and surgical jigs aid the complex reduction and fixation steps of the procedure and implant insertion. Temporary wires may be used to toggle the separated parts of the divided bone into the desired position. The bone fragments are then stabilised using plates, specialised screws, or wires. The temporary wires used for toggling pieces of bone are removed. The small incisions are closed and a dressing is applied. After surgery, a dressing or plaster may be used to support the foot in the corrected position until the divided bone heals. People are usually allowed to put weight on the foot immediately.

The proposed advantages of a percutaneous surgical approach (minimally invasive techniques) are shorter operation time, quicker recovery, less pain, fewer complications, shorter hospital stay, earlier weight bearing and smaller scars.