Correction of Hallux Valgus using the percutaneous META technique

Hallux Valgus is a common forefoot deformity affecting about 23% of people aged 18-65 and about 35% of patients older than 65. Women are affected more often than men.

How does Hallux Valgus deformity develop?

Hallux Valgus deformity develops due to a combination of age, heredity and environmental factors which weaken the ligaments and capsule. As a result, the muscles that support the position and function of the big toe become a deforming force, causing the first metatarsal to turn inward and rotate, while the big toe turns outward. This deformation leads to a painful callus on the inner side of the head of the first metatarsal and the deterioration of the foot's resistance function. When the loads change, a painful callus may also occur on the sole of the head of the second metatarsal, which is called metatarsalgia. In addition, a hammertoe deformity of the second toe often occurs, and a painful callus appears on the top of it. As the deformity worsens, it can cause the big toe and second toe crossing and calluses between the toes. Standard footwear often worsens the condition of calluses. Besides, it quickly stretches and wears out.

Treatment

Hallux Valgus is a deformity with no clear consensus on its conservative treatment. While night splints can reduce discomfort, they do not stop the deformity from progressing. At the same time, rigid splints may cause calluses and increase pain. A surgical treatment known as the percutaneous META (Metaphyseal Extra-Articular Transverse and Akin Osteotomy) technique is considered a reliable solution for this condition. This minimally invasive surgery effectively treats mild, moderate, and severe deformities.

The percutaneous META technique is performed through small 4-6 mm incisions. Bony incisions are made using a special drill (Shannon burr) that rotates at a slower speed with a constant stream of water to protect the tissues from burns. The correction and fixation with screws are done under the control of X-ray pictures. Using a postoperative shoe, the patient can safely walk on the operated leg on the first day after surgery.

Why is percutaneous Hallux Valgus correction preferable to standard open surgery without contraindications?

• Significantly smaller incisions guarantee small scars and a potentially better cosmetic result;

• There is less postoperative pain, and therefore less painkillers required;

• It allows a greater range of motion;

• The operation does not damage the capsule of the first metatarsophalangeal joint,

• Contrary to open surgery, it corrects the rotation of the metatarsal head and the distal articular angle;

• It enables greater correction possibilities,

• It is suitable for severe deformation,

• Less chance of a relapse (up to 7%).

Postoperative recommendations

• Keep your operated foot elevated at the level of your heart for 23 hours a day during the first 2 weeks after surgery.

• Your wound dressings will be changed during your visit, and your wound healing will be examined 1-2 weeks after surgery.

• Use special postoperative footwear with a hard sole for 6 weeks while walking with full weight.

• After 6 weeks, you can wear sports shoes with hard soles.

• Walking aids such as crutches are only recommended in exceptional cases.

• X-rays will be taken during your visit 6 weeks after surgery to confirm bone healing.

• Gradually return to normal physical activity starting from 6 weeks after surgery.

• Driving a car for 6 weeks after surgery is not advised. However, if you had surgery on your left leg, you can drive an automatic car shortly after the operation.

How to prepare for surgery

• Blood tests shouldn't be older than 4 weeks and should include a general blood test, Urea, Creatinine, electrolytes, clotting factors, and Vitamin D test.

• Have a conversation with your doctor about taking blood thinners.

• Avoid taking aspirin and clopidogrel for at least 3 days before surgery.

• Avoid using nicotine for 6 weeks before and 6 weeks after the surgery. This includes cigarettes, cigars, electronic cigarettes, etc.

• Take a Vitamin D (1000 IU) and Calcium (500mg) supplement for 6 weeks before and 6 weeks after the operation.

• Take a large dose of Vitamin C (500-1000mg) for 6 weeks before and 6 weeks after the operation. This will help reduce the risk of Pain Syndrome.

• Avoid taking non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac, etc.) for 3 days before and 6 weeks after the surgery.

• Do not eat anything before 8 AM on the day of surgery.

• You can drink a glass of clear water up to 3 hours before the surgery.

• Take the medicines you regularly take on the morning of the operation.