Hyperlife Medical Centre

010 020 5050 | 80 Van Bergen St,
Brackenhurst, Alberton

Morningside Mediclinic

011 883 1719 | Rivonia Rd, Hill Rd,
Sandton, 2057

HALLUX VARUS CORRECTION WITH TENDON TRANSFER

Hallux varus

What is it?

Hallux varus is a condition in which the big toe begins to deviate away from the midline of the foot (toe moves inwards, opposite to a bunion). Hallux varus most commonly develops after a failure of bunion surgery. There are however other conditions which may lead to hallux varus including trauma, removal of a sesamoid bone from the big toe joint and some forms of arthritis.

As the big toe deviates, it begins to get stiff. This stiffness can occur at one or both of the joints of the big toe.

Treatment is far easier when the big toe remains flexible. As the toe joints stiffen, then the ability to correct the deformity and keep the big toe flexible is quite limited, and a fusion of the toe needs to be performed.

The treatment of hallux varus depends upon how bothersome the condition is. If the deformity is mild and the toe remains flexible no treatment is required at all. If the toe begins to deviate considerably and is becoming stiff then this will be quite uncomfortable with shoe wear, and surgery is usually required to correct the toe.

Correction depends on the flexibility of both joints of the big toe and whether or not arthritis is present. Often, a tendon transfer is performed by shifting tendons around the big toe to straighten it and maintain flexibility. One of the more popular procedures which is used, is to redirect a small tendon of the big toe (the extensor halluces brevis transfer of the Myerson procedure). If there is severe arthritis or stiffness or deformity of the toe, then a tendon transfer cannot be performed and often, a fusion of the joint is required.

Hallux varus correction (open procedure)
General Facts

  • This operation is designed to correct the big toe deformity, and in order to correct it, the ligaments have to be tightened on the one side (outside of the toe), and loosened on the other side of the joint (inside of the toe).
  • Tightening or repairing the ligaments is however not strong enough to maintain correction, and a tendon transfer must be performed, using a small tendon on the side of the big toe for the transfer, called the extensor hallucis brevis.
  • The toe can however be normal, and although some flexibility will be present, there will always be some stiffness in the joint.
  • As with all types of surgery, you will be able to wear shoes more comfortably. This does not mean however that you will always be able to wear narrow tight shoes.

General Recovery Facts

  1. You can expect mild to moderate pain for the first 3-5 days.
  2. You are allowed to walk on the foot the day after surgery in the post operative shoe supplied.
  3. Many patients are however not able to walk on the foot because of pain.
  4. You may use crutches or a walker if you need support.
  5. You may drive an automatic car by about 10 days if it is your right foot, and 7 days if your left foot, however this should be if only absolutely necessary.
  6. You may drive a manual by about 10 days if it is your right foot, and 14 days if it is your left foot, however this should be if only absolutely necessary.
  7. The foot needs to be bandaged for about 2 weeks.
  8. You will not be able to get the foot wet while the foot is bandaged.
  9. You can start exercising under direction at about 6 weeks.
  10. You will be able to wear a sneaker type shoe at about 6 weeks.
  11. During recovery do not walk at all without the surgical shoe
  12. The foot will remain puffy and swollen for 4-6 weeks and continue improving from 2 months to 9 months.
  13. At approximately 2-3 months most patients are not aware that they have had any surgery performed.
  14. Range of motion of the big toe is inevitably stiffer immediately post operatively and with physiotherapy will improve continuously.

Specific post-operative recovery

  • Foot wrapped in bulky bandage and surgical shoe.
  • Do not remove surgical shoe – even at night.
  • Start walking on heel and outside of the foot.
  • Ice, elevate, take pain medication as prescribed.
  • Expect numbness in foot 12-24 hours then pain.
  • Blood drainage through bandage is expected, do not panic unless continuous bleeding occurs.
  • Do not change bandage under any circumstances, contact my rooms before any such thoughts cross your mind.
  • First follow-up in the office, X-rays taken if any incidents have occurred (falls, pain out of proportion, recurrence).
  • Wound inspection with dressing Sister.
  • Most of the time absorbable sutures are used and do not need to be removed and these will dissolve with time.
  • Dressing changed .
  • Bunion sleeve/strapping supplied for the next 4-6 weeks.
  • Wound therapy commences with micropore and Bactroban dressings for the next 4-6 weeks.
  • Second followup at 6 weeks.
  • Bunion dressing/Strapping if needed on a weekly basis
  • Continued use of flat post operative shoe.
  • Physiotherapy commences as this is helpful in decreasing the swelling of the foot and improving range of motion for the next 1-2 months.
  • Expect swelling in the foot for about 6 to 9 months.
  • Third followup in rooms at 12 weeks with weight-bearing control x-ray.
  • Light nonimpact exercise may commence to pain and swelling.
  • Sneakers with a straight medial border and supportive sole.
  • Discontinuation of hallux strapping.
  • Continued range of motion exercises.
  • Six-month followup in consultation with weight-bearing control x-ray.
  • Pictures taken for comparison to preoperative state.
  • Functional outcome score taken.
  • 1 year followup in consultation rooms with weight-bearing control x-ray.
  • Pictures and video taken for comparison to preoperative state.
  • Functional outcome score taken.
  • Patient is most likely discharged at this stage.