This very common deformity corresponds to the deviation of the big toe. Some people develop it from an early age, probably due to family causes. More often than not, it is due to the weakening of the joint capsule, which can no longer combat the stresses on the big toe. These stresses are permanent when walking and are accentuated by wearing heels and especially shoes with pointed toes.
The forefoot gradually widens, and the big toe pushes the lateral toes back. A painful exostosis develops and rubs against the vamp of the shoe. This is not a simple bump, but a genuine bone deformity that is irreversible and will get progressively worse. When the pain is disabling, the only effective treatment for straightening the big toe is surgery.
The operation consists of correcting the bony deviation by cutting the bone on the first metatarsal to straighten the big toe.
The correction is maintained by two screws embedded in the bone, which are usually left in place permanently. Certain tendons that pull the big toe and risk perpetuating the deformity are disinserted. Often, a bone procedure on the big toe is associated (the big toe is often shortened by a millimetre, which does not change the size).
The procedure most often performed is called a SCARF osteotomy, and its long-term experience and results make it a highly reliable procedure. At present, it is possible to make a percutaneous correction by performing a CHEVRON osteotomy. This correction is also maintained by two buried screws. This technique, which avoids the need for a scar, will be proposed depending on the clinical and radiological assessment.
The operation will be carried out as an outpatient or with an overnight stay in hospital postoperatively, under local anaesthetic (the leg is numbed).
You can get up the next day (or the same day if you are an outpatient) wearing an orthopaedic shoe that allows you to press on the heel (known as a Barouk shoe). The shoe is worn for one month. The foot should be kept elevated to prevent swelling for the first 15 days. The foot may remain swollen for two to three months.
Driving is permitted for six weeks. The length of time off work will depend on the profession. Two months off work is regularly allowed. Self-education and toe movement are essential.
The operation is reliable and regularly gives good results. Complications are rare. The risk of infection is very limited, and a further operation is exceptional. The deformity may reappear (recurrence), but rarely justifies a repeat operation. Currently, 5% of patients undergo a repeat operation within ten years.
Algoneurodystrophy may also occur, corresponding to prolonged painful swelling of the foot, which systematically regresses. Excessive correction can lead to a deformity in the opposite direction or Hallux varus (particularly with older surgical techniques).
This is the most common traumatic injury. It affects one person in 10,000 every day and accounts for up to 50% of footballer accidents. Nine times out of ten, it involves the lateral collateral ligament of the ankle.
Twisting the ankle is the most common cause of a sprain, with the foot moving inwards. The initial pain is acute. You may hear a cracking sound. However, in the heat of the moment, the patient is often able to continue playing sports. The pain recurs regularly a few hours later and intensifies.
The ankle swells and sometimes there is a "pigeon's egg", which is in fact a pocket of blood on the lateral edge of the ankle. The lesion varies. It may be a simple stretch, a partial tear or a complete tearing of the lateral ligament. Most often, it is the anterior bundle of the ligament that is injured.
Initial treatment involves "icing" the ankle to limit swelling and therefore pain. It is advisable to elevate the ankle and limit weight-bearing and movement. Painkillers, anti-inflammatories and walking sticks are useful in the initial phase.
As soon as weight-bearing is resumed, a flexible brace should be fitted, generally for four to six weeks (the time it takes for the ligaments to heal). These braces prevent the ankle from twisting and recreating the injury mechanism that caused the sprain, while allowing full weight-bearing and avoiding the need for anticoagulants.
Combating oedema and pain
With drainage massage and ultrasound
Recovery of joint amplitude
Proprioceptive re-education
Patients learn to lock their ankles by stabilising themselves on unstable trays or balls. These exercises are essential to prevent recurrence of the sprain and the development of an unstable ankle.
These are recurrent sprains: the patient sprains the ankle easily, with several episodes of trauma per year. Sport is frequently interrupted and it is the persistence of ankle pain that leads to the diagnosis. This is confirmed by dynamic x-rays, which require the ankle to be twisted to confirm excessive yawning of the joint between the tibia and talus. An MRI scan and (sometimes) an arthroscanner are required to assess ligament damage and analyse the surface of the cartilage.
If the instability does not improve sufficiently with well-administered proprioceptive physiotherapy, a lateral ligament plane needs to be reconstructed: this is called ligamentoplasty.
In most cases, this involves re-tensioning the lateral ligament plane that has healed in a distended manner. Depending on the quality of the tendon remnant, reinforcement is sometimes combined with part of a ligament in front of the ankle (frondiform) or with the tissue lining the fabula (periosteum).
In practice, the patient stays in hospital for 24 hours. The patient is discharged the day after the operation. The patient is immobilised by a boot for 21 days without support. Support is then allowed and rehabilitation begins. Immobilisation is limited to wearing a removable orthosis for a further three weeks. After the six weeks of immobilisation, around twenty rehabilitation sessions are required. The patient is off work for one month for a sedentary person and two months for a hard worker. Sports can be resumed from the fourth postoperative month.
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