Gustav White. /
Perpetual Help Hospital
Orthopedic Surgery and Traumatology
A study by HPS and the University of Las Palmas, however, establishes a minimal relationship between the radiological and clinical parameters of the patients
Hallux valgus, or what we popularly know as a bunion, is one of the most common deformities of the forefoot. It affects 20% of the population between 18 and 65 years of age, especially women, according to the Spanish Society of Medicine and Surgery of the Foot and Ankle.
Hallux valgus or bunions is the foot deformity that requires the greatest number of consultations. It consists of the deviation of the big toe outwards. It is a progressive deformity, in which the first metatarsal deviates inwards and its head protrudes internally, which causes the deformity known as a bunion.
When bunion pain interferes with a patient's daily activities, it's time to look at surgical options because it never goes away and usually gets worse over time. Bunion surgery improves radiological and clinical parameters, although there is no direct relationship between visual improvement and clinical results.
This is explained by a recent study by the Perpetuo Socorro Hospital (HPS) Orthopedic Surgery and Traumatology research team, led by Dr. Gerardo Garcés, in collaboration with the University of Las Palmas de Gran Canaria (ULPGC). The work has been published in the Journal of Clinical Medicine under the title «Pre- and Post-Operative Relationship between Radiological Measures and Clinical Outcomes in Women with Hallux Valgus».
The work methodology has consisted of the study, analysis and assessment of the case of 73 female patients, who underwent hallux valgus or bunion surgery. The patients were assessed by means of radiographs and objective and subjective clinical questionnaires prior to being operated on and six years after the operation.
The article published in the prestigious international journal confirms the improvement of the patients in the radiological and clinical parameters when comparing the preoperative and postoperative findings. This was observed in the angle of deviation of the hallux valgus -angle formed by the first metatarsal with the first phalanx of the big toe-, in the angle between the first and second metatarsals, and with the position of the sesamoid bones of the foot, small bones located under the head of the first metatarsal.
The objective evaluation carried out by the traumatologists and nurses who treated these patients improved significantly. For their part, the more than 70 women who participated in the study expressed their satisfaction with the improvement in their quality of life. Bunions are a common but painful deformity, and the more severe it is, the more likely the person will have pain in other parts of the body, leading to declines in overall health-related quality of life. Six years after the operation, the patients generally stated that they were satisfied with the result of the intervention due to the improvement in their quality of life, pain and functionality.
However, the most relevant conclusion of the study underlines that there is no significant relationship between the improvement of radiological and clinical parameters. In other words, the radiological changes are not directly related to the clinical changes. The researchers responsible for the report stress, therefore, the need to warn patients undergoing this intervention not to expect apparent visual improvement to automatically translate into clinical results.
The best treatment is preventive. Especially in the case of women, they must take into account that if one of her parents suffers from hallux valgus, the chances that she will also acquire this deformity are high. This can be detected even during adolescence and should be studied. Hence, the excessive use of heels or narrow-toed shoes should be avoided. Ideally, go to the doctor when you have the first signs of the problem.
As for surgical treatment, there is no technique that works for everything. When indicated, corrections must be made to align the finger. The surgery can be performed open or percutaneous, which many people mistakenly consider to be laser.
The HPS team has been operating percutaneously for more than 20 years on more than 200 patients each year with excellent results. Its main advantage over open surgery is the presence of minimal scarring and very little postoperative pain. Fixation with needles or plates is not required, it is enough to make specific bandages that are changed every two weeks. Although it is a technique that requires surgical experience to obtain optimal results, there are more and more international publications that support its use.
Multidisciplinary work team
The study has been carried out by a multidisciplinary team made up of excellent professionals from the Hospital Perpetuo Socorro and the University of Las Palmas de Gran Canaria, led by Dr. Gerardo Garcés. Two HPS nurses, Luci Motta and Ignacio Manchado, also doctoral students at the ULPGC, have participated in the work; two traumatologists from HPS, doctors Gustavo Blanco and Felipe García Flemate; Dr. Jesús González, biostatistician from the Research Unit of the Dr Negrín Hospital; and Dr. Gerardo Garcés himself, professor and professor of Traumatology at the ULPGC. The study is part of the teaching and research collaboration agreement between HPS and the ULPGC, which has been operating for years with great scientific productivity at an international level.