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All seven Medical Spheres ›With hallux valgus, the big toe drifts to the side and the bunion presses against the shoe. If shoes, insoles and exercises no longer help, an operation can correct the position – as it can for a stiff big toe and for hammer or claw toes.
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Typical figures from the medical societies; after a fusion in the midfoot, it takes longer. Your personal plan is discussed at the preliminary consultation.
The deformity
Hallux valgus, also known as a bunion, is one of the most common deformities of the foot. The big toe drifts towards the smaller toes, while the first metatarsal bone moves towards the inside of the foot. As a result, the big toe joint sticks out on the inner edge of the foot – the bunion, which presses and hurts in the shoe. Women are affected more often, and a hereditary tendency often plays a part; tight shoes with high heels and a splayfoot can make the deformity worse.
Over time, the whole forefoot can change: the neighbouring toes are crowded and bend into hammer or claw toes, and painful calluses develop under the heads of the metatarsal bones. If the cartilage in the big toe joint wears away, the toe becomes stiff. This condition, hallux rigidus, can also occur without the toe being crooked.
Treatment starts without surgery: shoes with soft uppers and enough room, insoles, padding, splints, tape and physiotherapy. These can ease pain but hardly straighten the toe again. If the symptoms persist after about three months, restrict walking, or hardly any shoe fits any more, surgery becomes an option. The deciding factor is the symptoms, not the appearance.
In the operation, the first metatarsal bone is usually cut through, shifted and fixed with screws or a plate – a realignment, or osteotomy, sometimes performed through very small incisions. Procedures on the tendons and joint capsule hold the toe in its new position. With a severe deformity, an unstable joint in the midfoot or osteoarthritis, a fusion can be the better choice. None of the common techniques is clearly superior to the others.
The treatment
If the bony bump at the bunion is removed and the toe is put in a straighter position, the shoe presses less. This can ease pain when walking.
Realigning the first metatarsal bone brings the big toe into a better axis. How much can be corrected depends on the severity.
Hammer or claw toes that have been crowded by the crooked big toe can be corrected in the same procedure.
The path
Surgery on the forefoot can almost always be planned. That leaves time to make use of the non-surgical options first and to prepare the procedure well.
The position and mobility of the toes, pressure points, shoes and insoles are checked; X-rays taken while standing show the extent. Please bring your health insurance card, a referral if you have one, a list of your medications and previous results.
The procedure depends on the severity and the condition of the joints. The anaesthetic consultation covers general anaesthesia or an anaesthetic that numbs only the leg.
The bone is realigned or a joint is fused and held with screws, a plate or wires. A nerve block in the leg can continue to relieve pain for a while afterwards.
Elevation and cooling ease the swelling. In the special shoe with its stiff sole, you can usually put weight on the foot, after some procedures only with crutches at first; if needed, anticoagulant medication prevents thrombosis.
Wound checks and X-rays show whether the wound and bone are healing as planned. You then gradually return to wide, comfortable shoes, and physiotherapy works on mobility and on rolling the foot when walking.
Statutory or private insurance
Statutory health insurance
If the operation is medically indicated because pain and limitations persist despite non-surgical treatment, German statutory health insurance covers the costs, for outpatient and inpatient surgery alike. The operation is then performed at the Bürgerspital Wertheim, a hospital with a public healthcare mandate from the state of Baden-Württemberg.
A correction purely for the sake of appearance is not covered by statutory health insurance.
Private insurance or self-pay
Private health insurers and Beihilfe (the German healthcare allowance for civil servants) cover a medically necessary operation under the terms of their policies. Patients with private insurance and self-pay patients can be operated on at the Bürgerspital or at the Main-Tauber-Klinik, a private clinic in the same building.
If you stay overnight, a room with optional extra services is available at the Bürgerspital, if one is free.
Specialists
Foot surgery is the focus of this specialist in the orthopaedics and trauma surgery team at the Bürgerspital.
Locations
Each clinic shows on its own website how the treatment works there.
Germany
The Bürgerspital is a hospital with a public healthcare mandate and has its own foot surgery specialism within orthopaedics; the Main-Tauber-Klinik works in the same building as a private clinic.
Frequently asked questions
With some procedures, yes. Whether you are operated on as an outpatient or stay for a few days depends on the procedure, any existing conditions and the help available at home. After outpatient surgery, please arrange for someone to collect you.
After realigning the metatarsal bone, usually four to six weeks, until the bone has healed firmly; as a rule, you can put weight on the foot in it. After a fusion in the midfoot, the foot often bears only part of your weight at first, and it takes eight to twelve weeks on average until it can carry your full weight again.
Swelling is normal and goes down gradually. In the first year, however, the foot still swells more easily after long periods of standing or walking. Elevation, cooling and lymphatic drainage help.
That depends on the procedure, on which foot was operated on and on your job, and is discussed at the follow-up appointments. You can only drive once you can brake safely and firmly – as a rule, not in the special shoe. Seated work is usually possible sooner than work on your feet. Sport involving running and jumping follows once the bone has healed firmly.
As with any operation, bruising, wound-healing problems, infection and thrombosis are possible. In the forefoot, the big toe joint can become stiffer, the bone can heal more slowly or the deformity can return; the toe can also tip over to the other side, or the pressure can shift to beneath the neighbouring toes. Numbness in the toe is also possible. The consent discussion goes through the risks one by one.
Osteoarthritis in the big toe joint: the cartilage wears away, extra bone grows at the edge of the joint, and the toe becomes stiff and hurts as the foot rolls forward. An insole with a stiff plate and a rocker sole on the shoe can take the strain off. If that is not enough, the bony outgrowths can be removed or the joint fused.
Padding, insoles and shoes with enough room over the toes relieve pressure but do not change the deformity. In an operation, tendons are lengthened or transferred; if the toe is stiff, a small piece of bone is removed at the joint or the joint is fused. A thin wire often holds the toe in position for a few weeks.
Consultation
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Reviews
CGCE GroupVerified
5,888 reviews on ProvenExpert
This was the best decision I have ever taken for myself. The whole experience has changed my life for the better. From the first consultation I felt welcomed and treated very well. I did not feel alone during the journey because the team were just a WhatsApp away and they made regular check-ups on me. Thank you for everyone at the hospital from the staff to the doctors, you are all amazing.
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Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch habe eine Unterlidstraffung machen lassen und bin mit dem Ergebnis sehr zufrieden. Mein Dank geht vor allem an Frau Dr. Simidjiiska für ihre Fürsorge, Kompetenz und Empathie. Aber auch das gesamte Team der Klinik macht einen hervorragenden Job!
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch bin rundum begeistert von meiner Erfahrung in dieser Haartransplantationsklinik. Von der ersten Kontaktaufnahme bis zur Nachsorge war alles hervorragend organisiert und professionell. Das gesamte Team war unglaublich freundlich, hilfsbereit und zuvorkommend. Man hat sich jederzeit gut aufgehoben und ernst genommen gefühlt. Besonders positiv fand ich, dass sich alle Mitarbeiter ausreichend Zeit genommen haben, um meine Fragen zu beantworten und jeden Schritt verständlich zu erklären. Auch der Service war erstklassig. Die Organisation, die Betreuung vor und nach dem Eingriff sowie die Kommunikation waren wirklich hervorragend. Das gesamte Team hat einen sehr kompetenten und gleichzeitig menschlichen Eindruck gemacht. Die Klinik selbst ist modern, sauber und sehr gut ausgestattet. Während der Behandlung wurde äußerst sorgfältig und professionell gearbeitet, und ich hatte zu jedem Zeitpunkt das Gefühl, in guten Händen zu sein. Ein großes Dankeschön an das gesamte Team für die tolle Betreuung und den freundlichen Umgang! Ich kann die Klinik absolut weiterempfehlen und bin mit meiner bisherigen Erfahrung sehr zufrieden. Wer Wert auf Professionalität, Qualität und einen hervorragenden Service legt, ist hier meiner Meinung nach bestens aufgehoben.
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanBisher war es nur ein Beratungsgespräch aber es war sehr gut.
Weight Doctors Group · Original in GermanIch fand, dass der Arzt gut und verständlich erklärt hat. Ich habe diese Woche noch einen Termin in einer anderen Klinik, da ich mich gründlich informieren möchte; auch der Preis wird dabei eine Rolle spielen – darüber bin ich ganz offen.
QUOLE Medisch Centrum · Original in GermanHervorragende Behandlung. Von der ersten Beratung bis zur Nachsorge hat mir Dr. Koch stets ein sehr gutes Gefühl vermittelt. Ich litt jahrelang unter einer echten Gynäkomastie, nach der OP kann sich das Ergebnis sehen lassen, mein Selbstbewusstsein ist endlich zurückgekehrt. Ich kann die Alster Klinik jedem empfehlen, der schon lange mit dem Gedanken spielt sich operieren zu lassen.
Alster-Klinik Hamburg · Original in GermanDr. Schubert gab mir das Gefühl, in genau der richtigen Praxis zu sein für mein Anliegen. Ich habe mich beim Beratungsgespräch sehr wohl gefühlt und verstanden gefühlt.
Alster-Klinik Hamburg · Original in GermanÜber die ehrliche Einschätzung
Alster-Klinik Hamburg · Original in GermanIch habe mich sehr wohl geführt, das Gespräch war sehr gut, die Ärztin hat mir sehr ausführlich alles erklärt und bin mit einem sehr guten Gefühl nach Hause gegangen.
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch bin eine sehr ängstliche Person. Bei Herrn Dr. Neis habe ich mich sofort wohlgefühlt. Behandlungsgespräche, Umgang, Freundlichkeit – es passt alles. Ich kann ihn ohne Bedenken und Einschränkung nur weiter empfehlen. Dankeschön Herr Dr. Neis für die tolle Arbeit.
CGCE Group · Original in GermanDr. Klarner ist sehr nett, hat mich sehr gut beraten und aufgeklärt. Ich hab mich gut aufgehoben gefühlt, vielen Dank!
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