Complications of Hallux Valgus Surgery

Abstract

Hallux valgus deformity is one of the most common pathologies seen by a foot and ankle surgeon, with an estimated incidence of 23% in adults aged 18–65 years and 35.7% in patients over 65 years [1]. With such a high prevalence of hallux valgus deformity, surgical correction is commonplace for foot and ankle surgeons. With a large volume of procedures being performed, minor and major complications can arise. The complication rate throughout the literature has a wide range extending from 1% to 55% following hallux valgus surgery in general [2–4]. There are a multitude of factors that contribute including physician experience, procedural selection, and patient selection. Meticulous attention to detail in the preoperative, intraoperative, and postoperative setting can reduce the incidence of complications. Prevention of complications begins with a thorough history and physical examination and detailed radiographic evaluation. It is imperative that the surgeon assesses concomitant deformities such as pes planovalgus deformity, hypermobility of the first ray, metatarsus adductus, equinus, second metatarsal pathology with instability, and evidence of other biomechanical factors such as plantar callosities, as the presence of any of these plays a role in procedure selection and is directly attributed to postoperative success. Intraoperative assessment of positioning, careful attention to fixation techniques, and emphasizing postoperative compliance is essential. Defining a complication or operative failure is also important, because what appears corrected to the surgeon clinically and radiographically can still be deemed a failure if the patient is not satisfied. A discussion of the postoperative plan, expectations, and possible long-term complications is paramount in the preoperative setting. Knowing the patient’s, the procedure, and the surgeon’s limitations is vital in limiting complications.