Rehabilitation Exercises After Minimally Invasive Hallux Valgus Surgery
What are the rehabilitation exercises after minimally invasive hallux valgus surgery? Here are all the recommendations from the surgeon.
Dr. Julien Lopez specializes in minimally invasive foot and ankle surgery in Nice and Cannes. As an expert in minimally invasive hallux valgus surgery, Dr. Lopez aims to improve his patients' comfort by tailoring his surgical technique to each individual case of hallux valgus. Minimally invasive hallux valgus surgery, also known as "mini-invasive" surgery, aims to realign the big toe, remove the bunion, and relieve pain during activities like wearing shoes or experiencing bursitis flare-ups. Although this technique is less traumatic than traditional surgery, it still requires a postoperative recovery period and rehabilitation to optimize long-term results.
Postoperative rehabilitation for hallux valgus following minimally invasive surgery is essential for restoring joint mobility, muscle strength, and improving foot functionality. This rehabilitation involves targeted exercises for active and passive mobilization in plantar flexion and dorsiflexion. These exercises can be performed at home, with a physical therapist, or both. Another crucial aspect of rehabilitation is walking, which helps restore a natural and functional foot posture, preventing postoperative complications such as joint stiffness, phlebitis, or muscle imbalances. It is essential to follow the surgeon's instructions and regularly practice the prescribed rehabilitation exercises to facilitate a quick return to daily activities.
Here's everything you need to know about minimally invasive hallux valgus surgery and its rehabilitation.
What Is Minimally Invasive Surgery?
Minimally invasive surgery refers to surgical techniques that involve making small puncture incisions through the skin to minimize tissue trauma. The procedure is performed using small instruments such as a shannon reamer or beaver blade.
The primary goal of minimally invasive surgery is to leave little to no visible scarring and allow the patient to recover more quickly while minimizing pain.
The surgical procedure for this condition is typically performed on an outpatient basis, allowing the patient to return home on the same day. In rare cases or depending on the patient's health status and logistical constraints, the procedure may require a one- to two-night hospital stay. The foot is operated on under local regional anesthesia, meaning only the operated foot is anesthetized. General anesthesia is also an option, and the choice of anesthesia is determined during the mandatory pre-anesthesia consultation after discussion with the patient.
Patients undergoing minimally invasive hallux valgus surgery experience significantly less postoperative pain. Compared to traditional surgery, the percutaneous technique offers several advantages:
- Scars are much less visible, if not nearly absent, thanks to the micro-incisions.
- There is no need to insert pins, screws, or other metal devices to hold the toe in place.
- Pain is reduced because soft tissues are less traumatized during the operation.
- Infections are less frequent.
- Operating time is shorter.
This list is not exhaustive.
What Are the Exercises to Perform After Minimally Invasive Hallux Valgus Surgery?
Here are Dr. Lopez's recommendations for exercises to perform after minimally invasive hallux valgus surgery. These exercises are necessary for the foot to recover from the surgery. The patient is advised to follow certain measures and engage in rehabilitation exercises. These recommendations can be divided into four categories: immediately after returning home, after the first postoperative appointment, after 45 days, and after the second month.
Here are all the stages of the exercises to implement:
1. Exercises to be performed immediately upon returning home: passive and active mobilization of the big toe and icing
Upon returning home, the patient has the option to perform postoperative self-rehabilitation exercises. Here is a passive mobilization exercise:
- Place your foot on your knee so that your metatarsal area is stabilized in the operative area.
- Use your first hand to stabilize the operative area while the second hand mobilizes the big toe.
- Begin by performing dorsiflexion, positioning the toe upward, then hold this position for five seconds before releasing.
- Repeat this movement ten times, then switch to maximum plantar flexion, positioning the toe downward.
- Maintain this position for five seconds before releasing. These movements should be repeated ten times and performed 2-3 times a day, if possible.
Here is an active mobilization exercise:
It is advisable to actively move the toes (contract them yourself), even when the dressing is still in place to protect the operated area. These small flexion and extension movements are beneficial for long-term recovery and pose no risk to the scar.
Remember to regularly ice the foot.
2. Rehabilitation after minimally invasive hallux valgus surgery starting from the 4th week (after dressing removal): beginning of physical therapy
The patient should continue with rehabilitation exercises after the percutaneous hallux valgus surgery after the dressing is removed, allowing for increased foot movement. It is essential to work on plantar and dorsiflexion by maintaining positions at the extremes to improve mobility and muscle strength. The patient will also enhance active mobilization through flexion and extension movements, with a focus on flexion. This is crucial for a quick recovery of flexion and, most importantly, the strength of the big toe's flexor tendon. It is recommended to increase the intensity of exercises by concentrating on toe flexion.
Three weeks after minimally invasive hallux valgus surgery, rehabilitation should continue with a physical therapist. The patient can also start wearing shoes, ideally comfortable and appropriate sneakers.
The practitioner can introduce more intense and complex exercises:
- To work on toe plantar flexion, you can place a sheet of paper under your foot and lift and lower it repeatedly. Repeat this exercise ten times.
- Regarding walking, it is essential to consciously make an effort to keep the foot flat at each step and ensure that the big toe remains in contact with the ground throughout the movement. This is particularly important for walking recovery after foot surgery, as you should avoid placing weight on the lateral edge of the foot, which is a natural reflex after toe surgery to protect the operated area.
Starting from the 4th week after the surgery, it is possible to resume gentle sports activities such as swimming, gentle cycling (avoid standing positions), yoga, elliptical training, stretching, or others, just ask your surgeon.
3. Rehabilitation after percutaneous hallux valgus surgery after 45 days
You can intensify sports activities gradually and you can rise onto one or two tiptoes without risks.
Of course, the key word is pain. Any suspected or unusual pain should temporarily halt the respective sports activity. However, feeling discomfort or slight pain is a good sign. It indicates the stresses you are placing on the operated area, and these stresses stimulate bone consolidation.
4. Rehabilitation after percutaneous hallux valgus surgery after the 2nd month
You can resume all sports activities without limitations. If the foot is sufficiently de-swollen, you can also wear heels up to 10 cm.