Dr Julien Lopez : a specialist who operates the bunionette on the foot
Do you want to know which specialist or surgeon operates a bunionette on the foot? Dr Julien Lopez, exclusive foot surgeon, explains everything about the treatment of the bunionette of the foot and for the operation of the quintus varus.
What is the bunionette ?
It is colloquially nicknamed the bunionette, the hallux valgus of the little toe, the digitus quintus varus or the quintus varus supraductus. The medical name for this condition is the "Quintus Varus" which means a deformation of the little toe : the 5th toe turns towards the inside of the foot while the 5th metatarsal deviates outwardly of the foot.
When medical treatment is unsuccessful, tailor's bunion surgery for the little toe is a simple and effective solution with few complications. A consultation with your digitus tailor's bunionsurgeon will allow you to make the diagnosis, to offer medical treatment or even surgical treatment if necessary.
Where does it come from and what are the aggravating factors?
The Quintus varus is a deformity of the fifth toe, congenital and often worsen with age.
Pathophysiologically, the varus quintus is a pathology similar to the hallux valgus : it is the 5th toe that Hallux valgus is the first ray of the foot. We speak of Quintus Varus " supraductus " when the 5th toe overlaps the 4th toe and " infraductus " when it goes below (as announced himself the term used).
The quintus varus deformity is based on bony deviations. The 5th metatarsal deviates outwards while at the same time the joint of the little toe is inclined inwards : this is the formation of the ball. This deformation is maintained by the retraction of the soft parts of the 5th toe such as the extensor or flexor tendons or the joint capsule. This is the reason why medical treatment is difficult.
Certain factors promote this deformation, such as walking on the outer edge of the foot or wearing narrow, stiff shoes or high heels, for example. However, it seems that these factors are not enough on their own, and it is the association with the abnormal bone shape that generates functional impairment.
Other factors favoring the bunionette:
- Flat or hollow foot shape
- Certain chronic inflammatory diseases (inflammatory arthritis)
- History of trauma
- Congenital pathology
- Certain sports such as skiing or dancing
What are the symptoms of bunionette?
The consultation is most often motivated by pain, discomfort when putting on or a painful deformation of the outer edge of the foot. This deformation changes the support of the 5th toe which can cause pain or a conflict with the shoes, especially if they are narrow. Putting on the shoes is sometimes difficult or even impossible. In response to this abnormal friction, the body develops a serious defense bursa called “bursitis” (which is a fluid-filled pocket that separates bones, tendons, and muscles). This bursitis, protective at the start, can become inflammatory and very painful preventing any footwear: we speak of “acute bursitis”. It is easily recognizable in the form of an effusion and a red skin swelling.
The pain felt during a bunionette of the foot is part of the large diagnostic field of metatarsalgia, that is to say pain in the forefoot. In addition to pain, bunionette can cause the following symptoms:
- Difficulty with the footwear imposing to adapt and favor more flexible and loose shoes
- Pain when skiing (amateur or professional)
- Corns on the foot, hyperkeratosis, horn or calluses on areas of friction
- 5th toe that rises in the air (supraductus) or down (infraductus)
- Bursitis and redness
- Partridge's eyes
- Associated signs like toe claws or hallux valgus
- Complications : infections or wounds
Once the diagnosis is made, it is essential to carry out a standard radiographic assessment in charge. It will allow your surgeon to confirm the diagnosis and assess the overall shape of the forefoot in order to suggest the most suitable surgical solution.
Si on If we let it evolve without treatment, the bunionette will tend to worsen over time causing pain and making it more and more difficult to put on the boot. The mechanism of this aggravation is comparable to hallux valgus. The toe being deviated, the tendons retract which increases the deformation and so on. In rare cases, these deformities can become seriously complicated as in diabetic patients in whom the risk is an ulceration (wound) with a risk of major and dramatic infection. In fact, in these cases, the skin opening sits at the top of the deformation facing the bursitis and the joint : arthritis (joint infection) or even osteitis (infection of the bone) may appear.
List of the main symptoms and possible complications of Quintus Varus:
- Pain and discomfort
- Difficulty putting on
- Inflammation of the bursa (acute bursitis)
- Aggravation of the deformity (quintus varus supraductus or infraductus)
- Eye partridge or ulceration of the 4th and / or 5th toe
- Skin complications : open wound
- Infectious complications : joint or bone infection
- Osteoarthritis, Subluxation, Dislocation...
To limit the risk of these complications appearing, it is essential to treat as soon as the first symptoms appear and to consult a digitus quintus varus surgeon.
What is involved in tailor's bunion (Quintus varus) treatment?
Before treating, it is essential to make the diagnosis. The bunionette is easily identifiable as it reached the 5th toe unlike bunions or hammer toes touching the toes.
Once the diagnosis is made, non-surgical treatment should always be offered. The different measures of the bunionette and its treatment are
- the first measure of treatment is to modify and adapt the shoes to remove the mechanical conflict. In the case of a professional skier, it is possible, for example, to change to wider boots or to heat the liner adapting the boot to the foot.
- Pharmacy toe orthosis : these are standard orthopedic devices such as the digitube or a toe separator
- Custom-made toe orthosis : these are custom-made orthotics (orthoplasties). They are made of silicone and molded onto your foot.
- Foot soles : they are also made to measure by the podiatrist
- Medicines : painkillers or anti-inflammatory drugs by local route (cream and ointment) or by general route (per os)
- Pedicure care : they are intended to remove corns and horn to reduce mechanical conflict and irritation.
In the particular case of acute bursitis, it is advisable to walk barefoot or in slippers for a few days.
If these measures are ineffective and functional discomfort persists, surgical treatment may be considered. In this case, it is necessary to consult a professional to discuss an operation for hallux valgus of the little toe or bunionette.
How to prevent quintus varus?
As we have seen previously, the quintus should be treated as early as possible. If you think that you have a bunionette that begins, that is to say a deformation without pain or conflict in the footwear, it is possible to prevent the aggravation by simple preventive measures :
- Avoid overweight
- Favor flat shoes and avoid wearing high heels
- Prefer shoes with a wide forefoot that does not tighten the toes
- Have a pair of made-to-measure soles made (to be changed every year)
The quintus varus and its operation? How is the claw toe operation performed?
You will find all the information to know everything about the bunionette, the operation and its prices.
To know exactly the nature of the treatment to be performed for the bunionette of the foot and for the operation , the surgeon will first have to specify certain elements in consultation. The choice of technique and the assessment of the actions to be performed is left to the surgeon depending on the severity of the damage and the complexity of the intervention. The approaches of a few millimeters to a few centimeters depend on the technique used.
Percutaneous (micro-incisions) and minimally invasive surgery largely find its place in the surgical treatment of the bunionette. The surgical procedures performed are the same as in conventional surgery except for the incisions made which are smaller. These modern surgical techniques reduce postoperative pain and allow faster rehabilitation in everyday life.
The main goal of tailor's bunion surgery is to have a painless and shoe-able foot. The presence of corns (plantar hyperkeratosis) disappears in a few weeks with the removal of the hypo-support and the mechanical conflict. This disappearance testifies to the effectiveness of the intervention.
HospitalizationThe operation usually takes place on an outpatient basis (hospital stay for one day) . However, for various reasons, it is possible to plan a few days of hospitalization depending on your social situation and your associated illnesses.
AnesthesiaYou will have to carry out the obligatory pre-anesthetic consultation with the anesthesiologist. During this consultation, the anesthesiologist will explain the possible modes of anesthesia to you according to your associated pathologies and the planned operative procedure. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others.
Several types of anesthesia are possible: you may benefit from local or regional anesthesia meaning that only your leg will be desensitized : this is the most common. General anesthesia is also a solution if you prefer to sleep.
The intervention- Before the operation of a quintus varus : you will be placed on a bed and then taken to the pre-anesthesia room. Local anesthesia will be performed before entering the operating room.
- Installation in the operating room : you will be installed in the supine position (on your back)
- The tourniquet : Throughout the operation, a tourniquet is usually placed at the ankle to prevent bleeding.
- The incision : the incision measures a few millimeters with the percutaneous technique (minimally invasive or micro-invasive surgery). The surgeon works with the help of specific instruments through the skin and with a preoperative x-ray machine. The surgeon performs a section of the retracted structures then the osteotomies. The technique called " open " requires an incision of a few centimeters, this technique is useful in severe deformities : the scar is made on the top of the toe or on the side.
- The surgery : The goal of surgery is to refocus the 5th toe and relax the retracted parts. The correction is possible by translating the metatarsal head and possibly by performing a fracture on the 1 st phalanx to optimize the correction. This translation makes the bump disappear. Tenotomies (tendon lengthening) or joint releases (MP5 arthrolysis) are often performed. At the end of the operation, a temporary pin can be positioned in the axis of the toe. This does not prevent walking and will be removed during the postoperative consultation (D21).
- Operative time : the duration of the surgical procedure is relatively short, generally 30 minutes. The intervention may be longer in the event of associated procedures or operating difficulties.
- The material : in most cases, the osteotomies performed are not fixed and do not require any fixing material. In other cases, fractures require fixation with screws, pins or wires.
- At the end of the operation : the surgeon uses a dressing that must be kept for 21 days.
It is important to note that the surgeon may face an unforeseen or unusual situation requiring different acts than those initially planned. In this case, the surgeon will explain the difficulties encountered and the actions taken as soon as you wake up or return to your room.
What are the postoperative consequences?
As soon as you leave the operating room, walking is authorized in most cases on condition that you wear the special shoe that has been prescribed for you in consultation. This shoe is worn for a minimum of 15 days. After this time, you can put on regular shoes if the pain permits. You must strive to walk with your whole foot and not just with the inner edge. Crutches can be useful for the first few days to make walking easier..
By the end of surgery, the surgeon uses a bandage on the 5th toe. This dressing is an integral part of the surgical treatment and must be kept until the next consultation appointment. It can only be removed or changed by the surgeon even if it is stained with blood. If you are worried, contact the secretary to have the dressing checked as soon as possible. We will redo the dressing to make sure there is no problem. The first dressing will be repaired by us during your postoperative appointment 21 days after the operation.
Swelling is not a complication and it is a frequent phenomenon after such an operation. To speed up its absorption, it is recommended to regularly ice the foot and put the foot up as soon as you feel the swelling. It takes about 2 months for the swelling to deflate 80% and 6 to 9 months for the foot to deflate completely.
Unless your surgeon advises otherwise, no dressing is necessary.
Depending on your history, your existing medical conditions and your mobility, the anesthesiologist may prescribe anticoagulant treatment by injection (subcutaneously) or systemically (per os). This treatment makes it possible to prevent the appearance of a phlebitis, that is to say the formation of a clot in the veins.
It is strongly recommended to take the painkillers prescribed systematically during the 2 days following the surgery.
Physiotherapy is not systematic, its usefulness will be evaluated by the surgeon during your first postoperative consultation. In order to accelerate the functional recovery and the melting of the swelling, self-rehabilitation is essential. If necessary, physiotherapy sessions will be prescribed to you during your first postoperative appointment.
Driving is prohibited for 3 weeks (unless you have had surgery on your left foot and you have an automatic car). The average time off work is 30 to 60 days depending on your professional activity.
The resumption of swimming and cycling is permitted from the 1st month and the resumption of other activities from the 2nd postoperative month.
Two appointments are necessary postoperative : 21st day and then 60 days after the operation.
For any additional questions or in the event of a problem, you can contact his secretary.
The quintus varus orthoplasty operation the tailor's bunion
Orthoplasty operation will allow you to realign the 5th radius in order to remove the bump and the conflict with the shoe. This realignment is possible thanks to the small bone fractures (osteotomy) and to the release of the soft parts. The intervention is performed on an outpatient basis and support is authorized immediately.
ComplicationsThe following list of complications is not exhaustive, but the most frequent complications are mentioned.
For the bunionette, surgery exposes you to complications that are both common and specific to the type of intervention performed. This risk varies from one individual to another depending on their age, comorbidities (hypertension, diabetes, poor skin condition, etc.) as well as depending on their lifestyle (tobacco, alcohol, practice of an activity. athletic).
Some complications can be prevented by simple measures such as:
- Compliance with postoperative instructions
- Quitting smoking
Common Complications
- Hematoma is an infrequent complication, favored by certain drug treatments (anticoagulants). Some high-risk drugs can be stopped and relayed by the anesthesiologist. The hematoma rarely requires surgical revision, it usually resolves with ice and rest.
- The healing problems are exceptional thanks to the use of a combined minimally invasive and percutaneous technique. Their occurrence is increased by tobacco and poor skin condition.
- Swelling not a complication but a reaction of the body to the aggression that surgery represents. In order to reduce its importance, it is useful to carry out self-rehabilitation by moving the toes, to limit movements for 15 days and to elevate the foot as much as possible when you are lying down.
- The thrombophlebitis is the formation of a clot in a vein, usually in the leg or foot. Its prevention involves the administration of an anticoagulant treatment for 10 days.
- Algodystrophy or " complex regional pain syndrome " is an overreaction of the body to the aggression of surgery. The symptoms are: redness, stiffness, edema and pain. The evolution is always towards healing without sequelae but the evolution is long (up to 18 months). Certain simple measures minimize this risk: - do not let the pain set in, systematically take the painkillers prescribed by your surgeon during the 48 hours after surgery - take preoperative treatment (vitamin C) - in the event of a history of algodystrophy, a medicine will be prescribed to you before the operation (lyrica).
- Infection can occur despite precautions (preoperative shower, surgical aseptic preparation). It should be evoked in the event of fever, scar breakdown, purulent discharge or significant redness. It requires surgical advice.
Specific complications
Hypercorrection is an excess of correction: the 5th toe deviates towards the outside of the foot. This complication requires surgical revision.
- Insufficient correction is the persistence of a deviation after the intervention.
- Pseudarthrosis is the absence of consolidation of the fractures. This complication is rare. It requires revision surgery if it is painful and disabling.
- Bone necrosis is the death of bone by damage to its vascularization.
- Deformity recurrence is the recurrence of the deformity after bunion surgery for the little toe.
- Osteoarthritis is the wear and tear of the cartilage of the metatarsophalangeal joint.
- Neighboring complications : given the proximity of the operating area to the bone, tendon, vascular or nervous elements, there may be direct or indirect consequences on these nearby elements (hemorrhage, hematoma, paresis, paralysis, insensitivity, deficit mobility, joint stiffness, etc.). Given the location of the scar, damage to a small nerve can cause insensitivity or even persistent pain. In some cases, it may be necessary to intervene again, to drain a hematoma, decompress a nerve, free tendons...
- Secondary displacement is the displacement of fractures or screws during the period of bone healing. Protecting the support with the postoperative shoe reduces this risk. It most often occurs as a result of trauma or a sudden landing on the operated foot.
FAQ
Am I allowed to drive after surgery for a bunionette?
No surgical contraindication stands in the way of driving. If you are allowed to walk, you can press a pedal safely. You have the right to drive a motor vehicle as soon as you feel able to do so. In the event of a serious accident with bodily injury, you could have a lack of insurance because you will not be considered in possession of all your physical capacities. Remember to check with your insurance that you are covered after such an operation.
Bunionette who to consult?
In the presence of a painful distortion of the 5th toe, you can consult the podiatrist, your doctor or a specialist surgeon. Whichever specialist you consult, medical and non-surgical treatment is always indicated as the first line. In case of failure, you can consult Dr. Lopez, digitus quintus varus surgeon, who will offer you a bunionette operation in Nice or a bunionette operation in Monaco.
For patients who live in the Isle of Beauty, it is sometimes difficult to have an appointment with a surgeon specializing in quintus varus of the little toe in Corsica. If you cannot get an appointment, Dr Lopez can see you in Nice.
How to treat toe claws?
The orthoplasty operation are 2 possible solutions. Before treating, it is essential to make the diagnosis. The bunionette is easily identifiable as it reached the 5th toe unlike bunions or hammer toes touching the toes.
Once the diagnosis is made, non-surgical treatment should always be offered. The different measures of the bunionette and its treatment are
- the first measure of treatment is to modify and adapt the shoes to remove the mechanical conflict. In the case of a professional skier, it is possible, for example, to change to wider boots or to thermoform the liner hot to adapt the boot to the foot.
- Pharmacy toe orthosis : these are standard orthopedic devices such as the digitube or a toe separator.
- Custom-made toe orthosis : these are custom-made orthotics (orthoplasties). They are made of silicone and molded onto your foot.
- Foot soles : they are also made to measure by the podiatrist.
- Medicines : painkillers or anti-inflammatory drugs by local route (cream and ointment) or by general route (per os).
- Pedicure care : they are intended to remove corns and horn to reduce mechanical conflict and irritation.
In the particular case of acute bursitis, it is advisable to walk barefoot or in slippers for a few days.
If these measures are ineffective and functional discomfort persists, surgical treatment may be considered.
Bunionette operation?
The choice of technique and the assessment of the actions to be performed is left to the surgeon depending on the severity of the damage and the complexity of the intervention. The approaches of a few millimeters to a few centimeters depend on the technique used. the objective of the surgery is to refocus the 5th toe and relax the retracted parts. The correction is possible by translating the metatarsal head and possibly by performing a fracture on the 1stt phalanx to optimize the correction. This translation makes the bump disappear. Tenotomies (tendon lengthening) or joint releases (MP5 arthrolysis) are often performed. At the end of the operation, a temporary pin can be positioned in the axis of the toe. This does not prevent walking and will be removed during the postoperative consultation (D21).
How long does the operation of a quintus varus take?
The duration of the surgical procedure is relatively short, generally 30 minutes. The intervention may be longer in the event of associated procedures or operating difficulties.
What is the anesthesia during the operation of a bunionette?
You will have to carry out the obligatory pre-anesthetic consultation with the anesthesiologist. During this consultation, the anesthesiologist will explain the possible modes of anesthesia to you according to your associated pathologies and the planned operative procedure. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others. Several types of anesthesia are possible : you may benefit from local or regional anesthesia meaning that only your leg will be desensitized : this is the most common. General anesthesia is also a solution if you prefer to sleep.
What is the period of immobility after an operation for a quintus varus?
No immobility is necessary : you have the right to walk immediately after the intervention with the protective shoe. In some surgeries the shoe is not mandatory, it should be discussed with your surgeon before the operation. The sick leave varies a lot with your professional activity and the intervention carried out : it is 2 to 8 weeks on average.
What is a bunionette?
The Quintus varus is a deformity of the fifth toe, congenital and often worsen with age.
Pathophysiologically, the varus quintus is a pathology similar to the hallux valgus : it is the 5th toe that Hallux valgus is the first ray of the foot. We speak of Quintus Varus " supraductus " when the 5th toe overlaps the 4th toe and " infraductus " when it goes below (as announced himself the term used).
The quintus varus deformity is based on bony deviations. The 5th metatarsal deviates outwards while at the same time the joint of the little toe is inclined inwards : this is the formation of the ball. This deformation is maintained by the retraction of the soft parts of the 5th toe such as the extensor or flexor tendons or the joint capsule. This is the reason why medical treatment is difficult.
Can we operate on both feet at the same time ?
No, it is not possible to operate both feet at the same time. However, it is possible to operate several toe claws on a single one during the same operation. On the other hand, it is possible to operate on 2 feet at intervals of 15 days or more.
How much does a toe claw surgery cost?
The operation of the quintus varus and its prices vary according to the clinical state of the patient and the procedures to be performed. Social security covers the costs of the operation. The reimbursement of additional fees depends on your insurance contract. The average remaining charge after reimbursement by your insurance company is € 300.
If you would like to learn more about forefoot anomalies, click here for all the information you need.
