Foot Surgery. Interview with Dr. Alfredo Orefice.

Bunions, known as hallux valgus, is one of the most common foot conditions, but it is not the only one. Dr. Alfredo Orefice, a surgeon specialized in orthopedics and traumatology at UPMC Salvator Mundi International Hospital, describes the symptoms of this and other conditions that can affect the forefoot and outlines the differences and advantages of minimally invasive surgery compared to traditional approaches.

Doctor, today we are talking about hallux valgus. Is this a common disorder?

Hallux valgus is an extremely common condition that affects up to 23% of the population to varying degrees. Women are certainly more affected than men because factors that favor and aggravate hallux valgus include wearing tight, pointed shoes with heels.

What problems can hallux valgus cause?

Certainly, a biomechanical issue, such as gait problems, and pain due to inflammation of the metatarsal bursa, in addition to aesthetic problems. This is one of the main reasons why women, especially younger ones, visit an orthopedic specialist for treatment.

Doctor, can you tell us what are the main forefoot diseases, related or unrelated to hallux valgus?

There are numerous forefoot conditions related to hallux valgus. The main ones are metatarsalgia (a condition in which the ball of the foot becomes painful), hammer toes, and claw toes. These can often be very painful conditions that must be treated with hallux valgus.
Then there are forefoot conditions less related to hallux valgus but that can coexist, such as Morton's neuroma, a painful condition that involves a thickening of the tissue around one of the nerves leading to the toes.

What is the plantar fasciitis?

Plantar fasciitis is a painful condition that involves an inflammation of a thick band of tissue that runs across the bottom of each foot, known as the plantar fascia. This can often generate a stabbing pain in the hindfoot, specifically in the heel, but also in the midfoot and forefoot.

What are the advantages of minimally invasive surgery compared to traditional approaches?

Minimally invasive surgery is an advanced surgical technique for correcting hallux valgus and associated conditions, especially metatarsal overloads and hammer toes.
It uses small scalpels and small burrs, and through mini-incisions with no evident cuts, corrective osteotomies can be performed to correct the forefoot deformity. This technique offers numerous advantages: it causes no aesthetic damage, and is much less aggressive on the soft tissues, often allowing for a much quicker recovery.

Are minimally invasive techniques always applicable?

In my experience, minimally invasive techniques can be used for younger, middle-aged, and even elderly patients. However, they cannot be applied universally to everyone in any condition. Determining factors when selecting the surgical technique include the severity and type of hallux valgus, and also the quality of the bone.

If you suffer from hallux valgus, don't miss our free open house: Dr. Orefice is waiting for you for a free orthopaedics consult.