First Principle
The post operative period
Our first principle is to make a surgery follo- wed by painless postoperative period and early functional recovery (Fig. 45a1-2): Thanks to the improvement of the surgical technique, we can be less invasive by the respect of soft tissue, by strong fixation of the osteotomies, and generally by accurate surgery respecting the forefoot architecture. Furthermore, a local, long-lasting anesthesia injection is made (ex.: naropeine).
Postoperative period is also carefully mana- ged with the foot elevated at least for two days following the surgery. The physiotherapy and the self-training are critical and need discipline from the patient which has to be strongly concerned in the successful achievement of this foot surgery.
Second Principle
Where to focus the surgery (law of the most impaired ray)
The second principle is to focus the surgery on the most affected ray, and to harmonize the foot (and the contra-lateral foot) from or around the correction of this focused ray (Fig. 45b1).
This is particularly useful when shortening of this ray (mainly metatarsal) is necessary.
Since we now have very reliable and harmless procedures to shorten the metatarsals, we must not be afraid to shorten as far as required. The pictures illustrate some examples of this mana- gement. As a rule now, the metatarsal shortening has to be up to the proximal bases of the first phalanx, on the first ray in severe hallux valgus, on the lesser rays in MTP dislocation or trans- versal inclination of the toes.
