The essential criterion is the level of pain that the patient complains of. For a similar deformity, the feeling of pain can be completely different from one person to another. When walking and shoeing become painful, it is essential to put the option of surgery on the table.
A hallux valgus cannot resolve itself, it will necessarily deteriorate more or less quickly and progressively evolve towards a self-deformation.
The earlier the surgery is performed, the more likely it is to permanently prevent recurrence and the less invasive it will be.
Indeed, the new techniques of intervention can be used, they are much less cumbersome and have postoperative consequences in general limited.

This technique appeared a few years ago and is increasingly used for hallux valgus. When properly performed, it offers many advantages. It consists of operating through the skin, making mini incisions just sufficient to pass miniaturized instruments.
It is not possible for the surgeon to see directly what he is doing. His touch and his experience will be essential. Nevertheless, he has a complementary technique that allows him to have a vision of the operation: the fluoroscopic image intensifier.
It consists of using a very low-powered x-ray machine that allows visualization of a key element in the treatment of hallux valgus: the bones. The device is of course qualified and sterilized, and its radiation level is low enough for surgeons to use it very regularly without risk. Note that this technique is only an aid and an extension of the surgeon's feeling. Nothing can replace his know-how and experience.

The advantages of this technique are obvious: the incisions are very small, pain is reduced and recovery is faster. It allows to avoid hospitalization.

The techniques used in the past have tarnished the image of this type of surgery to treat hallux valgus. Mini-invasive techniques and advances in local anesthesia allow for operations with very little pain in the overwhelming majority of cases.
As sensitivity to pain is not the same for all people, it is not possible to guarantee a "zero pain" procedure. However, the fact that this procedure is only performed on an outpatient basis is a sign that the management of postoperative pain does not generally pose any serious problems.
The management of pain is done very seriously in spite of everything. The quality of the local anesthesia will of course make it possible to feel no pain during the operation, but its effects will last at least 12 hours, limiting the pain that would immediately follow the operation. It is in fact in these hours following the operation that the pain can reappear, and the fact of having a prolonged analgesia in the operated area makes it possible to reduce post-operation stress and anxiety.
This device is complemented by a special device that will help the patient manage any pain once they leave the hospital. In the past, the patient had to stay in the clinic with an infusion to get an electric syringe.

Now the patient has a single-use analgesic diffuser which, with the help of home nurses, allows the patient to return home as soon as possible. This has several important advantages. The patient can indeed
- Eat at home and sleep outside the clinic
- To be quiet compared to the noisy environment of a clinic
- Be surrounded by your loved ones without restriction.

When symptomatic treatment options are exhausted, the only option left is surgery. It is the only way to eradicate the cause and the pain. The technique to be used must be shared between the patient and the practitioner. There are several approaches. The first is the percutaneous technique, which leaves only almost invisible incisions, and the second is called mini-invasive, and will be performed with incisions limited to 2 centimeters.
The procedures are performed with local anesthesia and sedation (optional). The patient does not need to stay at the clinic in the evening, and can leave immediately after the procedure.

Surgery is said to be minimally invasive when the incisions made are of the order of 2 centimeters. However, the techniques used inside the foot are similar to those used in conventional surgery.
Once the incisions have been made, the surgeon will carry out the operation. By performing osteotomies with specific instruments, most of which are inspired by the percutaneous technique.

The techniques used allow the patient to regain support on his or her foot immediately after the operation, with the help of a specific shoe that the patient will have to keep for about a week. The resumption of support must be done with the entire sole of the foot. Indeed, one should not walk by pressing on the side of the foot or on the heel. This is not necessarily obvious and many patients instinctively do not respect this instruction. It is normal to be apprehensive about resuming walking after the operation, so a progressive protocol is recommended to reassure patients.
During the first week, walking is allowed but must be limited to what is strictly necessary. It is recommended not to leave your home. Treading and prolonged standing without walking should be avoided. When the patient sits or lies down, it is recommended to elevate the foot and leg.
The following week, the patient can walk outside the home, gradually. Walking periods should be limited to about 15 minutes, but should not exceed a total of two hours per day.
Gradually increase the amount of walking according to how you feel. It is advisable to abandon the special shoe for good and to put on a soft, flat shoe such as sneakers.
The time off work depends on the activity. Work can be resumed after two weeks in favorable cases. Of course, the activity must not require a lot of walking or repetitive "stomping". If this is not the case, the recovery period will have to be extended. In case of an early return to work, it must be possible to elevate the foot when the patient is sitting.
In general, as a precaution, the prescribed time off work is about three weeks.