RM INTERVIEW – DR RASTISLAV HROMADKA, ORTHOPAEDIST
Hallux valgus treatment with doc. MUDr. Rastislav Hromádka, Ph.D., a leading Czech orthopedist
Ouch, a bunion, one of the biggest foot pains a man can feel. Although it is not a problem which occurs all of the sudden, it takes the patients often long time to finally decide to deal with it. What kind of deformity is it in particular, what are the options for a conservative solution, and mainly – what does modern medicine offer when you have to undergo the surgical procedure? We have asked the most competent person, Dr. Rastislav Hromádka, a leading Czech podiatry specialist.
1. Podiatry is a quite specific field. Why did you choose this medical specialty, and what do you like most about it?
Over the past fifteen years, were developed many orthopaedic sub-disciplines that focus specifically on a certain parts of the musculoskeletal system of the human body. This is one of them and its magic lies is in the fact that it is based on the principles of surgery using basic orthopaedic procedures. The main procedures performed are osteotomies and arthrodeses, not total joint replacements. The surgical treatment of bunions has changed significantly and modern materials and tools are used.
2. A bunion treatment is one of your main specialties. How common is this problem in the Czech Republic and in Europe in general? Who are your patients?
Sadly, it is a big and common problem in Europe. It is estimated that up to 23 % of people suffer from this deformity. The occurrence of the defect increases with age. The symptoms also worsen with age and it is estimated that up to 36 % of the population over 65 have this medical condition. Most people who come to our clinics are usually living with this condition for several years, even decades. The patient should see a specialist and be informed how to avoid improper positions of the thumb and fingers to prevent foot joint deformities in the future.
3. Genetics probably is probably the main influence here, but how can this problem be prevented? What are the current options for conservative treatment?
Everyone has certain genetic predispositions and legs can carry only a certain amount of load. The deformities usually occur due to a combination several external effects. To name the most common ones: overweight, sedentary employments, heels and, unfortunately, pregnancy and breastfeeding. These factors are contributing to the more frequent occurrence of this medical problem in women’s population.
Conservative therapy is mainly used to relieve the patient’s discomfort (pains and stiffnesses). The most common forms of this therapy are exercises and massages. The treatment also includes the use of different corrective paddings, cushions, shoe inserts, and various types of patch fixations. Comfy and roomy shoes are an important part of the cure too. Scientific studies have shown that conservative therapy indeed results in relief but it cannot remove the existing bone deformities.
4. Is this problem still being treated today by applying “injections”? How effective are these methods?
Injections are another medical form of conservative therapy. They eliminate pain but do not correct the incorrect position of the toe. Moreover, if used too frequently, they can lead to joint degeneration and thus worsen the problem.
5. The operation is usually the last option, often inevitable. Many patients are also afraid of long convalescence or even relapse. Are these concerns justified?
As has already been mentioned, significant progress has been made in the surgical treatment. New materials (screws and splints) and new surgical techniques are used. A good example is a new tool that we started using in the Czech Republic for these procedures four years ago. This tool in particular reduces the size of the incision we need to made in order to approach the bones. In addition, modern procedures that use screws and splints fix the bones so tightly that the patient can start walking earlier and the probability of a successful treatment increases.
