BUNION SURGERY | SOUTH TEXAS FOOT SPECIALIST
Bunions appear as areas of enlargement at the base of the big toe joints. They can be painful due to chronic irritation from shoegear but may also cause pain for two other reasons. Bunions, also known as hallux abductovalgus deformity, involve a mis-alignment of the big toe joint. Such misalignments can cause premature wearing of the joint lining or cartilage thus joint pain. The poor alignment can also involve the big toe pointing toward the second toe. The big toe, in advanced cases, can push the second toe upward, deforming it and creating a hammertoe.
Pain due to shoe irritation can be alleviated with wider shoegear or pads, but if there is joint pain or the big toe is abutting the second toe then surgical may be considered. Surgical treatment of a bunion is called a bunionectomy. The type of bunionectomy used depends on the severity of the deformity and structural changes caused by the deformity.
There are over 30 different bunion procedures available, but bunion surgeries fall into three major categories:
- Mild bunionectomies involve a simple shaving of the extra bone protruding from the side of the big toe joint and possibly some soft tissue correction. Some common names of such procedures include the Silver and McBride bunionectomies. Such procedures are not commonly performed as most patients can accommodate mild deformities with shoegear changes.
- “Head” procedures that realign the “knuckle” or metatarsal head of the big toe joint. Common names for such procedures include the Austin bunionectomy, Reverdin-Green, Mitchell bunionectomies. This type of bunionectomy involves repositioning the just behind the joint, moved into its correct position. A pin or screw may be used to ensure that the bone is held securely in place while healing. Such procedures generally allow immediate walking with a surgical shoe or boot.
- Base procedures concentrate on the toe itself and are used to further straighten the toe if needed. The Akin procedure is a common version of this. Such procedures are often combined with the “head” procedure if the big toe is very deformed or underneath the second toe. Such procedures may involve the removal of a wedge from the base of the big toe in order to straighten it. Ligaments on either side of the joint may be lengthened and shortened as needed to help achieve good alignment.
- Severe deformities may require a larger procedure in which the surgery is performed at the front part of the arch of the foot. An example of such is the Lapidus bunionectomy.
Bunions are caused by a combination of hereditary and biomechanical issues, so chose a surgeon with a knowledge of all the major procedures, experience in surgical treatment of bunions and training in the mechanical of the foot.
Be realistic in your expectations about what a bunion surgery can accomplish. It is not possible to guarantee that a bunion won't recur or that a patient will be absolutely pain free. Surgical treatment can straighten the big toe joint making it function better, feel better and look better but cannot address the underlying hereditary and biomechanical factors that led to bunion formation in the first place. It is advisable to listen to the podiatrist's advice on proper shoegear and use of orthotics when appropriate.
Bunion surgery can reduce or eliminate the joint deformity, improve joint alignment and function, attempt to reduce wear and tear on the big toe joint and prevent deformity of other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
Bunion surgery is not a magic bullet in that correction of the deformity is all that is needed. After surgery, a number of patients experience prolonged healing and recovery times and often have to spend time in physical therapy. Additionally, you may need better shoegear or a prescription orthotic device on an ongoing basis.
What To Expect
Most bunionectomies today are performed on an outpatient basis at an stand alone surgical center or hospital outpatient surgery department. Such procedures typically take about 45 to 90 minutes but aside the entire day for the surgery.
Prior to the surgery, patients may need to make some preparatory steps. These include:
- Seeing your Family or Primary Care Physician ensure sure any other health conditions are stabilized prior to surgery and to inform the surgeon of any pertinent issues concerning your medical history.
- Re-arranging your schedule so that you don't need to take any long trips for at least two to three weeks following the surgery.
- Arrange to have another person to drive you home and be available for you for the day of surgery.
- Ceasing the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or naprosyn for two to three days before the surgery. If one is on blood thinning medication, discuss that with the surgeon.
- The anesthesiologist requires one have an empty stomach for 8 hours before the procedure. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.
Bunion surgery may be performed with IV sedation (twilight sleep) and a local anesthetic and is administered by an anesthesiologist. General anesthesia may also be utilized at times. A long acting local anesthetic is injected by the surgeon before the surgery is over so that there is no or minimal pain immediately after the surgery.
The type of bunionectomy will determine how soon one can bear weight on the foot after surgery. The majority of such procedures do allow weight bearing with a surgical shoe. It is important to elevate the foot after surgery to prevent swelling. The foot will be covered in bandages, which you will need to keep dry for up to 2 ½ weeks or until the sutures are removed.
Sutures are generally removed about 2 to 2 1/2 weeks after the surgery in the office. Once the sutures are removed, you can bathe and shower, but occasionally may need to wear a dressing over the wound to prevent infection.
The majority of patients can start to return to a running shoe or walking shoe between the third and fourth week. Physical therapy may be recommended to restore strength and flexibility and help eliminate swelling. Follow your podiatrist's instructions for increasing exercise and activities until you are back to normal.
For more information on Bunions in the San Antonio, TX area, call Ed Davis, DPM, FACFAS. at (210) 490-3668 today!