BUNION SURGERY

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WHAT TO EXPECT WITH BUNION SURGERY


 

Many patients considering bunion surgery have come into contact with other individuals who have already gone through the process and have shared their experiences, some good and some bad. As a physician it is my job to explain the process of having bunion surgery on a daily basis and regularly explain how it is very difficult in comparing apples to apples when it comes to bunion surgery. There are many different variables regarding bunion surgery as it relates from one patient to the next and hopefully the following can help answer your questions if you are deciding on having bunion surgery in the future.

THE BASICS

Click here for more information on the basic of bunions. The best time to have bunion corrective surgery is if after conservative treatment such as shoe modifications and orthotics have failed to give any relief and the pain has begun to affect your activities of daily living. Only one foot is operated on at a time to enable patients with one good foot to walk on, ensuring a safer recovery. 

There are a variety of different procedures that can correct a bunion and that largely in part is determined by the foot type that you possess and the severity of the bunion. Other factors that are taken into consideration include age, weight, bone stock or appearance on radiographs, and level of daily activities. The procedure chosen for you will have an impact on your post-operative recovery period including the protective device that you will need, weight-bearing status, and ability to return to your normal activities. These procedures generally takes less than an hour to complete, are performed under twilight sleep (IV only), and are done in an out patient setting. Due to the IV sedation, you are not permitted to eat or drink after midnight the night before surgery and you are not permitted to drive yourself home after the surgery. Lastly, a prescription for pain medicine and an anti-inflammatory will be given before the surgery and it is recommended that these are filled so that you have these ready after your surgery. 

THE SURGERY

In general, most individuals having bunion surgery have a procedure similar to that described in the above video. This procedure essentially shaves down the prominent "bump" and performs a cut in the bone (metatarsal) which allows for a portion of the bone to be shifted back into a natural position. Once the bone is determined to be in a good position, the two pieces are stabilized with either a screw or a pin. The screw or pin is maintained internally unless it becomes bothersome in the future, which for the most part is rare. Additionally, any soft tissue contractures including ligaments and tendons maybe released as needed. Absorbable sutures are used to eliminate the need for removal afterwards and are buried underneath the skin to give more of a cosmetic scar during the healing process. When the surgery is complete, a post-operative block is administered around the surgical site to yield numbness and a painless recovery and return home. Even thought it is sometimes typical for the the local anesthesia to render numbness to the foot until the following morning, I recommend that you begin using your pain medication around dinnertime the night of your surgery. Ice, foot elevation on a pillow, and rest will all help to aid in a smooth recovery after your procedure. 

AFTER SURGERY

The post-operative course for this surgery includes a sterile dressing and protective shoe or walking boot. The dressing is not to be changed or tampered with until seen by your doctor one week after surgery and is not to get wet. Patients are permitted to walk on the operative foot as tolerated immediately after surgery, however, it is important to keep the foot dry for the first two weeks. At two weeks after surgery, all bandages are removed and patients are permitted to wet the foot while bathing. It is at this point that patients can transition back to a supportive athletic shoe as tolerated. In general, I advise individuals to decrease their normal activities for six weeks as post-operative pain and swelling is correlated to patient activities. Although everyone heals at a different rate, in some cases swelling can occur for up to a year after surgery. Patients are advised to take a minimum of one week off from work to recover from the anesthesia and the procedure.  

OTHER BUNION PROCEDURES

For those individuals who do not fall into the above category, the type of procedure and post-operative course will differ. For example in some pediatric patients, a different type of bone cut (osteotomy) may be more appropriate as it is important to take into consideration the child's growth plates. Based on the placement of the osteotomy, this can dictate how the metatarsal can grow and develop after the surgery on until it reaches maturation. These cases require the patient to be in a short leg cast for six weeks with crutches and are not permitted to put any weight on the foot. At six weeks the patient is transitioned to a walking boot and then from there back to a normal shoes. In general the recovery period involves two to three months until the individual is back to walking in normal shoes. 

Additionally, some bunions may have developed to where they are so severe that instead of making an osteotomy to shift the bone back into position, the entire joint may need to be fused. Again this procedure requires the use of screws, pins, or even a small plate. Due to the nature of the procedure and the importance of protecting the operative site for adequate healing, a short leg cast is required for six weeks with crutches. For those individuals unable to safely use crutches, other devices such as walkers, wheelchairs, and roll-a-bout scooters are excellent alternatives to navigate around while not putting the operative foot down.

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BUNION SURGERY: BEFORE & AFTER