The surgical correction of bunions is dependent upon the severity of the deformity, the patient's over-all health and activity level. Age and conditions such as diabetes do not preclude bunion surgery as a form of treatment.
There are several different approaches to the surgical correction of bunions. Most commonly, the surgery is performed in the area of the big toe joint. The bony prominence is removed and the bone is surgically fractured to allow realignment of the joint and straightening of the big toe joint. This surgery is designed so that the patient can walk on the foot almost immediately following the procedure; however, activity must be significantly curtailed for several weeks following the surgery. Typically, the patient is instructed to remain home from work for at least one week with the foot propped up and elevated above the heart throughout the day. If the patient's job requires much standing or walking, they may be required to stay home from work for as much as six weeks. Often the patient may return to work sooner if they are placed in a removable below-the-knee walking cast. There are no short cuts to the healing time. Healing time is based upon basic physiological principles that are common to all human beings. Certain vitamins and nutrients may help with the healing process. Laser surgery does not alter the healing time and provides no significant advantage to the performance of the surgery.
Surgical Correction of Severe Bunion Deformity
If the bunion is more sever in nature surgery is performed further back on the bone in order to straighten the big toe. When surgery is performed in this area of the bone, there is greater instability of the bone after it is cut and moved into a corrected position. Generally, the surgeon will require the patient to wear a below-the-knee cast and use crutches for three to eight weeks. Initial bone healing takes six to eight weeks. This period of time can take longer in people who smoke.
The overall success rate and satisfaction of patients who have had bunion surgery is quite high. The most common complaint of patients is the healing time. This is particularly true if the patient is not adequately prepared or informed as to what to expect. Most patients experience minimal pain following the procedure and this pain is easily controlled with pain medication prescribed by the surgeon.
Potential complications associated with the surgery are infection, over or under-correction of the bunion, joint stiffness, delays in healing or non healing of the bone, or healing of the bone in the wrong position. Most of these complications can be avoided by following the surgeon's instructions. Walking on the foot without the protection of a post-operative shoe or cast, or against the surgeons advice can lead to a dislocation of the bone where it has been cut. This results in delays in healing, non-healing of the bone or healing of the bone in the wrong position. Allowing the bandage to get wet increases the risk of infection. The most critical time for an infection to occur is within the first three days following surgery. Infection can also occur following this period of time but is less common.
Joint stiffness following bunion surgery is common, but generally improves with time. Postoperative physical therapy is useful to improve the movement of the joint but is not always necessary.
Bunions on Both Feet- Considerations with Regard to Surgery
If a person has bunions on both feet, many surgeons feel that their patients recover quicker and with fewer complications if the surgery is performed on one foot at a time. Many surgeons prefer to wait a minimum of four to five weeks between surgeries. Other surgeons prefer that their patients wait longer between surgeries.
Place of Service and Anesthesia Considerations
Most often the bunion surgery is performed in an outpatient surgery center or hospital. Some surgeons will perform this procedure in their office. Anesthesia for the surgery can range from a straight local anesthesia, given by injection into the area of surgery, to a general anesthesia with the administration of an anesthetic gas. A very common form of anesthesia is a combination of a local anesthesia and medicine given intra-venous to make the patient drowsy. This is commonly called twilight anesthesia.
Generally there is very little blood loss during surgery. Most often the surgeon will use some form of tourniquet to stop bleeding during surgery. Because the surgery can be performed in a relatively short period of time the use of a tourniquet is very safe. Technically, the tourniquet can be left in place for as long as 90 minutes safely in most cases. Surgeons who perform bunion surgery are very knowledgeable in the use of tourniquets. The potential for the need for a blood transfusion with bunion surgery is nearly non-existent.
Can My Bunion Come Back?
It is important to understand that bunion surgery does not correct the cause of the bunion. Therefore there is the possibility that the bunion can reoccur. How quickly a reoccurrence will occur is difficult to predict. It may take several years or just a matter of months for the bunion to begin to come back. Bunions are caused by abnormal movement of a set of joints below the ankle joint in the foot called the subtalar joints. To help prevent the bunion from reoccurring the patient should be prescribed a functional orthotic. These are custom-made shoe inserts that correct the abnormal function of the foot. Generally they will fit in normal shoes without requiring the use of larger shoes. Most foot surgeons will suggest the use of orthotics following bunion surgery to help prevent the reoccurrence of the deformity.
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