Bunions

What is a bunion?

Bunions are progressive bone deformities of the foot that often cause recurring or chronic inflammation, irritation, and pain that require surgical correction. Approximately 90% of the bunion deformities are inherited. Most often a bunion deformity is a progressive problem. The longer it exists, the more structural change including the great toe moving toward the second toe, enlargement of the bump, and possible progression of the arthritic changes in the joint.

An untreated bunion can cause hammertoes, corns, callus, arthritis of the joint besides being painful and difficult to manage with shoe wear. Surgical removal of a bunion is called a bunionectomy. However, there are multiple types of bunionectomies, each designed to resolve different structural changes caused by the deformity.

Common reasons patients seek treatment for bunions are:

• Bunion pain
• Enlarging bunion
• Interference with walking/activities
• Difficulty fitting shoes
• Pain at the ball of the foot
• Overcrowding of the toes and hammertoes
• Unsightly appearance

What is the best bunion procedure?

It typically depends on what kind of bunion you have. There are different severities of bunions and different patient goals. It has been said that there are over one hundred types of bunion procedures. Foot and Ankle surgeons have training on how to fix a bunion using a traditional technique. However, there are also new, innovative techniques that have changed the way we treat bunions. The surgeons at Dominion Foot and Ankle are leaders in the use of these techniques as it provides many advantages for many patients seeking surgery for their bunion deformity.

Innovative, Minimally-Invasive Surgery

A minimally-invasive bunionectomy procedure can help you to get back on your feet faster, with less pain. The minimal incision bunionectomy surgery is performed with small 3-5mm incisions, compared to 3-5 inch incisions used in traditional bunion surgery. The innovative technique utilizes percutaneous, micro-incisions to correct bunions (hallux valgus), as well as hallux rigidus and other foot conditions, which cause far less damage to your foot.

Advantages of the minimal incision bunionectomy include:

• Less pain
• Earlier return to function compared to an open procedure
• Smaller incision
• Minimal disruption of the tissues about the big to joint eliminating joint stiffness
• Smaller scars
• Able to avoid general anesthesia
• Ability to obtain the same results as traditional surgery with all the benefits listed above.

    Preop left                            Postop left

Postoperative day # 12

  

Preop (left), in surgery (center), postop (right)

Lapiplasty® 3D

A patented procedure designed to secure the root cause of your bunion. The Lapiplasty® Procedure naturally restores your natural anatomy. The entire metatarsal bone is rotated and shifted back into position, eliminating the unsightly bump. The unstable foundation is permanently secured with patented, titanium technology allowing you to get back on your feet quickly. This may be an option for those that do not qualify for a minimally invasive bunionectomy.

• Fix the root cause of your bunion (unstable joint)
• Walk in a boot within days to a few weeks of surgery
• No casts
• Minimal down time and lost work time

Traditional bunion surgeries generally fall into three major categories:

• Head procedures that treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Patients are often weight bearing soon after the surgery.
• Mid-shaft procedures that concentrate on the big toe joint by utilizing procedures in the middle of the bone such as the Z- or Scarf-type bunionectomy. These afford the benefit of correcting larger bunions and correcting other associated deformities at the same time. Additionally, patients are able to bear weight early.
• Base procedures concentrate on the bone farther behind the big toe joint. Different types of base procedures are completed depending on the nature of the deformity. These range from cutting a wedge out of the bone and splitting it so that it can be moved into its proper position; making a semi-circular cut and rotating the bone into its correct position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure. Often these require up to six weeks of non-weight bearing following the surgery.

                     

Z-osteotomy preoperative       Z-osteotomy postoperative

There are three important factors that impact the success of bunion surgery:

1. Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient’s foot, as well as the intricacies of each surgical option, is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
2. Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won’t recur or that a patient will be absolutely pain-free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
3. Bunion surgery is not a magic bullet. Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times and often have to spend time in physical therapy. Additionally, you may need a corrective orthotic device on an ongoing basis.

What to Expect

Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

• Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to the foot surgeon.
• Arranging your schedule to make sure you don’t need to take any long trips for at least two to three weeks following the surgery.
• Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
• Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure with Hibiclens to help reduce surrounding bacteria and prevent infection.

Bunion surgery is usually performed with a local anesthetic and is administered by your surgeon. This may be combined with sedation medication administered by the anesthesia staff to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.

By the third or fourth week post-surgery, swelling often subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lubricants to soften the skin in the surgical area.

By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeon’s instructions for increasing exercise and activities until you are back to normal.