A lot of people with bunions find pain alleviation with basic treatments to decrease pressure on the big toe, like using wider shoes or utilizing padding within their shoes. However, if these measures do not alleviate your symptoms, your physician might suggest bunion surgery. Mexico, Missouri’s orthopedic specialist, Dr. Kathleen Weaver, would like you to understand bunion surgery so you can be informed before you enter your doctor’s office.
There are various kinds of surgeries to correct a bunion. Bringing the big toe back to its proper position may involve realigning bone, ligaments, muscle tendons, and nerves.
Are You a Candidate for Surgery?
Overall, if your bunion is not painful, you don't need surgery. Though bunions frequently get bigger with time, physicians do not suggest surgery to stop bunions from getting worse. Many people can slow the growth of a bunion with proper shoes and other preventive care, and the bunion never leads to pain or any other issues.
It is also crucial that you note that bunion surgery shouldn't be done for cosmetic reasons. Following surgery, it's possible for ongoing pain to develop in the affected toe — even though there was no bunion pain before surgery.
Good candidates for bunion surgery frequently have:
- Considerable foot pain that limits their everyday activities, including walking and wearing sensible footwear. They may find it hard to walk more than a few blocks (even in athletic shoes) without immense pain.
- Chronic big toe inflammation and swelling that doesn't improve with rest or medicines
- Toe deformity—a drifting in of the big toe to the lesser toes, making the chance of the toes to cross over each other.
- Toe stiffness—the lack of ability to bend and straighten the big toe
- Failure to get pain alleviation with modifications in footwear
- Failure to get pain relief from nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. The effectiveness of NSAIDs in curbing toe pain varies significantly from person to person.
Choosing to Have Bunion Surgery
After bunion surgery, most patients have significantly less foot pain and are better in a position to take part in everyday activities.
As you take a look at bunion surgery know that alleged "simple" or "minimal" surgical operations are often inadequate "quick fixes" which can do more harm than good. Even though many bunion procedures are carried out on a same-day basis without hospital stay, a long recovery period is normal. It often takes up to six months for full recovery, with follow-up visits to your physician sometimes necessary for up to a year.
It is crucial to have realistic expectations about bunion surgery. For example, bunion surgery might not enable you to put on a smaller shoe size or narrow, pointed shoes. The truth is, you might need to restrict the types of shoes you wear throughout your life.
As you think about bunion surgery, do not hesitate to ask your doctor questions relating to the operation and your recovery. Some examples of helpful questions to ask include:
- What are the benefits and risks of this surgery?
- What are the possible complications and just how likely are they to happen?
- How much pain will there be and just how will it be managed?
Make sure to write down your physician's answers so you are able to remember them at a later date. It is essential to understand both the potential benefits and limitations of bunion surgery.
Overall, the common goals of the majority of bunion procedures include:
- Realigning the metatarsophalangeal (MTP) joint at the bottom of the big toe
- Reducing pain
- Correcting the deformity of the bones making up the toe and foot
Since bunions vary in shape and size, you will find different surgical procedures performed to correct them. Typically, bunion surgery includes fixing the alignment of the bone and fixing the soft tissues around the big toe.
Your physician will talk with you concerning the kind of surgery which will best correct your bunion.
Repairing the Tendons and Ligaments Around the Big Toe
In many cases, the soft tissues around the big toe may be too tight on one side and too loose on the other. This brings about an imbalance that causes the big toe to drift in the direction of the other toes.
Surgery can shorten the loose tissues and extend the tight ones. This is hardly ever done without some sort of alignment of the bone, known as an osteotomy. In the majority of cases, soft tissue correction is simply one portion of the entire bunion corrective procedure.
In an osteotomy, your doctor makes little cuts in the bone tissues to realign the joint. After cutting the bone, your doctor fixes this new break with pins, screws, or plates. The bones are now straighter, and the joint is balanced.
Osteotomies may be carried out in various places along the bone to take care of the deformity. In some instances, along with cutting the bone, a small wedge of bone is taken away to give adequate correction to straighten the toe.
As mentioned previously, osteotomies are often performed in combination with soft tissue procedures, as both are often necessary to preserve the big toe alignment.
In this procedure, your doctor removes the arthritic joint surfaces, then inserts screws, wires, or plates to hold the surfaces together until the bones heal. Arthrodesis is commonly utilized for patients who have severe bunions or serious arthritis, and for people who may have had previous unsuccessful bunion surgery.
In this procedure, your physician gets rid of the bump from your toe joint. Exostectomy alone is seldom utilized to treat bunions because it doesn't realign the joint. Even when coupled with soft tissue procedures, exostectomy hardly ever corrects the cause of the bunion.
Exostectomy is most often performed as one part of an entire corrective surgery which includes osteotomy, plus soft-tissue procedures. If a doctor performs exostectomy without osteotomy, however, the bunion problem frequently returns.
In this technique, your doctor removes the damaged area of the joint. This increases the space between the bones and makes a flexible "scar" joint. Resection arthroplasty is utilized chiefly for people who are elderly, have had prior unsuccessful bunion surgery, or have extreme arthritis not amenable to an arthrodesis (see above). Since this procedure can change the push off power of the big toe, it is really not frequently suggested.
Preparing for Surgery
Before your surgery, you may be asked to consult with your doctor for a total physical examination. He or she will assess your health and identify any issues that could interfere with your surgery. If you've got a heart or lung condition or a chronic illness you will need a preoperative medical clearance from your doctor.
Tell your physician about any medicines you are taking. He or she will tell you which medicines you can keep taking and which you ought to stop taking prior to surgery.
You may require a number of preoperative tests, such as blood counts, a cardiogram, and a chest x-ray. You may even need to give a urine sample.
To help plan your procedure, your doctor may order specialized foot x-rays. These x-rays should be taken in a standing, weight bearing position to ensure your physician can clearly see the disfigurement in the foot. These x-rays assist your physician in making choices about where along the bone to carry out an osteotomy to offer enough corrective power to straighten out the toe.
In planning your surgery, your physician will start thinking about a number of things, such as how serious your bunion is, your age, your general health and activity level, and any medical issues which could affect your recovery.
Almost all bunion surgery is done on an outpatient basis. You will most likely be required to arrive at the hospital or surgical center one or two hours before your surgery.
After admission, you'll be examined by a member of the anesthesia team. Most bunion surgery is carried out with anesthesia that numbs the area for surgery but doesn't put you to sleep.
- Local anesthesia. An ankle block numbs just your foot.
- Regional anesthesia. A popliteal block works for an extended period of time compared to an ankle block and numbs more of the leg. The numbing medicine is injected behind the knee.
- Spinal anesthesia. This injection is going to numb the body below your waist.
- General anesthesia. This form of anesthesia is going to put you to sleep.
The anesthesiologist will remain with you throughout the process to provide other medications, if needed, and to ensure that you are comfortable.
Based upon your bunion and the procedures you need, your physician is going to make an incision along the inside of your big toe joint or on top of the joint. In many cases, more than one incision is necessary to correct the bunion disfigurement.
The surgical time varies dependent on how much of your foot is malaligned. Surgery takes longer if your deformity is greater or if more than one osteotomy is needed. Every bunion correction is a bit different, and there isn't any reason to be concerned if your surgery takes more time.
Afterward, you're going to be transferred to the recovery room. You will be all set to go home in an hour or two. Be sure to have a friend with you to get you home.
As with every surgical procedure, there are dangers associated with bunion surgery. These occur rarely and are usually treatable — though, oftentimes, they might limit or extend your full recovery. Prior to your surgery, your doctor is going to discuss all of the risks with you and take specific measures to avoid complications.
The possible risks and complications of bunion surgery include:
- Nerve injury
- Failure to relieve pain
- Failure of the bone to completely heal
- Stiffness of the big toe joint
- Return of the bunion
Recovery at Home
The success of your surgery will depend mainly on how well you follow your physician's instructions at home during the first few weeks after surgery. You'll see your physician frequently for a number of months — sometimes up to a year — to make certain your foot heals effectively.
You'll be discharged from the hospital with bandages holding your toe in its corrected position.
Because keeping your toe in position is very important for effective healing, it is vital to follow your physician's directions about dressing care. Don't disturb or replace the dressing without talking to your doctor. Meddling with proper healing might lead to a recurrence of the bunion.
Make sure to keep your wound and dressing dry. When you are showering or bathing, cover your foot with a plastic bag.
Your surgical seam will be removed around two weeks following surgery, but your foot will require continued support from dressings or a brace for 6 to 12 weeks.
Your doctor will recommend pain medication to alleviate surgical discomfort. The most effective medications for providing postsurgical pain relief are opioids. These kinds of medications are narcotics, however, and can be addictive. It is essential to use opioids only as directed by your physician.
As soon as your pain actually starts to improve, stop using opioids. Speak to your doctor if your pain hasn't begun to improve within a few days of your surgery.
In addition to pain medication, the doctor may recommend antibiotics to help prevent infection in your wound for a few days after surgery.
Keep your foot elevated as much as possible for a few days after surgery, and apply ice as suggested by your physician to alleviate swelling and pain. Do not apply ice directly on the skin. It's quite common to have some swelling in your foot from 6 months to a year following bunion surgery.
Your physician will provide you with strict instructions regarding whether and when you are able to put weight on your foot. Depending on the type of procedure you have, if you place weight on your foot too early or without the right support, the bones can shift and the bunion correction will be lost.
Some bunion procedures enable you to walk on your foot right after the surgery. In these cases, patients have to use a special surgical shoe to protect the bunion correction.
Many bunion surgeries need to have a period of no weightbearing to ensure bone healing. Your doctor will apply dressings, a brace, or a cast to maintain the appropriate bone position. Crutches are typically utilized to avoid putting any weight on the foot. A newer device known as a knee walker is a wonderful alternative to crutches. It has four wheels and works like a scooter. Instead of standing, you place the knee of your affected foot on a padded cushion and push yourself along with your healthy foot.
In addition to no weightbearing, driving might be limited until the bones have healed properly — especially if the surgery was carried out on your right foot.
Regardless of what type of bunion surgery you have, it is vital to follow your doctor's instructions regarding weightbearing. Do not put weight on your foot or stop utilizing supportive devices until your physician gives approval.
Physical Therapy and Exercise
Particular exercises will help restore your foot's strength and range of flexibility following surgery. Your physician or physical therapist may suggest exercises using a surgical band to strengthen your ankle or utilizing marbles to bring back motion in your toes.
Always start these exercises gradually and conform to instructions from the doctor or physical therapist regarding repetitions.
It will take several months for your bones to completely heal. When you have finished the initial rehabilitation period, your physician is going to give you advice on shoewear. Athletic shoes or soft leather oxford type shoes are going to best protect the bunion correction until the bones have totally healed.
To help prevent your bunion from recurring, don't wear fashion shoes until your physician permits it. Bear in mind that the doctor might suggest that you never go back to wearing high-heeled shoes.
Although uncommon, complications could happen after bunion surgery. During your recovery at home, speak to your doctor if:
- Your dressing loosens, comes off, or becomes wet.
- Your dressing is moistened with blood or drainage.
- You develop adverse side effects from postoperative medications.
Furthermore, contact your doctor right away if you see any of these warning signs of infection:
- Prolonged fever
- Shaking chills
- Persistent warmth or redness around the dressing
- Increased or prolonged pain, specifically a "sunburn" type pain
- Significant swelling in the calf above the treated foot, especially when there is a "charley horse" pain behind the knee, or if you develop difficulty breathing.
Most patients who go through bunion surgery experience a decrease in foot pain, in addition to improvement in the alignment of their big toe. The duration of your recovery will depend on the surgical procedures that were performed, and how well you adhere to your doctor's directions. Just because a main cause of bunion deformity is a tight-fitting shoe, returning to that type of shoe may cause your bunion to return. Always follow your doctor's recommendations for proper shoe fit.
Dr. Kathleen Weaver of Audrain Orthopaedics wants to make sure everyone in Central Missouri, including Mexico, Fulton, Columbia, and Moberly, know what options are available for bunion surgery. If you think that bunion surgery may be the next step for you, set up an appointment with her today to help you get the solutions you need.