Nail & Skin Disorders

A Podiatrist’s Guide to Bunion Surgery

[GRAPHIC IMAGES] Bunion’s, those ugly painful bumps at the base of the big toe, have plagued man since he started walking upright, but with 21st century surgical techniques, removal is now relatively easy and usually pain-free.

Bunions are those ugly bumps just behind the toe that either protrude out on the side of the foot or protrude up. Surgical removal of the bunion – called bunionectomy – is the most commonly performed foot surgery in the United States.

A bunion occurs when the big toe bone (the first metatarsal) separates from the second toe bone. As the base of the big toe bones comes out, the tip of the big toe starts to point in toward the foot and the space between the first metatarsal and the second metatarsal increase. The bump forms in large part because the bone is coming out the socket and to a lesser degree because of degenerative arthritis. A tendency to develop bunions is often hereditary and affects more women than men. They are related to shoe wear, which can irritate the area and cause bunions to occur more rapidly (though rubbing doesn’t cause the excess bone to form).

The bone has been cut and the head of the metatarsal (where the “v” is) has been slid over toward the second toe, putting the bone in the proper position.
<p>The bone has been cut and the head of the metatarsal (where the &ldquo;v&rdquo; is) has been slid over toward the second toe, putting the bone in the proper position.</p>

The only conservative treatment for bunions is to wear bigger and wider shoes so there’s less friction and pressure on the foot. If more aggressive treatment is needed, podiatrists may perform bunionectomies on an outpatient basis. The two most commonly performed surgical approaches are the “Austin” and “chevron” methods.

To correct the bunion, the first metatarsal must be move closer to the second metatarsal by cutting is physically moving it closer to the second metatarsal bone. After this is accomplished, the remaining bump is shaved off. Then the bone is held in place using a screw or pin. Although metal pins are commonly used. Over the past year, I have been performing bunionectomies with new Bionixs plastic pins and screws. These plastic screws are from the same materials as dissolvable sutures, which has been pressed together under high pressure to form a rigid pin or screw that dissolves within six months.

The operation generally should be performed as an outpatient utilizing “twilight sleep.” Twilight sleep is anesthesia that allows the patient to stay awake but sedated (think three martinis). Local anesthetic is also used. This enables the patient to undergo the surgery and then leave the operating room immediately.

Bunion surgery, when performed properly, should be painless and have a quick recovery. The only medicine necessary to take after surgery is an-inflammatory such as Motrin to reduce swelling. Less than 10% of my patients require any type of pain pills after surgery.

Usually patients are to go back to work within a day or two of the surgery though they must wear surgical shoe for approximately 3-4 weeks. Patients are able to drive their cars and do necessary activities of life, but are prohibited from doing any strenuous activity such as exercise, shopping, or heavy cleaning.

After approximately three weeks, when the dressings are removed, the patient should wear a running-type shoe for another three weeks. This helps keep the swelling down and allows the patient to move her toes. Sometimes physical therapy is necessary due to post-operative stiffness or swelling. After approximately six weeks, most patients are able to begin wearing their regular shoes. As with any surgery, there are no guarantees, but the success rate is at least 90% meaning no recurrence.

The most common compilations of surgery are swelling, and infection. As long as patients follow instruction carefully, such as not getting the surgical site wet for three weeks by using a special shower bag, they can avoid infection.

The last important aspect of having successful results with bunion surgery is finding a good doctor who performs these types of procedures on a regular basis. Getting a second opinion from another qualified podiatrist is important and he or she should take the time to answer all your questions before you undergo this type of surgery. If done correctly, this procedure should permanently eliminate the patient’s bunions.

[Photo 1] Note the patient’s severe bunion deformity and the bump by the fifth toe which is called a “tailor bunion”.

[Photo 2] The surgery is usually performed under local anesthesia with twilight sleep. A tourniquet is place around the ankle so the surgery can be done while the patient is in this semi-conscious state. The incision is made on the side of the foot for cosmetic purposes.

[Photo 3] The foot has been surgically opened and you can see the end of the head of the metatarsal there is a big bump with a ridge going down the center. This is the exercise bone.

[Photo 5] The pin holds the bone together. Later, before the skin is closed, the pin is cut short at the level of the bone and is covered over by skin



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