Foot Bunion Surgical Treatment
(price range: from €1,701 to €3,033)
Introduction
The word bunion is from the Latin "bunion," meaning enlargement. Bunions are one of the most common foot deformities. It is generally considered as an enlargement of the joint (a lump of bone) at the base and side of the big toe - (specifically, the first metatarsophalangeal joint).
This causes the big toe to move towards the smaller toes. As the big toe bends towards the others, this lump and the bunion becomes larger, it may also become painful giving rise to arthritis and stiffness.
Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe and a bunion refers to the enlargement of the joint - most of the time the two go together and can just be referred to as 'bunions'.
A bunion is more common in women than in men due to women wearing tighter fitting shoes. This condition can cause a variety of different soft tissue and bony complaints which may result in severe pain.
Symptoms include redness, swelling and pain which may be present along the inside margin of the foot.
The patients feet may become too wide to fit into their normal size shoe and they may experience moderate to severe discomfort which may occur when the patient is wearing tight shoes.
Description
Orthopaedic surgeons use many different surgical procedures to treat bunions. The common goal of these procedures is to realign the joint, to relieve pain, and to correct the deformity.
These procedures include: Repair of the Tendons and Ligaments Around the Big Toe. These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. This is often combined with an osteotomy, this procedure shortens the loose tissues and lengthens the tight ones.
Arthrodesis
Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis and when other procedures have failed.
Exostectomy
Removal of the bump on the toe joint, used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion.
Resection Arthroplasty
Removal of the damaged portion of the joint, used mainly for patients who are older, or have had previous bunion surgery, or have severe arthritis. This creates a flexible "scar" joint.
Osteotomy
The surgical cutting and realignment of the joint. The orthopaedic surgeon will choose the procedure best suited to the patient’s condition.
Anesthesia
The surgery can often be done with : Ankle block anaesthesia, which numbs only the foot; Spinal anaesthesia, which numbs the patient from the waist down; Or, general anaesthesia, which induces a temporary unconsciousness. However, this latter is only occasionally needed.
Indications
Bunion surgery is indicated if there is severe foot pain which limits the patient’s activities, especially work and if it restricts being able to walk when wearing reasonable shoes and for significant deformity or stiffness of the big toe.
Failure to respond to medication and conservative treatments such as changes in padding, exercises and footwear underlines the importance of the surgical solution.
Risks, Complications and Side Effects
Possible complications can include infection, recurrence of the bunion, nerve damage, and continued pain. If complications occur, they are treatable, but may affect the extent of full recovery.
The orthopaedic surgeon will explain various options in treating these complications.
Post-operative care, convalescence
The success of the surgery will depend in large part on how well the patient follows the orthopaedic surgeon’s instructions at home during the first few weeks after surgery.
The patient will see the surgeon regularly for the next several months to make sure the foot heals properly.
Dressing Care
The patient will be discharged from the hospital with bandages holding the toe in its corrected position. The patient will also wear a special post-operative surgical shoe or a cast to protect the foot which will require continued support for six to eight weeks.
To ensure proper healing, it is very important to keep dressings dry. Interference with proper healing could cause a recurrence of the bunion. Be sure to place a plastic bag over the foot while showering.
Bearing Weight
The orthopaedic surgeon may advise the patient to use a walker, a cane or crutches for the first few days after surgery. The patient can gradually put more weight on the foot as the wound heals.
However, only walk short distances during the first few weeks following surgery. The patient will probably be able to drive again within about a week.
Swelling and Shoe Wear
Keep the foot elevated as much as possible for the first few days after surgery and apply ice as recommended by the orthopaedic surgeon to relieve swelling and pain. The patient will have some swelling in the foot for about six months.
After the dressings have been removed, only athletic shoes or soft leather oxford type shoes must be worn for the first several months until the surgery has completely healed.
Do not wear fashion shoes, including high heels, until after six months. Follow the tips on shoe fit presented earlier in this booklet when selecting shoes. This will help prevent the recurrence of the bunion.
Exercises to Strengthen The Foot
Some exercises or physical therapy may be recommended to restore the foot's strength and range of motion after the surgery. The surgeon may recommend exercises using a surgical band to strengthen the ankle, or marbles to restore motion in the toes.
Always start these exercises slowly and follow the surgeon's or the physical therapist's instructions regarding repetitions.
Medication
The orthopaedic surgeon may prescribe antibiotics to prevent infection for several days after surgery. Pain medication to relieve surgical discomfort will also be prescribed for several days.
Recovery time
Weight bearing on the foot depends on the procedure. A head procedure allows for immediate weight bearing, but we still feel that it is best to use crutches for 1-2 weeks. Base procedures require crutches for a longer period of time.