Bunion Correction

A bunion, also called a hallux valgus, is an enlargement of bone or soft tissues around the joint at the base of the big toe that results in the formation of a bump. The bone that joins the big toe with the first metatarsal bone thickens and enlarges, tightening the tendons, which in turn causes the base of the big toe to angle out resulting in a painful bony deformity.

Causes

The most common cause of a bunion is prolonged wearing of ill-fitting footwear that compresses the toes into unnatural positions. This can include high heeled shoes, narrow shoes, shoes that are too small or pointy shoes with a narrow toe box.  Genetics and certain disease conditions such as arthritis or polio may increase the risk of developing a bunion.

Bunions are much more prevalent in women than men, which may be associated with the use of heels and fashionable shoes by women.

Signs and symptoms

The signs and symptoms associated with bunions are as follows:

• Pain with ambulation when wearing shoes
• Swelling with red, calloused skin at the base of the big toe
• Decreased mobility in the big toe
• Inward turning of the big toe toward the second toe
• Bulging of a bony bump at the base of the big toe
• Formation of corns and calluses at the overlapping of the big toe and second toe

Diagnosis

The diagnosis of a bunion by an orthopaedic surgeon includes taking a medical history, and performing a physical examination to assess the extent of misalignment and damage to the soft tissues.  Your doctor may order X-rays to help determine the extent of damage and deformity of the toe joints.

Treatment

Your surgeon initially will recommend conservative treatment measures with the goal of reducing or eliminating foot pain.

Such measures include wearing properly fitted shoes with specially designed shoe inserts, padding, and taping of bunions. Certain medications may be prescribed for relieving pain and inflammation.

If conservative measures fail to treat the bunion pain, then your surgeon may recommend a surgical procedure to remove the bunion.

There are several surgical options to treat a bunion but the common goal is to realign the joint, correct the deformity, and to relieve pain and discomfort. These surgical procedures include:

• Repair of the tendons and ligaments - The soft tissues around the big toe may be tighter on one side and looser on the other creating an imbalance.  This can result in drifting of the big toe towards the second toe. Your surgeon will shorten the loose tissue to tighten it and lengthen the tight tissues to loosen them.  This procedure is often combined with an osteotomy, removal of bone pieces.
• Arthrodesis- Involves surgical removal of the damaged joint, followed by insertion of screws, wires, or plates to hold them together while healing. This procedure is used for severe bunions or severe arthritis patients.
• Osteotomy- Includes surgical cutting and realignment of the bones in the foot. This is the most common method of treatment and can be performed using open or minimally invasive technique. Most common types of Osteotomy performed are Scarf Osteotomy and Chevron Osteotomy.

The orthopaedic surgeon selects the appropriate surgical procedure based on the patient’s presentation.

Risks and complications

Apart from general complications related to any surgery, complications after bunion surgery can include infection, recurrence of bunion, nerve damage, stiffness fracture, further surgery, failure of implant and unresolved pain.

Post-operative care

Patients should follow all instructions given by the orthopaedic surgeon. Common post-operative instruction includes:

• Keep your dressing dry and do not remove for the specified time given by your surgeon
• Elevate the foot as much as possible for the first six weeks to minimize swelling.
• Exercise and physical therapy are recommended for strengthening and restoring range of motion to the foot.
• Stopping smoking will drastically reduce the chances if complications following surgery.
• X-Ray may be necessary after your operation.

When Can I Return to Work After Surgery?

• This will depend on the type of work you do:
  Sedentary jobs: Return after 2 weeks, if able to maintain foot elevated at level of waist, otherwise 4 weeks off
• Standing/walking jobs: Return after 6 weeks, but may be sooner depending on comfort and swelling
• Manual/laboring jobs: Return after 8 weeks, but may be sooner depending on comfort and swelling

When Can I Drive After Surgery?

You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe at 2 weeks post operatively. For right sided surgery, driving is probably safe at 6 weeks post operatively, once in a normal shoe. If you are unsure, please ask your doctor.

The operation can be performed as a Day Case procedure, under a local anaesthetic ankle block, making the whole foot numb for 6-12 hours. You can be awake, sedated or have a general anaesthetic during surgery, which takes about 45 minutes. Most patients do not experience significant pain after surgery with the modern techniques.