One of the most common surgical procedures that a podiatrist
performs is bunion correction. Bunions
are a result of hallux abducto valgus, a deformity of the foot that leads to
increased pressure at the first metatarsophalangeal joint. Bunions can become extremely painful, and can
limit a person’s activity level and restrict them to only certain types of
shoes. Conservative therapy can help to
alleviate some of the symptoms of bunions, but even the best methods of
strapping and bracing do not correct the problem. Surgical correction of hallux abducto valgus
and the bunion associated with the deformity is paramount to treatment.
A small incision is made along the medial side of the
metatarsaophalangeal joint, where the bunion is. This incision site is then deepened until the
joint is reached, being careful to avoid the nerves and veins that run in the
area. Once the joint is reached, the
joint capsule can be cut to access the bone.
The surgical approach to bunions most commonly involves an
osteotomy, or cutting of the bones, at the head of the first metatarsal. This is the part of the metatarsal that is
closest to the joint. By cutting the
metatarsal, the operating surgeon is able to reposition the head of the
metatarsal in a more functional position, thus eliminating the bunion. The bone is then fixed with one or two
screws, which keep the two pieces of the bone in place while it can heal. Any remaining bone in the area that may be
prominent or painful is also removed.
Some other approaches to bunions may involve simply removing
the painful bump, repositioning the metatarsal head to gain more motion at the
joint, or the use of joint implants.
Some bone cuts may be positioned further away from the joint, which
allows for a greater correction of a more significant bunion. A number of different surgical osteotomies
have been used over the years.
A lateral release may be performed as well, which is when
the tendons on the lateral side of the metatarsophalangeal joint are cut. The tendons that course through the foot and
function at the first metatarsophalangeal joint often become contracted in the
presence of hallux abducto valgus. These
structures are cut in order to reposition the toe in a more straightened
position.
Following all of the corrective procedures in bunion
surgery, the final step is to close everything up, layer by layer. The joint capsule is often closed using a technique
to tighten it, as the once prominent joint has now been removed. This leaves an excess of tissue that should
be addressed. The skin is then closed
with suture, and stitches may be left in for two or three weeks. Some sutures are absorbable, and there is no
need to take them out.
After the surgery, the patient is usually placed in a
bandage and a surgical shoe, which they are allowed to walk in. Patients receiving bunion surgery are
instructed to only walk a little bit, and to keep the foot elevated most of the
time. This is done so that the body has
time to heal the surgical wounds that have been created. They are typically seen in the podiatrist’s
office following the surgery, or in some sort of follow-up clinic.
Some amount of pain and swelling is to be expected following
surgery, as the surgery itself can be rather traumatic. This swelling should resolve after a week or
so, and the pain should go away also. Pain
is usually addressed with oral pain medications. Elevation of the foot and ice placed behind
the knee or calf for fifteen minutes at a time will also help with pain and
reducing swelling.
Typically the skin will heal after two or three weeks, at
which time the sutures, if necessary, can be removed. Once the sutures are removed and the skin is
healed, the patient may either continue in the surgical shoe, or return to a
stiff-soled shoe or gym shoe. Much of
the post-operative treatment plan is surgeon-dependent. The bones will typically heal in six to eight
weeks. In the post-operative period, it
is common for the surgeon to obtain x-rays to evaluate the status of the
bones. This helps to determine the
post-operative course.
Bunions are sometimes corrected in conjunction with other
deformities of the foot, such as hammertoes or tailor’s bunions. If there are other areas of pain in the foot
besides the bunion, be sure to point them out to your doctor.
Talk to your podiatrist if you have painful bunions or any
other painful foot condition.
Conservative therapy will generally be attempted first, but surgical
intervention should be discussed with the operating doctor. They will be able to fill you in on details
regarding pre-operative preparation, the surgery, and the post-operative treatment
protocol.
Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
863-299-4551
www.FLFootandAnkle.com
