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Bunion Surgery - Overview
The surgical correction of bunions is
dependent upon the severity of the deformity, the patient's over-all
health and activity level. Age and conditions such as diabetes do not
preclude bunion surgery as a form of treatment. There
are several different approaches to the surgical correction of bunions.
Most commonly, the surgery is performed in the area of the big toe
joint. The bony prominence is removed and the bone is surgically
fractured to allow realignment of the joint and straightening of the
big toe joint. This surgery is designed so that the patient can walk on
the foot almost immediately following the procedure; however, activity
must be significantly curtailed for several weeks following the
surgery. Typically, the patient is instructed to remain home from work
for at least one week with the foot propped up and elevated above the
heart throughout the day. If the patient's job requires much standing
or walking, they may be required to stay home from work for as much as
six weeks. Often the patient may return to work sooner if they are
placed in a removable below-the-knee walking cast. There are no short
cuts to the healing time. Healing time is based upon basic
physiological principles that are common to all human beings. Certain
vitamins and nutrients may help with the healing process. Laser surgery does not alter the healing time and provides no significant advantage to the performance of the surgery. Surgical Correction of Severe Bunion Deformity If
the bunion is more sever in nature surgery is performed further back on
the bone in order to straighten the big toe. When surgery is performed
in this area of the bone, there is greater instability of the bone
after it is cut and moved into a corrected position. Generally, the
surgeon will require the patient to wear a below-the-knee cast and use
crutches for three to eight weeks. Initial bone healing takes six to
eight weeks. This period of time can take longer in people who smoke. The
overall success rate and satisfaction of patients who have had bunion
surgery is quite high. The most common complaint of patients is the
healing time. This is particularly true if the patient is not
adequately prepared or informed as to what to expect. Most patients
experience minimal pain following the procedure and this pain is easily
controlled with pain medication prescribed by the surgeon. Possible Complications Potential
complications associated with the surgery are infection, over or
under-correction of the bunion, joint stiffness, delays in healing or
non healing of the bone, or healing of the bone in the wrong position.
Most of these complications can be avoided by following the surgeon's
instructions. Walking on the foot without the protection of a
post-operative shoe or cast, or against the surgeons advice can lead to
a dislocation of the bone where it has been cut. This results in delays
in healing, non-healing of the bone or healing of the bone in the wrong
position. Allowing the bandage to get wet increases the risk of
infection. The most critical time for an infection to occur is within
the first three days following surgery. Infection can also occur
following this period of time but is less common. Joint
stiffness following bunion surgery is common, but generally improves
with time. Postoperative physical therapy is useful to improve the
movement of the joint but is not always necessary. Bunions on Both Feet- Considerations with Regard to Surgery If
a person has bunions on both feet, many surgeons feel that their
patients recover quicker and with fewer complications if the surgery is
performed on one foot at a time. Many surgeons prefer to wait a minimum
of four to five weeks between surgeries. Other surgeons prefer that
their patients wait longer between surgeries. Place of Service and Anesthesia Considerations Most
often the bunion surgery is preformed in an outpatient surgery center
or hospital. Some surgeons will perform this procedure in their office.
Anesthesia for the surgery can range from a straight local anesthesia,
given by injection into the area of surgery, to a general anesthesia
with the administration of an anesthetic gas. A very common form of
anesthesia is a combination of a local anesthesia and medicine given
intra-venous to make the patient drowsy. This is commonly called
twilight anesthesia. Generally there is very
little blood loss during surgery. Most often the surgeon will use some
form of tourniquet to stop bleeding during surgery. Because the surgery
can be performed in a relatively short period of time the use of a
tourniquet is very safe. Technically, the tourniquet can be left in
place for as long as 90 minutes safely in most cases. Surgeons who
perform bunion surgery are very knowledgeable in the use of
tourniquets. The potential for the need for a blood transfusion with
bunion surgery is nearly non-existent. Can My Bunion Come Back? It is important to understand that bunion surgery does not correct the cause of the bunion.
Therefore there is the possibility that the bunion can reoccur. How
quickly a reoccurrence will occur is difficult to predict. It may take
several years or just a matter of months for the bunion to begin to
come back. Bunions are caused by abnormal movement of a set of joints
below the ankle joint in the foot called the subtalar joints. To help
prevent the bunion from reoccurring the patient should be prescribed a functional orthotic.
These are custom-made shoe inserts that correct the abnormal function
of the foot. Generally they will fit in normal shoes without requiring
the use of larger shoes. Most foot surgeons will suggest the use of
orthotics following bunion surgery to help prevent the reoccurrence of
the deformity.
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