Expected Outcome for Bunion Surgery
To eliminate pain, stiffness and malalignment of the big toe.
Bone which is limiting joint motion and/or protruding from the joint is removed and the big toe joint is realigned.
If the joint is very arthritic, the base of the big toe is removed and a pin (K wire) is inserted through the big toe and into the first metatarsal bone. This allows for a fibrous joint to form in place of the arthritic one. The pin is removed (with minimal pain) in the office. No anaesthetic is required. This procedure allows for immediate weight bearing after surgery.
Little or no arthritis
Usually a bone cut is made to allow for realignment of the metatarsal bone. Tight soft tissues are released on the inside of the joint and loose soft tissues on the outside of the joint are tightened. A combination of bone and soft tissue procedures allow the big toe to be properly aligned. A screw or pin is used under the skin to hold the bone in its new position. Occasionally these are removed under local anaesthetic in the office but this is not done before three months after surgery. The majority of these procedures allow for immediate weight bearing after surgery. However, in cases of very large bunions or juvenile bunions a period of six weeks of non weight bearing using crutches may be needed.
All of these procedures may be performed as Day Surgery. This may be in the Podiatrist’s office operating room or in a Hospital or a Day Surgery Centre.
A specialist Anaesthetist is used for the administration of anaesthesia and intravenous antibiotics to prevent infection. Intravenous sedation in combination with local anaesthetic block is used in the vast majority of bunionectomy procedures.
The advantage of this type of anaesthesia over general anaesthesia is that your recovery is usually more rapid. You will go off for a “light sleep” for most of the procedure. Often patients are partially aware of the last few minutes in the operating room. However as this type of anaesthesia has calming and amnesic effects, very few patients can recall any of this. You will be required to fast for 8 hours before the surgery and a responsible adult must accompany you home and be available for the first 24 hours after surgery.
POST OPERATIVE CARE:
A post operative shoe is provided and used for 3 weeks. The dressing is changed from 3 to 7 days after surgery. Sterile dressings are then dispensed with after a further 2 weeks. The foot is kept dry for 2 weeks after surgery. At this point in time a compression bandage is used. The patient is then asked to obtain a lace up sneaker which is a half to a full size larger than normal. The toe is splinted and the modified foot wear is used for 6 to 8 weeks after surgery. Usually at 10 to 12 weeks after surgery normal foot wear can be used.
Non Arthritic Bunions
A post operative sandal is used for 5 to 6 weeks after surgery. The dressing is changed at 3 to 7 days after surgery and again at 2 weeks after that. Depending on the procedure performed the foot must be kept dry for 2weeks and sometimes for up to 6 weeks. The same type of splint and modified foot wear as previously mentioned is used post operatively. Return to normal foot wear occurs at 10 to 12 weeks after surgery.