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When you hear the term “bunionectomy”, your thoughts focus mainly on the possible complications. What are they?

Complications of bunion surgery are not common but include infection of soft tissue or bone, slow healing of skin or bone, irritation from fixation pins or screws, nerve entrapment, and reaction to the foreign material. Bunionectomy patients commonly report side effects such as excessive swelling, scarring, or stiffness, and recurrence of the deformity. Rarely, some complications may require a second surgery to correct the problem, so people are not sure what to do. Although these complications are rare, they should be weighed against the difficulty that you are experiencing to determine whether surgery is an acceptable risk. It is necessary to know both the benefits and the side effects of bunion removal. It is also important to know as much as possible about preparing for the surgery and post operative recovery. [1]

What is a Bunion Deformity?

The term “bunion deformity” is used to describe an enlargement that causes pain to the first metatarsal head. The bone enlargement can cause inflammation and pain in the form of bunion bursitis. Bunion deformities are inherited and can be aggravated by shoes. Most patients begin to feel increasing pain when a joint changes position and improper subluxation of the joint creates increased pressure to the medial aspect of the foot. An enlargement of the bone can cause a painful swelling of the joint when it moves. [2]

Conservative measures such as anti-inflammatory drugs, padding, and shoe modification can sometimes help. However, if inflammation and pain persist, a surgical correction of the deformity can be considered.

Surgical correction involves removing bone from the first metatarsal head to decrease pressure against the skin during movement. The key to a successful bunionectomy is a relocation of the joint surface without compromising joint function. Most patients can walk in a postoperative shoe directly after surgery, while bone healing takes 6 weeks and residual swelling can sometimes persist for 2 months after the correction.

Good bunion correction will give the patient a significant relieve of bunion pain.

Definition of Bunionectomy

Bunionectomy is a surgical procedure to excise or remove a bunion. As we already said, a bunion is an enlargement of the joint at the base of the big toe and is comprised of bone and soft tissue. It is usually a result of inflammation and irritation from poorly fitting shoes in conjunction with an overly mobile first metatarsal joint.

Over time, a painful lump appears at the side of the joint, while the big toe appears to buckle and move sideways towards your second toe. New bone growth can occur in response to the inflammatory process, and a bone spur may develop, which causes a problem. That is why the development of a bunion may involve soft tissue as well as a hard bone spur. The intense pain makes walking and other activities extremely difficult. Therefore, many people decide to have a bunionectomy. The involved joint is a structure significant in providing weight-bearing stability. Therefore, walking on the foot while trying to avoid putting pressure on the painful area can result in an unstable gait. [1]

Condition Description: What Are Bunions and How Is Surgery Performed?

Bunions become more common later in life. One reason is that the foot spreads with age and cannot maintain a proper alignment. 

A constant friction of poorly fitting shoes against the big toe joint can create a greater problem over time. Ignoring the problem in its early stages leads to a shifting gait that further aggravates the situation, which might end in a bunionectomy. 

Once surgery has been decided on, the extent of the procedure will depend on the degree of deformity. There are several different surgical techniques, mostly named after the surgeons who developed them. The degree and angle of deformity, as well as the patient’s age and physical condition, play a significant role in the surgeon’s choice of technique, who is going to determine how much tissue will be removed and whether or not bone repositioning will occur.

If bone repositioning is done, that part of the surgery is referred to as an osteotomy. The type of anesthesia — ankle block, general, or spinal — will depend on the patient’s condition and anticipated extent of surgery. 

For surgery done on an outpatient basis, the patient will usually be asked to arrive one to two hours before the surgery. He will also be asked to stay for about two to three hours after the procedure.

The surgeon will make an incision over the swollen area at the first joint of the big toe so that the enlarged lump can be removed. The surgeon may also need to reposition the alignment of the bones of the big toe, which may require more than one incision. The bone itself may need to be cut, but if the joint surfaces have been damaged, the surgeon may hold the bones together with screws, wires, or metal plates. In severe cases, the entire joint may need to be removed. 

If pins were used to hold the bones in place during recovery, they will be removed a few weeks after the bunionectomy. In some mild cases, it may be sufficient to repair the tendons and ligaments of the big toe.

When the surgery is complete, the surgeon will close the incision with sutures. Commonly, a compression dressing will be wrapped around the surgical wound, which helps keep the foot in alignment as well as reduce postoperative swelling.

Preparing for Bunion Surgery

Intense pain at the first joint of the big toe is what most commonly brings the patient to the doctor, but a loss of toe mobility may also have occurred. The problem might be located in either foot or in both. 

Diagnosis of a bunion is based on a physical examination, a detailed history of the patient’s symptoms and their development over time. X-rays are also used to determine the degree of deformity.

Conservative measures are usually the first line of treatment and deal with the acute phase of the condition. Your doctor will also attempt to stop the progression of the condition to a more serious form. These measures may include rest and elevation of the affected foot, and elimination any additional pressure on the tender area, perhaps by using soft slippers instead of shoes. You will also be recommended to soak the foot in warm water to improve blood flow (after the stitches are removed) and to use oral anti-inflammatory medication

Some patients systematically use orthotic, either an over-the-counter product or ones that are molded to the foot. It might also help to use the cushioned padding against the joint when wearing a shoe.

If all these measures prove unsuccessful, or if the condition has worsened to significant foot deformity and altered gait, then a bunionectomy is recommended. The doctor may use the term hallux valgus when referring to the bunion, which means big toe. 

You will be given anesthesia (numbing medicine) so that you won't feel pain. Anesthesia may be local, spinal or general.  

In discussing the surgical option, it is important for the patient to understand the degree of improvement after the surgery. As previously said, X-rays will be taken to determine the exact angle of displacement of the big toe and potential involvement of the second toe.

When patients prepare for bunionectomy, a doctor will probably order blood tests, an EKG, and a maybe even chest x-ray, which is done to be sure that no other medical condition that could affect the success of the surgery and the patient’s recovery had gone undiagnosed.

Postoperative Recovery

Recovery from a bunionectomy takes place both at the surgical center as well as in the patient’s home. Immediate post-surgical care is provided in the surgical recovery area after the procedure. The patient's foot will be monitored for bleeding and excessive swelling.

However, you should know that some swelling is considered normal.

The patient will need to stay for a few hours in the recovery area before being discharged, which allows time for the anesthesia to wear off. 

The patient will be monitored for nausea and vomiting, potential after effects of the anesthesia, which is an important part of postoperative care. He will also be given something light to eat, such as crackers and juice or ginger ale, to see how he tolerates food. 

Hospital policy usually requires that the patient have someone drive them home; the patient will most likely be on pain medication that could cause drowsiness and impaired thinking, besides fresh wound interferes with the ability to drive.

It is important to contact the surgeon if any strange symptoms occur after discharge from the surgical center. A patient should report any fever, chills, constant or increased pain at the surgical site, redness and warmth to the touch in the area around the dressing, swelling in the calf above the operated foot, or if dressing has become wet and fell off. [3]

A patient can expect to return to normal activities within six to eight weeks after the surgery, but the foot is at increased risk of swelling for several months. 

It is also important to know that during the six-to-eight-week recovery period, a special shoe, boot, or cast may be worn to accommodate the surgical bandage and to help provide stability to the foot that underwent the bunionectomy.