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A bunion is a bony prominence that forms along the inside of the first metatarsal head. When the space between the first metatarsal and the second metatarsal widens over time, the inside of the first metatarsal head pushes out, causing an appearance of a bone prominence. In addition, the great toe starts to push against the second toe. This can be a source of discomfort.
Bunions are often genetic, but can also occur from wearing ill-fitting shoes for years. Bunions can be painful and make it difficult to walk or wear shoes. While there are nonsurgical treatments that can help relieve pain associated with a bunion deformity, surgery may be needed for painful bunions to correct the deformity.
Bunion Surgery Procedure- What to Expect
Bunion surgery would be done in the operating room under IV sedation. You will be sleeping during the entire surgery.
There are several different types of bunion surgery. The type of surgery that is right for you will depend on the severity of your bunion and your overall health.
If the bunion is mild, your doctor may suggest a simple exostectomy procedure. This would entail resecting the bone prominence.
If the bunion is moderate to severe, your doctor will have to cut the first metatarsal bone and the bone in the great toe (by taking wedges away from the bones) to correct the deformity. This is called an osteotomy procedure. The osteotomy sites would be fixated using screws, plates, or staples. In some cases, a fusion at the midfoot may be needed to correct the deformity.
If you have a lot of arthritis in your big toe joint plus a severe bunion deformity, your surgeon may choose to fuse the great toe joint. This is an arthrodesis procedure.
Bunion surgery can take anywhere from 30 minutes to 2 hours to complete.
After the surgery, your surgeon will close the incision sites using a suture (thread) or staples. A post-operative dressing will be applied.
Bunion Surgery Recovery- What To Expect
If you have a simple exostectomy procedure, your doctor will recommend you stay partially weight-bearing in a surgical post-op shoe for 3-4 weeks after surgery. Stitches would be removed in 2 weeks.
If you undergo an osteotomy or arthrodesis procedure, you will need to remain non-weight bearing in a cast boot or splint for 6-8 weeks after the procedure. This will allow the bones cuts/fusion site to heal.
To help you stay off of your foot you can use a knee scooter or crutches. You can obtain them on Amazon or from a medical equipment store.
If you have a cast or cast boot on, your doctor will recommend that you wear them even while sleeping to prevent injury to the foot.
You will need to keep the dressing and cast dry while in the shower. Use a cast protector to keep your leg dry. You can obtain one from Amazon.
Make sure to keep your leg elevated to reduce swelling to the foot. Swelling after bunion surgery can last up to a year.
Your doctor will see you in the office every several weeks and obtain post-op radiographs to ensure your surgery site is healing. After 6-8 weeks, if the surgery site is healed, your doctor will allow you to transition into athletic shoes as tolerated.
Occasionally, physical therapy may be needed to improve strength and decrease pain and swelling. Physical therapy would be needed 3 times a week for 1 month.
Bunion Surgery Complications- What To Expect
Just like with any foot surgery, there is a chance that complications can occur.
Some of the more common bunion surgery complications include:
Infection: One of the most common complications of bunion surgery is infection. While the risk of infection is always present with any type of surgery, it’s important to understand that due to the nature of bunion surgery (i.e., cutting through bone and soft tissue), and the presence of internal hardware, the risk of infection is higher. If you develop an infection after bunion surgery, it’s important to seek medical help immediately. You will need antibiotics to clear the infection.
Nerve Damage: Another potential complication of bunion surgery is nerve damage. The bones in your feet are very close to the nerves that run along them, so there is a risk that these nerves could be damaged during surgery. Nerve damage can cause numbness, tingling, or pain in the affected area. The nerve damage can be temporary or permanent
Delayed healing: In some cases, the osteotomy and arthrodesis sites may not heal. This can cause continued pain and require another surgery. Delayed healing risks are increased if you smoke or have diabetes.
Blood Clots: Blood clots in the leg, although rare, can occur after bunion surgery. This is because prolonged immobilization in a cast places you at a higher risk for a deep vein thrombosis. If you experience severe calf pain, redness or swelling, contact your doctor immediately or go to the Emergency Room.
Recurrence of bunion deformity: Occasionally, bunions can recur. This can occur due to genetics, and due to tendons and ligaments that continue to pull on the bones. Not only that, wearing improper shoes without orthotics can cause bunions to recur as well. Make sure you wear well-fitted shoes and orthotics to prevent a recurrence.
To read more about how bad shoes can cause foot problems, check out this supplemental post.
Will Your Shoe Size Change After Bunion Surgery?
Your shoe size will change after bunion surgery. Your foot will be more narrow after surgery. However, for the first year after bunion surgery, your foot will be more temporarily swollen. Once the swelling goes down, you should go to a shoe store and get your feet measured for length and width before picking appropriate shoes.
Shoe size length and width can be done using a Brannock device.
Check out this video by SanLuis Podiatry on how to measure your feet using a Brannock device:
Can I Drive After Bunion Surgery?
You should refrain from driving for 6 weeks minimum after bunion surgery. This is especially true if you had surgery done on your right foot. You must be cleared by your surgeon to drive. Do not drive with a cast or boot on. Do not drive while you are taking narcotics. This can cause you to become light-headed and dizzy and increase the likelihood of a motor vehicle accident.
How Soon Can I Return to Work After Bunion Surgery?
Returning to work after bunion surgery will be dependent on your job position. If you have a sit-down job and can elevate your foot while seated, you can return to work within 2 weeks. Make sure you are not working while taking narcotics.
If you have a job that requires you to walk or stand on your feet a lot, you will need to take 6-8 weeks off until you can walk again.
Can You Feel the Screw After Bunion Surgery?
Most people cannot feel the hardware after bunion surgery because the screws are inside the bone. In some people, however, hardware from bunion surgery can be felt and cause discomfort. Once your osteotomy or arthrodesis site heals, your doctor may suggest removing the hardware several months later.
How Much Does It Cost to Fix a Bunion?
The cost of bunion surgery can vary anywhere from $3,000-$12,000 depending on the procedure performed. However, in many cases, insurance may cover most of the cost if not all of it. It’s best to call your insurance company to see if the surgery would be covered.
What Happens if Bunions Go Untreated?
In most cases, bunions do become larger over the years. However, in many people, bunions do not cause pain. You can certainly live with a bunion deformity. Simple shoe gear modifications and orthotics can slow down the progression of bunions. Talk to your foot doctor about custom orthotics and shoe gear recommendations.
In conclusion, bunion surgery can be complex and involves a lengthy recovery process. However, many bunions have been repaired successfully with good results. If conservative treatment options such as padding, shoe gear changes, and orthotics have not helped, talk to your doctor about whether bunion surgery would be a good option for you.
Have you had bunion surgery before? Leave a comment below!
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