Therapy after bunion surgery

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Information from the American Podiatric Medicine Association and the American Academy of Orthopaedic Surgeons

Most bunions can be treated without surgery. But when non-surgical treatments are not enough, surgery often can relieve the pain, correct any related foot deformity, and help with resumption of normal activities.

An orthopedic surgeon or podiatric surgeon can help you decide if surgery is the best option for you.

A bunion is one problem that can develop due to hallux valgus. The term "hallux valgus" is Latin and means a turning outward (valgus) of the big toe (hallux). The big toe joint becomes prominent on the inner border of the foot. This bump is the bunion and is made up of bone and bursal soft tissue swellinmg.

The most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezs the toes into an unnatural position. Bunions also may be caused by arthritis. Heredity often plays a role in bunion formation.

Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunions can be managed without surgery. In general, bunions that are not painful do not need surgical correction.

here are some tips on how to deal with bunions:

• Do not select shoes by the size marked inside the shoe. Sizes vary among shoe brands and styles. Judge the shoe by how it fits.
• Select a shoe that conforms as nearly as possible to the shape of the foot.
• Have your feet measured regularly. The size of feet changes as you grow older.
• Have both feet measured. Most people have one foot larger than the other. Fit to the largest foot.
• Fit at the end of the day when your feet are the largest. Stand during the fitting process and check that there is adequate space (3/8" to 1/2") for your longest toe at the end of each shoe.
• Make sure the ball of the foot fits well into the widest part of the shoe.
• Do not purchase shoes that feel too tight, expecting them to "stretch" to fit.
• Your heel should fit comfortably in the shoe with a minimum amount of slippage.
• Walk in the shoe to make sure it fits and feels right.

Some shoes can be modified by stretching the areas that put pressure on your toes. Splints to reposition the big toe and orthotics (special shoe inserts shaped to your feet) also may relieve pain.

If non-surgical treatment fails, surgery may be considered. Many studies have found that a majority of patients who undergo bunion surgery are satisfied with the results.

Reasons that you may benefit from bunion surgery commonly include:

• Severe foot pain that limits your everyday activities, including walking and wearing reasonable shoes.
• Chronic big toe pain and swelling that doesn’t improve with rest or medications.
• Toe deformity.
• Toe stiffness with inability to bend and straighten your toe.
• Failure to improve with other treatments such as a change in shoes and anti-inflammatory medication.

Beware of unrealistic claims that surgery can give you a "perfect" foot. The goal of surgery is to relieve as much pain, and correct as much deformity as is realistically possible. It is not meant to be cosmetic.

Orthopedic and podiatric surgeons use many different surgical procedures to treat bunions. The common goal of these procedures is to realign the joint, relieve pain, and correct deformity. These procedures include:

Repair of the Tendons and Ligaments
These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. Often combined with an osteotomy (removing a wedge of bone), this procedure shortens the loose tissues and lengthens the tight ones.

Arthrodesis is removal of damaged joint surface, followed by the insertion of screws, wires, or plates to hold the surfaces in place until healing occurs. This is used for patients with severe bunions, severe arthritis, and when other procedures have failed.

Resection arthroplasty is removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis.

Osteotomy is cutting and realignment of the joint. Your surgeon will choose the procedure best suited to your condition.

An important factor in deciding whether to have bunion surgery is understanding what the procedure can and can not do. The vast majority of patients who undergo bunion surgery experience a reduction of foot pain after surgery, along with improvement in the alignment of their big toe.

Bunion surgery will not allow you to wear whatever shoes you would like.

Remember that the main cause of the bunion deformity is a tight fitting shoe. If you return to that type of shoe wear, your bunion may reoccur.

Before surgery, tell your surgeon about the medications you are taking. He or she will tell you which medications you should and should not stop taking before surgery.

Almost all bunion surgery is done on an outpatient basis.

Possible complications can include infection, recurrence of the bunion, nerve damage, and continued pain.

Your surgeon may advise you to use a walker, cane, or crutches for the first few days after surgery. You can gradually put more weight on your foot as your wound heals. However, walk only short distances during the first few weeks following surgery. You will probably be able to drive again within about a week.

Keep your foot elevated as much as possible for the first few days after surgery, and apply ice as recommended by your surgeon to relieve swelling and pain. You will have some swelling in your foot for about six months. After your dressings have been removed, wear only athletic shoes or soft leather oxford type shoes for the first several months until the surgery has completely healed. Do not wear fashion shoes, including high heels, until after six months. This will help prevent the recurrence of your bunion.

Some exercises or physical therapy may be recommended to restore your foot’s strength and range of motion after your surgery. Your surgeon may recommend exercises using a surgical band to strengthen your ankle or marbles to restore motion in your toes. Always start these exercises slowly and follow your surgeon’s or physical therapist's instructions regarding repetitions.

Your surgeon may prescribe antibiotics to prevent infection for several days after your surgery. Pain medication to relieve surgical discomfort also will be prescribed for several days.

Though uncommon, complications can occur following bunion surgery. Contact your surgeon if:

• Your dressing loosens, comes off or gets wet.
• Your dressing is moistened with blood or drainage.
• You develop side effects from postoperative medications.

Also, call your surgeon immediately if you notice any of the following warning signs of infection:

• Fever.
• Chills.
• Persistent warmth or redness around the dressing.
• Increased or persistent pain.
• Significant swelling in the calf above the treated foot.

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