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Bunion
A bunion (hallux valgus) is a progressive deviation of the big toe towards the second toe and development of a knot on the ball of the big toe. This deformity is very common, more often effecting women, primarily due to narrow toed shoes, and can occur at any age.
The cause is due to an imbalance of the tendons attached to the base of the big toe. Like reigns on a horse, if one reign is pulled tighter than the other, the horse turns. Similarly, the flexibility of one's foot changes the tension on the tendons attached to the big toe. Over the course of many years, this causes a gradual drift of the big toe towards the second toe.
Development of a bunion is primarily genetic and prevention is aimed at reducing the flexibility of the foot.
Treatment options involve accommodative, wide shoes to reduce the pressure against the ball of the big toe, padding of the area, or surgery.
Surgical treatment varies widely by physician, as does the level of mobility allowed after surgery. Also, the actual techniques used to correct the bunion can also vary by provider and can alter the amount of mobility permitted in the post-operative period.
In my practice, most bunion surgeries are performed as an outpatient, where the patient arrives to the hospital or surgical center, has the procedure, and goes home all in the same day. The surgery is also frequently performed under IV sedation, also called "twilight anesthesia". This involves insertion of an intravenous (IV) line into the arm or hand. Medications to make the patient dose off to sleep will then be administered allowing pain free injection of local anesthetic into the surgical site. The patient does not feel the injections, does not inhale gas, have a tube down their throat, nor do they experience the nausea and vomiting often associated with a general anesthetic.
The surgery takes an average of 30-60 minutes. Depending upon the severity of the bunion, the amount of activity permitted after the surgery may range from walking in a removable walking boot to a below knee cast, complete nonweight bearing, and use of crutches.
Typically, in my practice, a bunion surgery involves use of a walking boot, where the patient is allowed to walk on a limited basis beginning the same day of surgery. This involves walking to the restroom, kitchen, car, etc. Prolonged walking or standing is not advised. Primary bone healing occurs in 4-6 weeks, and may extend to 8 weeks for smokers. The patient is allowed to return to a large tennis shoe at five weeks, pending everything looks good both clinically and on x-ray. The foot will continue to be wrapped with a compressive wrap in the shoe for up to two more months to minimize swelling.
It is my opinion that returning to a regular shoe within five weeks of the surgery is risky. During the first five weeks after surgery, the bones are healing, but not fully healed. Like glue partially dried, the bones that were corrected are fragile. If the foot is not sufficiently splinted or stabilized, and should the foot be jarred or a toe be stubbed, the surgical site can become dislodged and positioned out of alignment, resulting in a return of the deformity, continued pain, or a return to the operating room for repairs.
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Illustration copy of the American Podiatric Medical Association
Severe Bunion Deformity
Pre-operative
Post-operative
Please call the office with any concerns regarding insurance coverage.
Some insurance plans require a referral prior to being seen by a specialist (podiatrist).
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