Bunion Surgery

Bunion Surgery

Table of Contents

Bunion Surgery

What is a Bunion?

A bunion is a bony bump that forms on the joint at the base of your big toe. It occurs when some of the bones in the front part of your foot move out of place. This causes the tip of your big toe to get pulled toward the smaller toes and forces the joint at the base of your big toe to stick out. The skin over the bunion might be red and sore.

The symptoms of bunions often occur in adults, but adolescents might also experience them.

They might occur because of an inherent problem with the bones of the foot. The technical term for bunions is hallux valgus. Some people have hallus valgus but never develop symptoms. Shoes that crowd the toes can increase the risk of symptoms, but they do not cause bunions directly.

Bunions might also occur near the base of the little toe instead of the big toe. These are known as bunionettes or “tailor’s bunion.”

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What is Bunion Surgery?

Bunion surgery is an operation to correct a bunion, which is a deformity of the joint at the bottom of your big toe. A bunion causes a bony lump to form on the side of your foot. This can be painful, especially when you’re walking or wearing shoes. Bunion surgery can remove or straighten the bone to ease your pain.

About Iranian Surgery

Iranian surgery is an online medical tourism platform where you can find the best orthopedic Surgeons and hospitals in Iran. The price of a Bunion Surgery in Iran can vary according to each individual’s case and will be determined based on photos and an in-person assessment with the doctor. So if you are looking for the cost of Bunion Surgery in Iran, you can contact us and get free consultation from Iranian surgery.

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Before Bunion Surgery

Causes

Many medical scientists believe people inherit the bone structure that causes bunions to develop.

Other factors add to the risk of bunion growth, including.

. Overpronation, which means having a low arch or uneven weight-bearing in the foot and tendon that makes the toe joint unstable

. Hypermobility, or having a big toe bone that moves more than usual

. Foot injuries

. Types of arthritis, such as rheumatoid arthritis

. Conditions that affect both the nerves and muscles, such as polio

. Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more likely to develop bunions.

If the feet do not develop properly before birth, this can also increase the risk.

Some people suggest that high-heeled or narrow shoes promote the growth of bunions. They might aggravate already-existing bunions or cause bunions to develop in people with a genetic risk of the condition, but they do not cause bunion growth directly.

A 2014 systematic review suggests that around 2 percent of children under the age of 10 years have this condition and almost half of all adults.

Adolescent bunions are most likely to occur in girls between the ages of 10 and 15 years. This tendency usually runs in families.

A younger person with bunion is usually able to move their toe up and down. In adults, a bunion is more likely to restrict movement.

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Symptoms

The classic symptom of a bunion is a bump that forms at the base of the big toe. These can also form at the base of the little toe. When this occurs, a doctor will diagnose bunionette or “tailor’s bunion”.

Other symptoms of bunions may include:

. Pain and soreness

. Numbness

. A burning sensation

. Swelling at the joint of the affected toe

. Increased skin thickness at the base of the affected toe

. Hardened skin under the foot

. Redness

. Bump on the base of the affected toe

. The presence of corns or calluses

. Movement restriction within the affected toe

Wearing narrow shoes and high heels or standing for a long time may worsen the symptoms.

Bunions begin as small lumps. They get worse over time, however, causing pain and making walking difficult.

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Who is a good candidate for a bunion surgery?

In general, if your bunion is not painful, you do not need surgery. Although bunions often get bigger over time, doctors do not recommend surgery to prevent bunions from worsening. Many people can slow the progression of a bunion with proper shoes and other preventive care, and the bunion never causes pain or other problems.

It is also important to note that bunion surgery should not be done for cosmetic reasons. After surgery, it is possible for ongoing pain to develop in the affected toe — even though there was no bunion pain prior to surgery.

Good candidates for bunion surgery commonly have:

. Significant foot pain that limits their everyday activities, including walking and wearing reasonable shoes. They may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain.

. Chronic big toe inflammation and swelling that does not improve with rest or medications

. Toe deformity—a drifting in of the big toe toward the smaller toes, creating the potential for the toes to cross over each other.

. Toe stiffness—the inability to bend and straighten the big toe

. Failure to obtain pain relief with changes in footwear

. Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. The effectiveness of NSAIDs in controlling toe pain varies greatly from person to person.

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Preparing for Surgery

Medical Evaluation

Before your surgery, you may be asked to visit your family doctor for a complete physical examination. He or she will assess your health and identify any problems that could interfere with your surgery. If you have a heart or lung condition or a chronic illness you will need a preoperative medical clearance from your family doctor.

Medications

Tell your doctor about any medications you are taking. He or she will tell you which medications you can continue taking and which you should stop taking before surgery.

Tests

You may require several preoperative tests, including blood counts, a cardiogram, and a chest x-ray. You may also need to provide a urine sample.

To help plan your procedure, your doctor may order special foot x-rays. These x-rays should be taken in a standing, weight bearing position to ensure your doctor can clearly see the deformity in the foot. These x-rays assist your doctor in making decisions about where along the bone to perform an osteotomy in order to provide enough corrective power to straighten the toe.

Side-effects of bunion surgery

Side-effects after bunion surgery may include:

. A sore foot, especially your big toe

. Swelling of your foot

. Weakness of your leg if you’re wearing a cast for several weeks

It may take six months to a year for your swelling to go down completely.

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Complications of bunion surgery

Bunion surgery can cause some complications. These include:

. A stiff toe – this doesn’t bother most people but it can be important for athletes or dancers.

. A numb toe – the nerves in your toe may be injured

. An abnormal toe position – your big toe may heal out of line and bend outwards or upwards, or be slightly shorter.

. An infection – for which you may need antibiotics

. Pain under the ball of your foot – this can happen if there’s a change in the distribution of your weight.

. The bunion coming back – or a corrected bunion may get worse so you may need to have another operation.

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When to see/contact your doctor

Contact your hospital or GP if you have:

. A high temperature

. Worsening pain or pain that doesn’t get better when you take painkillers

. Redness around your dressing or if it feels warm

. Swelling or pain in your calf muscle of your leg

. Any discharge from your wound

During Bunion Surgery

Treatment

Two main options are available to actively treat bunion: Medications and surgery.

Medication

Medication can help with pain and swelling.

. Pain-relieving medications: Ibuprofen, for example, can reduce pain and swelling. They are available over-the-counter.

. Cortisone injections: These can relieve swelling, particularly in the fluid-filled pads that cushion the bones. A doctor will advise about these.

Surgery

Some people with bunions may need surgery. When bunions require surgery, several different procedures are available.

Types of bunion surgery

There are various types of bunion surgery aiming to either reposition the bone or remove a part of the tissue. Some of these techniques might be performed simultaneously for severe bunions. The surgeon chooses the type of surgery he or she wants to perform depending on certain factors, including:

. The degree of bunion deformity

. Whether the bunion includes inflamed tissue as well as enlarged bone

. The effect of a bunion on nearby toes

. Your age

. Your physical condition

Most surgical methods to correct a bunion involve bone repositioning. They could also include removing a part of the tissue, realigning ligaments or performing surgery on other toes. The following are the main techniques performed during bunionectomy:

. Repairing the Tendons and Ligaments around the Big Toe

In some cases, the soft tissues around the big toe may be too tight on one side and too loose on the other. This creates an imbalance that causes the big toe to drift toward the other toes.

Surgery can shorten the loose tissues and lengthen the tight ones. This is rarely done without some type of alignment of the bone, called an osteotomy. In the majority of cases, soft tissue correction is just one portion of the entire bunion corrective procedure.

. Osteotomy

In an osteotomy, your doctor makes small cuts in the bones to realign the joint. After cutting the bone, your doctor fixes this new break with pins, screws, or plates. The bones are now straighter, and the joint is balanced.

Osteotomies may be performed in different places along the bone to correct the deformity. In some cases, in addition to cutting the bone, a small wedge of bone is removed to provide enough correction to straighten the toe.

As discussed above, osteotomies are normally performed in combination with soft tissue procedures, as both are often necessary to maintain the big toe alignment.

. Arthrodesis

In this procedure, your doctor removes the arthritic joint surfaces, then inserts screws, wires, or plates to hold the surfaces together until the bones heal. Arthrodesis is commonly used for patients who have severe bunions or severe arthritis, and for patients who have had previous unsuccessful bunion surgery.

. Exostectomy

In this procedure, your doctor removes the bump from your toe joint. Exostectomy alone is seldom used to treat bunions because it does not realign the joint. Even when combined with soft tissue procedures, exostectomy rarely corrects the cause of the bunion.

Exostectomy is most often performed as one part of an entire corrective surgery that includes osteotomy, as well as soft-tissue procedures. If a doctor performs exostectomy without osteotomy, however, the bunion deformity often returns.

. Resection Arthroplasty

In this procedure, your doctor removes the damaged portion of the joint. This increases the space between the bones and creates a flexible “scar” joint. Resection arthroplasty is used mainly for patients who are elderly, have had previous unsuccessful bunion surgery, or have severe arthritis not amenable to an arthrodesis (see above). Because this procedure can change the push off power of the big toe, it is not often recommended.

Your Surgery

In planning your surgery, your doctor will consider several things, including how severe your bunion is, your age, your general health and activity level, and any other medical issues that may affect your recovery.

Almost all bunion surgery is done on an outpatient basis. You will most likely be asked to arrive at the hospital or surgical center 1 or 2 hours before your surgery.

Anesthesia

After admission, you will be evaluated by a member of the anesthesia team. Most bunion surgery is performed with anesthesia that numbs the area for surgery but does not put you to sleep.

. Local anesthesia. An ankle block numbs just your foot.

. Regional anesthesia. A popliteal block works for a longer period of time compared to an ankle block and numbs more of the leg. The numbing medicine is injected behind the knee.

. Spinal anesthesia. This injection will numb your body below your waist.

. General anesthesia. This form of anesthesia will put you to sleep.

The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.

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Procedure

Depending upon your bunion and the procedures you need, your doctor will make an incision along the inside of your big toe joint or on top of the joint. In some cases, more than one incision is needed to correct the bunion deformity.

The surgical time varies depending on how much of your foot is misaligned. Surgery will take longer if your deformity is greater or if more than one osteotomy is required. Every bunion correction is a little bit different, and there is no reason to be concerned if your surgery takes more time.

Afterward, you will be moved to the recovery room. You will be ready to go home in an hour or two. Be sure to have someone with you to drive you home.

Home remedies

Lifestyle adaptations to relieve bunions include:

. Appropriately fitting footwear: Shoes that leave sufficient space inside for the toes can relieve pressure.

. Foot measuring: A good shoe shop will measure your feet and advise on suitable footwear options.

. Shoe inserts: Also known as orthotics, inserts relieve pressure on the toe. Orthotics are available for purchase online.

. Padding, taping, or splinting of the toe: This can help provide support and reduce irritation.

. Avoiding activities that increase pain: These activities might include standing for a long period of time or playing contact sports.

. Ice: Applying ice to the affected area can help reduce swelling.

Prevention

Wearing well-fitting shoes with a wide toe box can help prevent the development of bunions. Avoid shoes with pointy toes and high heels.

People should also avoid wearing shoes that cause cramping, squeezing, pressing, or irritation of the toes and feet.

After Bunion Surgery

Recovery

The success of your surgery will depend in large part on how well you follow your doctor’s instructions at home during the first few weeks after surgery. You will see your doctor regularly for several months — occasionally up to a year — to make sure your foot heals properly.

Dressing Care

You will be discharged from the hospital with bandages holding your toe in its corrected position.

Because keeping your toe in position is essential for successful healing, it is very important to follow your doctor’s directions about dressing care. Do not disturb or change the dressing without talking to your doctor. Interfering with proper healing could cause a recurrence of the bunion.

Be sure to keep your wound and dressing dry. When you are showering or bathing, cover your foot with a plastic bag.

Your sutures will be removed about 2 weeks after surgery, but your foot will require continued support from dressings or a brace for 6 to 12 weeks.

Medications

Your doctor will prescribe pain medication to relieve surgical discomfort. The most effective medications for providing postsurgical pain relief are opioids. These medications are narcotics, however, and can be addictive. It is important to use opioids only as directed by your doctor.

As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

In addition to pain medicine, your doctor may prescribe antibiotics to help prevent infection in your wound for several days after surgery.

Swelling

Keep your foot elevated as much as possible for the first few days after surgery, and apply ice as recommended by your doctor to relieve swelling and pain. Never apply ice directly on your skin. It is common to have some swelling in your foot from 6 months to a year after bunion surgery.

Bearing Weight

Your doctor will give you strict instructions about whether and when you can put weight on your foot. Depending upon the type of procedure you have, if you put weight on your foot too early or without proper support, the bones can shift and the bunion correction will be lost.

Some bunion procedures allow you to walk on your foot right after the surgery. In these cases, patients must use a special surgical shoe to protect the bunion correction.

Many bunion surgeries require a period of no weightbearing to ensure bone healing. Your doctor will apply dressings, a brace, or a cast to maintain the correct bone position. Crutches are usually used to avoid putting any weight on the foot. A newer device called a knee walker is a good alternative to crutches. It has four wheels and functions like a scooter. Instead of standing, you place the knee of your affected foot on a padded cushion and push yourself along using your healthy foot.

In addition to no weightbearing, driving may be restricted until the bones have healed properly — particularly if the surgery was performed on your right foot.

No matter what type of bunion surgery you have, it is very important to follow your doctor’s instructions about weightbearing. Do not put weight on your foot or stop using supportive devices until your doctor gives approval.

Physical Therapy and Exercise

Specific exercises will help restore your foot’s strength and range of motion after surgery. Your doctor or physical therapist may recommend exercises using a surgical band to strengthen your ankle or using marbles to restore motion in your toes

Always start these exercises slowly and follow instructions from your doctor or physical therapist regarding repetitions.

Shoe Wear

It will take several months for your bones to fully heal. When you have completed the initial rehabilitation period, your doctor will advise you on shoewear. Athletic shoes or soft leather oxford type shoes will best protect the bunion correction until the bones have completely healed.

To help prevent your bunion from recurring, do not wear fashion shoes until your doctor allows it. Be aware that your doctor may recommend that you never return to wearing high-heeled shoes.

Avoiding Complications

Though uncommon, complications can occur following bunion surgery. During your recovery at home, contact your doctor 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 doctor immediately if you notice any of the following warning signs of infection:

. Persistent fever

. Shaking chills

. Persistent warmth or redness around the dressing

. Increased or persistent pain, especially a “sunburn” type pain

. Significant swelling in the calf above the treated foot, especially if there is a “charley horse” pain behind the knee, or if your develop shortness of breath.

Outcomes

The majority of patients who undergo bunion surgery experience a reduction of foot pain, along with improvement in the alignment of their big toe. The length of your recovery will depend upon the surgical procedures that were performed, and how well you follow your doctor’s instructions.

Because a main cause of bunion deformity is a tight-fitting shoe, returning to that type of shoe can cause your bunion to return. Always follow your doctor’s recommendations for proper shoe fit.

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4 Responses

    1. When bunions become severe, painful, or interfere with walking, surgery can be performed to realign the bones. Unfortunately, for many patients, bunions gradually return after surgery — previous studies have reported recurrence rates of up to 25 percent

    1. Patients may also expect faster relief from pain and swelling than the procedure allows. Problem rates from various studies have shown different percentages ranging from 10% to 55%. The most common complication is recurrence of the bunion, making up 16%.

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