Post-Operative Bunionectomy
A bunionectomy is performed in patients with a mass of bone or soft tissue on the medial side of the first metatarsal head at the base of the great toe, called a bunion. A bunionectomy is indicated in patients with significant pain that interferes with normal activities, walking, or wearing shoes, those in which medication has not relieved the pain or swelling, or those with extreme toe joint stiffness and OA.
Bunionectomy Procedure
The objective of this procedure is to fix the deformity, reconstruct the toe, and restore function for the patient. There are more than 100 variations of bunionectomy procedures, the best approach is based on the size and etiology of the bunion. Common variations include osteotomy, exostectomy, arthrodesis, and the Lapidus procedure. Soft-tissue correction of tendons and ligaments is typically required with any procedure selected. In osteotomy, the bones surrounding the metatarsophalangeal joint are moved back into the correct position using pins, screws, or plates. This can be done anywhere along the toe where the deformity has developed and in some patients, a small piece of bone also may need to be removed to create more space for the correction. In exostectomy, the bunion is removed but no metatarsophalangeal joint repositioning is performed and this procedure is typically performed in combination with other corrective procedures, such as an osteotomy. If this procedure is performed alone, the bunion is likely to re-appear. In arthrodesis, the arthritic portion of the metatarsophalangeal joint is removed and the bones are held in place with screws, wires, or plates for fusion to occur. This procedure is the most beneficial for patients with severe arthritis or bunions, or those who have had other surgical procedures where the bunion removal has failed. In the Lapidus procedure, the first tarsal-metatarsal joint is fused to reduce the space between the first and second metatarsal and this procedure is the most beneficial for patients with large bunions.
Post-Operative Bunionectomy Complications
Some rare but possible complications associated with a bunionectomy include bone infection, nerve injury, inadequate pain relief, unhealed bone, toe stiffness, or a bunion recurrence. In most cases, pain and toe alignment are improved for most patients after the procedure but the length of recovery will depend on the surgical procedure selected. It may take up to 6 months to fully heal and for swelling to reduce. The foot should remain elevated as much as possible after surgery, and weight bearing and driving should be restricted.
Post-Surgical Bunionectomy Treatment
A surgical boot or cast will likely be needed for several weeks, followed by a foot brace, or the use of crutches or a walker depending on the patient. Physiotherapy can be a great option post-surgery to help improve strength and range of motion at the affected joints, tendons, and ligaments. Patients are urged to wear proper footwear after the surgery, such as wide and deep oxford or tennis shoe, to protect the surgical site until the bones are completely healed. Patients should not be wearing high heels for 6 months after surgery and may want to avoid them indefinitely. Once fully healed, supportive shoes are essential, encompassing a wide toe box to allow for plenty of room for your toes to spread out comfortably. Footwear styles that have good arch support and a firm outsole will aid in providing stability and reducing pressure on the ball of the foot and toes. Custom Orthotics are also highly beneficial once the patient is fully healed post-surgery, as they are designed to provide customized support and alignment to each individual foot. They can aid in the redistribution of pressure across the foot, reducing strain on the forefoot and affected joints. They can also help to correct any underlying biomechanical issues that may be contributing to bunion formation or reformation such as excessive pronation or excessive medial toe-off. Lastly, they can provide essential shock absorption during walking and running, reducing the impact of ground reaction forces on the joints and soft tissues of the foot, especially the forefoot.