About Hallux Valgus
Hallux valgus is the commonest forefoot deformity, with an estimated prevalence of 23% to 35%. It causes symptoms on the medial edge of the foot, the sole, and the small toes. Non-operative treatment may alleviate symptoms but does not correct the deformity of the big toe. Surgery is indicated if the pain persists. The correct operation must be selected from a wide variety of available techniques.
The Treatment of Bunions
Most bunions can be treated without surgery. But when nonsurgical treatments are not enough, surgery can relieve your pain, correct any related foot deformity, and help you resume your normal activities. The Orthopedic Surgeon can help you decide if surgery is the best option for you. .
What Is A Bunion?
A bunion is one problem that can develop due to hallux valgus, a foot deformity.
The term “hallux valgus” is Latin and means a turning outward (valgus) of the
big toe (hallux). The bone which joins the big toe, the first metatarsal,
becomes prominent on the inner border of the foot. This bump is the bunion and
is made up of bone and soft tissue.
A study by the American Orthopedic Foot and Ankle Society found that 88 percent By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions. of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men.
Bunions often become painful if they are allowed to progress. But not all
bunions progress. Many bunion problems can be managed without surgery. In
general, bunions that are not painful do not need surgical correction. For this
reason, orthopedic surgeons do not recommend “preventive” surgery for bunions
that do not hurt; with proper preventive care, they may never become a problem.
Bunion pain can be successfully managed in the vast majority of cases by
switching to shoes that fit properly and don’t compress the toes. Your
orthopaedic surgeon can give you more information about proper shoe fit and the
types of shoes that would be best for you.
Follow these general points of shoe fit:
- 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 on your foot. - Select a shoe that conforms as nearly as possible to the shape of your foot.
- Have your feet measured regularly. The size of your feet change 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 your foot fits well into the widest part (ball pocket) 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. (Fashionable shoes can be comfortable.)
Some shoes can be modified by stretching the areas that put pressure on your toes. Splints to re-position the big toe and orthotics (special shoe inserts shaped to your feet) also
may relieve pain. For bunions caused by arthritis, medications can be prescribed to reduce pain and swelling.
If nonsurgical treatment fails, you may want to consider surgery. Many studies
have found that 85 to 90 percent 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. You 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 doesn’t improve with rest or medications.
- Toe deformity-a drifting in of your big toe toward the small toes.
- Toe stiffness-inability to bend and straighten your toe.
- Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs. Their effectiveness in controlling toe pain varies greatly from person to person.
- Failure to substantially improve with other treatments such as a change in shoes and anti-inflammatory medication.
As you explore bunion surgery with us, remember that the goal of surgery is to relieve as much pain as possible, and correct as much deformity as is realistically possible. It is not meant to be cosmetic.
The Orthopedic Surgeon uses 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 Around the Big Toe
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, this procedure shortens
the loose tissues and lengthens the tight ones.
.
Arthrodesis
Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis, and when other procedures have failed
.
Exostectomy
Removal of the bump on the toe joint; used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion
.
Resection Arthroplasty
Removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis. This creates a flexible “scar” joint
.
Osteotomy
The surgical cutting and realignment of the joint. Dr. Lopez will choose the procedure best suited to your condition
If you are interested in exploring bunion surgery, Please feel free to contact us via email or telephone.
The orthopedic evaluation consists of three components:
-
A medical history,
in which your orthopedic surgeon gathers information about your general
health and asks you about the extent of your pain and ability to find shoes
that don’t hurt. He or she also will ask you about other medical conditions
that could affect your surgical outcome. Diabetes and rheumatoid arthritis,
for example, can increase the risk of infection and interfere with proper
healing. Circulatory problems can increase postoperative pain and impede
healing as well. - A physical examination to
assess the extent of the misalignment and soft tissue damage and to check
for the presence of other foot deformities, such as hammertoes and corns. - X-rays to
determine the extent of damage and deformity in your toe joint.
The Orthopedic Surgeon also will explain the potential risks and complications
as well as review the results of your evaluation with you and
discuss whether surgery would be the best method to relieve your pain and
deformity.
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 dramatic reduction of foot pain after surgery, along
with a significant improvement in the alignment of their big toe.
Bunion surgery will not allow you to wear a smaller shoe size or narrow-pointed
shoes. In fact, you will have some shoe restrictions for the rest of your life.
Always follow the recommendations for shoe fit presented in this booklet.
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 will reappear.
Before surgery, tell your Orthopedic Surgeon about the medications you are taking. He will tell you which medications you should and should not stop
taking before surgery. He will take a medical history and perform tests which include blood samples, a cardiogram, a chest X-ray, a urine sample, and special foot X-rays.
Almost all bunion surgery is done on an outpatient basis. You will be asked to arrive at the hospital one or two hours prior to surgery.
After admission, you will be evaluated by a member of the anesthesia team. Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. General or spinal anesthesia is used occasionally. The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.
The surgery takes about one hour. Afterwards, you will be moved to the recovery
room. You will be ready to go back to your hotel in one or two hours.
Fewer than 10 percent of patients experience complications from bunion surgery.
Possible complications can include infection, recurrence of the bunion, nerve
damage, and continued pain.
If complications occur, they are treatable but may affect the extent of your
full recovery. Your orthopedic surgeon will explain various options in treating
these complications.
The success of your surgery will depend in large part on how well you follow
your orthopedic surgeon’s instructions at home during the first few weeks after
surgery. The Orthopedic Surgeon will follow up with you for the next several months 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. You also will wear a
special postoperative surgical shoe or cast to protect your foot. Your
sutures will be removed about two weeks after surgery, but your foot will
require continued support from dressings or a brace for six to eight weeks.
To ensure proper healing, it is very important not to disturb your dressings
and to keep them dry. Interference with proper healing could cause a
recurrence of the bunion. Be sure to place a plastic bag over your foot
while showering
.
Bearing Weight
The Orthopedic 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
.
Swelling and Shoe Wear
Keep your foot elevated as much as possible for the first few days after surgery, and apply ice as recommended by your orthopedic 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.
Exercises to Strengthen Your Foot
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.
Medication
The Orthopedic 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 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 us 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.
Our doctors are orthopedic surgeons, a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves.
Please feel free to contact us with any questions. You may also always call us TOLL FREE: 866.509.0571 or +1817.405.2778 or SEND US AN EMAIL to info@orthopv.com