Bunionectomy

A bunionectomy is a surgical procedure used to remove a bunion and often straighten the affected toe.


Understanding bunions
A bunion is an enlarged joint that typically develops at the base of the big toe. A bunion may also develop at the base of the little toe, referred to as a bunionette or a tailorhe skin over the joint. The affected toe often begins to point toward the other toes instead of straight ahead.
Bunions have various causes, including bone or joint diseases such as arthritis or post-polio syndrome, injuries, and wearing shoes that squeeze the toes together and put too much pressure on the ball of the foot. Bunions are more common in women, probably due to high-heeled shoes. Certain occupations that put stress on the feet increase the risk, such as dancing, waiting tables and athletics. Some people have a genetic predisposition to bunions due to inherited foot shape. People with flat feet or low arches are also prone to bunions.


Purpose
There are many different ways to perform a bunionectomy, but all have the same goals: to relieve foot pain, correct the deformity and realign the joint, improve toe function, and enable normal walking and related activities.

Indications
Nonsurgical treatments for bunions are often recommended first. The doctor may suggest shoe padding or shields to take pressure off the bunion. Switching to well-fitting shoes with box toes or orthopedic shoes may also be effective. Sometimes, physical therapy or medication, such as acetaminophen or anti-inflammatory medications, may be recommended. The doctor may also suggest certain lifestyle or occupational changes to encourage healing. If these measures aren't effective after several months and the bunion is painful, surgery may be appropriate.

Patient preparation
As with most types of surgery, you may need routine blood work, urinalysis, X-rays and an electrocardiogram (a recording of the electrical activity of the heart) before the bunionectomy. Based on your age, history and medical condition, you may need additional tests as well. Dietary restrictions before the procedure will depend on the type of anesthesia to be used, but you generally can't have anything to eat or drink after midnight before the day of surgery.

Procedure
Although every surgery has its own standard procedure, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
Depending on your age and medical condition, the bunionectomy may be done in the doctor's office, an outpatient facility, or the hospital by a podiatrist or an orthopedic surgeon. Because there are many methods available, ask your doctor for details of the specific type of bunionectomy you'll have. The surgery can often be done with an ankle block anesthesia, which numbs only the foot. Spinal anesthesia (which numbs you from the waist down) or general anesthesia (which induces temporary unconsciousness) is occasionally needed, however.

Generally, portions of the toe bone will be removed, particularly from the excessive bone tissue that has formed around the bunion. This typically gives the doctor room to reposition the toe. Wire, pins or screws may be used to keep the toe correctly aligned. Depending on the severity of the condition, the doctor may use an artificial or replacement joint. After the procedure, your foot will be bandaged with gauze and you'll be taken to the recovery room.


Postprocedure care
You'll probably go home the day of the procedure. Make sure to arrange ahead of time for some to drive you home. It's also a good idea to have someone help you at home the first few days after surgery.
Expect pain and tenderness at the site, which should improve within a few days. Your doctor may limit your activity for a few weeks, so be sure you understand the discharge instructions and follow them closely. Your doctor will tell you when you can get your foot wet and begin weight-bearing activities. The doctor will also describe special types of exercises to do after surgery. You may need to wear a special support shoe while your foot is healing, which may take up to six weeks. In some cases, a cast may be applied to hold your foot in position. The doctor may use a series of X-rays to monitor your healing.

Call your doctor if you experience any of the following after surgery:

uncontrolled bleeding despite the pressure bandage
more discomfort or pain than anticipated
any signs of infection, such as increased redness, swelling, pain or tenderness, pus drainage, fever, warmth to the touch, red streaks coming from area or feeling ill

Benefits
A bunionectomy can decrease or relieve foot pain caused by a bunion. You may enjoy an improvement in joint mobility, as well as have less need for pain relievers. Plus, easier walking helps contribute to a more normal lifestyle.

Risks
As with any surgery, there are risks associated with anesthesia. Even after surgery, bunions may recur.
Other risks may include:

infection
bleeding
damage to foot blood vessels or nerves
loss of circulation to the toe
development of a stiff toe
misalignment of the toe
delayed or incomplete healing
continued or increased pain after surgery

Considerations
The affected toe may be shorter than before surgery, but walking and standing should be more comfortable. You may need to permanently avoid certain types of shoes, such as high heels.

Pregnancy-specific information
The added weight of pregnancy puts more pressure on your feet. It also changes your center of gravity, which will redistribute your weight and possibly increase bunion pain. Because surgery to remove bunions is elective, it should be done either before or after pregnancy.

Senior-specific information
Due to higher rates of diabetes, bunions in older adults are more likely to become infected. Older adults must carefully consider any surgical procedure, however. Risks of surgical complications increase with age, and the healing and recovery period is often longer.