Bunion surgery: preparation, recovery, long-term care

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Bunion (hallux valgus) surgery is done to correct bone growth at the base of the big toe, pushing it inward. This may include cutting / straightening the bone, repositioning the foot muscles / tendons / ligaments, and splicing or replacing the joint, as appropriate. Surgery can also be done for bunions , growths that develop just below the little finger.

Treatment for bursitis is really only indicated when it causes discomfort. Conservative treatments (such as using a big toe pad or a special foot insert) may be enough, but not always. Bursitis surgery may be recommended if these options do not help and the associated symptoms (pain, stiffness, swelling, and redness) are affecting your ability to walk or your overall quality of life.

Many are surprised by the length of the recovery period after bunion surgery. If this procedure has been suggested, it will help you to better understand what exactly it entails.

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What is bunion surgery?

Bunion surgery is done to restore the affected toe to its normal position in order to reduce pain and improve function. This operation is almost always performed on an outpatient basis, so a hospital stay is not necessary.

While it seems logical that thumb bone surgery might simply involve shaving the bone, this is often ineffective as the bone tends to reappear over time. Instead, bursitis surgery involves removing the ridge and / or cutting and straightening the bone of the affected toe.

The surgeon then moves the surrounding tendons and ligaments in the foot. For example, the surgeon may tighten the ligaments on the outside of the toe and loosen the ligaments on the inside. This creates the necessary tension to restore the toe to the correct position.

If the toe is cut, it can be stabilized and held in place with metal plates, screws, or wire while it heals.

Bunion surgery can be performed using the traditional open access, in which a larger incision is made in the skin to access the foot. Minimally invasive surgery involves accessing the foot with small keyhole-shaped incisions, special surgical instruments, and an imaging technique called fluoroscopy .

Bursitis is a relatively quick operation, but it is a complex deformity and therefore requires an experienced surgeon to operate.

Minimally invasive bursitis surgery takes less time and offers a lower risk of infection and faster healing compared to an open procedure. Also less scars. However, research shows that for mild to moderate bursitis, the open approach offers a superior functional outcome.

Types

There are more than 150 types of operations for bursitis. The following procedures are commonly used:

  • Bunionectomy: removal of bone growth and restructuring of the muscles, tendons, and ligaments that surround the affected joint.
  • Osteotomy : Dissection of the toe bones to align the affected joint in a more upright position using pins or screws.
  • Arthrodesis: fusion of the bones around the damaged (and removed) joint using screws, wires, or plates.
  • Arthroplasty – removes the damaged part of the joint and allows scar tissue to fill the space between the two bones. Sometimes the joint is replaced with an implant.

In all scenarios, tendons and ligaments are corrected.

The exact procedure performed depends on the severity of the bursitis (mild, moderate, or severe), the presence of arthritis in the toe joint, and the experience and care of the surgeon.

Procedure Soft bunion Moderate to severe bunion Severe or arthritic bursitis
Bunionectomy
Osteotomy
Arthrodesis
Arthroplasty
Soft tissue restoration

Be sure to talk to your surgeon about the procedure or combination of procedures that he will use to correct your bursitis. Factors such as your age, activity level, general health, and the severity of your bursitis are generally considered.

Contraindications

Contraindications to bunion surgery include:

Potential risks

Specific risks associated with bunion surgery include:

  • Stiffness or scarring of the big toe
  • Wound infection
  • Nerve damage resulting in ongoing numbness or pain
  • Failure of the bone to fully heal ( nonunion )
  • Recurrent bursitis
  • Avascular necrosis of the big toe

Purpose of bunion surgery

The goal of bunion bursitis surgery is to relieve pain and restore function by removing bone growths and aligning the joint.

Bursitis surgery is generally considered if you have one or more of the following problems:

  • Severe pain that prevents them from doing normal activities (for example, walking several blocks in sneakers)
  • Pain, redness, swelling, and / or stiffness associated with toe bursitis that persists despite rest or taking non-steroidal anti-inflammatory drugs (NSAIDs) .
  • Toe deformity (for example, the big toe begins to overlap or overlap the adjacent toe)

If you are considered a good candidate and decide to continue with your surgery, your surgeon will order a special X-ray of your foot to help plan your surgery.

You will also need to see your healthcare professional for preoperative tests such as:

How to prepare

When you are scheduled for thumb bursitis surgery, your doctor will instruct you on the best way to prepare for it. Careful adherence to these instructions will help prevent possible complications.

Location

Bone marrow surgery is performed in a hospital, surgical center, or surgeon's office by an orthopedic surgeon or podiatrist .

Your doctor will likely ask you to come in about an hour or two before the day of your surgery.

Food and drink

Do not eat or drink for 8 to 12 hours before surgery. The exact time will depend on the type of anesthesia you are receiving, so be sure to ask.

Medicines

You will be advised to stop taking certain medications, such as NSAIDs, a few days before your surgery.

Be sure to tell your surgeon about all the medications you take, including prescription and over-the-counter medications, herbal products, vitamins, and recreational medications.

What to wear and take with you

Since you will be donning a hospital gown when you arrive at the hospital or surgery center, it is advisable to wear loose fitting clothing that is easy to remove.

Special shoes that are worn on the leg after surgery, so you can opt for baggy sweatpants that fit comfortably on the leg. You can also bring shorts to change into before going home.

For footwear, you will need supportive, non-slip, rubber-soled shoes for use on the non-operated foot.

Leave jewelry, including piercings, at home.

Make sure you take with you:

  • Driver's license and insurance card.
  • List of your medications
  • An assistive device, such as crutches or a knee brace, to wear after surgery (talk to your surgeon ahead of time about which device he recommends).

After the operation, you will not be able to walk or drive home. Remember to arrange for a friend or family member to drive you home.

Lifestyle changes before surgery

In addition to optimizing any underlying medical conditions you have (such as diabetes or high blood pressure ), your surgeon will recommend that you stop smoking at least a few weeks before surgery. Smoking increases the risk of wound and bone healing problems after surgery.

What to Expect the Day of Surgery

On the day of your bone marrow surgery, you will arrive at the hospital or surgical center where you will be noted. At this time, you may need to verify your insurance and you may be asked to sign various consent forms.

Before the surgery

You will be taken to the preoperative room where you will change into your hospital gown. The nurse will then review your Medication List, record your vital signs (heart rate, blood pressure, etc.), and place an intravenous (IV) tube in a vein in your arm to administer fluids and medications.

Your surgeon and possibly your anesthesiologist will come to greet you and briefly discuss the operation with you. From there you will be taken to the operating room on a stretcher, where the anesthesia process will begin.

During the operation

Surgery for bursitis can be performed under local, general, or spinal anesthesia.

  • Local anesthesia : Your surgeon will inject medicine into your ankle to numb the entire foot. You may feel a tingling sensation while injecting the medicine. You will also be given a sedative to help you relax and fall asleep during the procedure.
  • Regional anesthesia: The anesthesiologist will inject anesthetic in the lower back (spinal block) or below the knee (popliteal block). You will be awake, but you will not feel pain or other sensations in the numb part of your body. You will also be given a sedative.
  • General anesthesia: The anesthesiologist will put you to sleep by injecting medications by inhalation or intravenous injection. You will not remember or feel anything that happened during the operation. After you fall asleep, the anesthesiologist will insert a breathing tube, called an endotracheal tube, through your mouth into your windpipe. The tube is connected to the ventilator .

Once the anesthesia is effective, the surgeon's assistant will clean the skin of the operated foot with an antiseptic solution to kill any bacteria.

The exact course of the surgery will depend on the specific procedures performed on the thumb bone. However, you can usually expect the following steps:

  • Incision: The surgeon will make one or more incisions in or on the affected joint. The size of the incision depends on whether the operation is open (larger) or minimally invasive (smaller).
  • Removing and / or cutting the bone : The surgeon will perform one or more specific procedures depending on the severity of the bone (such as removing the bone or cutting the bones to align the joint).
  • Bone Stabilization – If the finger bone has been cut, it will be held in place with screws, plates, or wire.
  • Soft tissue repair : The soft tissues (tendons and ligaments) around the affected finger are shortened or lengthened to return the affected finger to its correct position.
  • Closure: The incisions will be sutured and your foot will be covered with a soft gauze bandage. Then a special self-closing support boot is placed on the foot.
  • Preparation for recovery: If you have been given general anesthesia, it will be stopped. Your breathing tube will be removed and you will wake up. Then you will be taken to the recovery room.

The surgery time for bursitis surgery is usually less than an hour, but it can be longer depending on the procedures that are performed. In the vast majority of cases, one leg is operated on at the same time. A second surgery is prescribed if the patient needs surgery on the bone of the other foot.

After the operation

In the recovery room, a nurse will check your vital signs. As soon as you regain consciousness (about an hour or two after surgery, or longer if you have undergone general anesthesia), you will be discharged home.

Recovery

As you recover at home, you will need to follow several instructions.

These instructions usually include:

  • Keep your leg elevated on a pillow or two to reduce swelling. Your doctor may also recommend that you apply ice to your leg.
  • Taking prescription medications (eg, opioids for pain; antibiotics to prevent infection).
  • Keep the incision dry. Before you shower, your surgeon may recommend that you remove your boot and cover the surgical bandage with a plastic bag and tape.
  • Do not put any weight on the operated foot (the schedule depends on the advice of your surgeon). Use an assistive device when you need to walk.
  • Don't drive for a week or more until you stop taking all pain relievers.

Since you may not be able to move around much in the first few weeks after your bursitis, be sure to make arrangements for help with shopping and household chores during this time.

Your surgeon may also recommend daily stretching exercises for your foot and toes as you recover to help you regain strength and range of motion in your foot after surgery. Be sure to stick to these exercises to get the best results from your surgery.

Expect a follow-up from your surgeon about a week or two after surgery. At these appointments, your bandage will be changed and the stitches will be removed.

Note that even if your surgeon allows you to remove the boot at a later appointment, you will most likely still need to wear the bandage or splint for another four to ten weeks.

When to call a doctor

Call your surgeon if you experience any of the following symptoms:

  • Fever or chills
  • Redness, swelling, bleeding, or purulent discharge from the wound.
  • Increased pain in the foot or at the wound site.
  • Swelling of the lower leg of the operated foot.
  • Difficulty breathing

Long term care

Although you can expect to gain weight on your operated foot two to six weeks after surgery, you will still need to wear an assistive device for 12 weeks after surgery. At this point, or when the swelling is completely gone, you can wear soft leather or athletic shoes and walk around in them.

The width of the forefoot will not change dramatically after bunion surgery. In fact, the average forefoot width correction is just a fraction of an inch. However, while some patients may wear narrower shoes over time (at least six months after surgery), others may not.

Possible future operations

In case of surgical complications, surgery may be required in the future. For example, if the bones do not heal after an osteotomy and realignment, another surgery may be required. Similarly, if a new problem develops as a result of the surgery, for example, if the deformity is overcorrected and the big toe points inward, you may need to undergo a new operation.

Big toe bursitis may also rarely reappear after months or years, especially if the initial deformity is not properly corrected (for example, shaving the bone without correcting the soft tissues of the foot). Surgical correction of recurrent bursitis can be complex and extensive.

Lifestyle adjustments

Not smoking after surgery is essential to reduce complications associated with wound healing.

To prevent your bursitis from recurring (or forming on the other foot), it is important to wear comfortable shoes with wide toes (so your toes have enough room to maneuver) and good arch support. If you need to wear shoes with narrower toes, keep them as short as possible.

Maintaining a normal body weight can also help prevent bunion recurrence.

Get the word of drug information

Deciding on bursitis surgery can be difficult. You must weigh your symptoms and their impact against the long recovery period and / or the potential risks of surgery, including ongoing pain, stiffness of the foot joints, or bone marrow recurrence.

The good news is that having bursitis, even if it is severe, does not require urgent medical attention. This means that you can take your time weighing the pros and cons of the procedure. If you can't decide, it may help to ask for the other person's opinion.

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