Got Bunions?

What to do now?

Michael J. Petrocelli, D.P.M., F.A.C.A.S., C.W.S.P.

Abunion, (medical term: hallux abductovalgus) is a condition resulting in boney prominence at the inside of the foot at the big toe joint. A bunion occurs when the big toe begins to deviate toward the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While that may be true in very few people, the bunion really represents a dislocation of the big toe joint as it bulges against the skin.

Symptoms Of Bunions
Most patients complain of pain directly on the bunion area, within the big toe joint, and/or on the bottom of the foot. The bunion may become irritated, red, warm, swollen and/or callused. The pain may be dull and mild or severe and sharp. The size of the bunion doesn’t necessarily result in more pain. Pain is often made worse by shoes, especially shoes that crowd the toes. While some bunions may result in significant pain, other bunions may not be painful at all.

Causes Of Bunions
Hereditary and shoe gear are probably the most likely causes. Tight pointy shoes (and high heels) may promote the formation of a bunion. A bunion may develop rapidly or develop slowly over time. Some people have bunions in their teens while others only develop a bunion later in life.

Bunions come in a variety of sizes – from small to severe. In some cases, the big toe may push against the second toe, and may result in pain and a hammer toe, or progress onto a severe disfiguring foot deformity. Depending on your overall health, symptoms and severity of the bunion, the condition may be treated conservatively and/or with surgery.

How Are Bunions Surgically Corrected?
Depending on the severity of your bunion there are many surgical procedures available. With each procedure the goal is to realign the joint, relieve the pain and discomfort, and correct the deformity.

While hundreds of bunion surgery operations have been described, surgeons generally correct bunions using one of two methods to realign the malaligned bones – they are bone cut (osteotomy) or bone mending (fusion).

• Bone-cutting procedures involve creating a surgical ‘break’ (medically called an osteotomy) in the deviated metatarsal bone to realign only a portion of the bone. A variety of shaped cuts can be performed to treat varying sizes of bunions.
• Bone-mending procedures realign the entire deviated bone at the root of the problem, where the deviation originates.

Recovery
Bunion Surgery recovery is not as debilitating as it used to be. Each type of specific procedure to correct a bunion comes with different healing times.

The usual recovery period after bunion surgery is 8 to 10 weeks, depending on the amount of soft tissue and bone affected. Complete healing may take as long as 1 year. Around 90% of patients stop taking pain medication 3-5 days after surgery. In mild to moderate cases of bunions, patients are allowed to be weight bearing immediately with the help of a knee scooter or surgical boot. They are also allowed to walk in a surgical boot /shoe.

The time it takes for bones to set/mend in the corrected position generally takes six weeks. Smokers and those in poor medical health may take longer to mend the bone. The biology of bone healing is about six weeks — that time frame can’t be made quicker. What can be changed is the disability that one experiences while the bone is mending.

The success of your surgery largely depends on you. As the wound heals, you can gradually apply pressure and within the first few weeks you may walk short distances. You should be able to drive again within a week, but expect minor swelling for about six months.
It’s important to remember that bunion surgery will not allow you to wear a smaller shoe size or narrow-
pointed shoes. If you return to ill-fitted shoes, your bunion may reappear.

Benefits Of Immediate Walking After
Bunion Surgery
Technology advances have allowed for walking after bunion surgery despite bunion size, although some patients may be advised to wait a little while before walking.

Less Down Time. Without the anchor of a cast and crutches, patients are able to resume their routines much quicker. In many cases, walking after bunion surgery means patients can get around but not run around. Patients are generally walking in a surgical shoe and usually keep weight on the heel or outer edge. Some are able to get back to work soon after surgery, especially when their jobs are more sedentary. Nonetheless, being mobile earlier leads to more rapid return to overall function.

Avoid Cast/Crutch-Associated Limb Problems. Cast and crutch use is associated with lower limb muscular atrophy (requiring weeks of rehabilitation) and upper extremity fatigue. Being immobile and sedentary after surgery and can lend itself to swelling and serious blood clots. Obviously avoiding these issues is advantageous.

Walking after bunion surgery might take some getting used to since you might experience initial toe numbness, one of many possible bunion surgery complications. Follow all your surgeon’s recommendations, especially try to keep your foot elevated for the first 3-5 days to keep the swelling under control. In order to avoid most of the bunion surgery complications, make sure you do not put your weight on the healing toe or walk without special stiff-soled shoe to avoid re-injuring your foot.

Post surgery physical therapy will begin according to your surgeon’s vision on how your bones and soft tissues are healing. Physical therapy can help make walking after bunion surgery more comfortable over time and ensure that your toe joint doesn’t get too stiff.

Remember, we are here for you. Get back in action today, call for more information or to schedule an appointment, 239-775-0019.

Collier Podiatry, P.A.
Michael J. Petrocelli
D.P.M., F.A.C.A.S., C.W.S.P.

239-775-0019
www.collierpodiatry.com