What is a bunion?
A bunion is a condition in which the big toe begins to gradually deviate from the midline of the foot. Bunions are most often secondary to failed surgical treatment of bunions. However, other conditions can also cause bunions, including trauma, displacement of the seed bone at the big toe joint, and some arthritis.
With the displacement, the big toe begins to harden. Sclerosis can occur in one or both joints of the big toe joint. When the big toe is still flexible, it is very easy to treat. As the interphalangeal joints harden, our ability to correct the deformity and maintain flexibility in the big toe is limited. At this point, we need to perform a joint fusion.
Treatment of a bunion depends on the extent of the condition. If the deformity is mild and the big toe is still flexible, then no treatment is needed; if the deviation is very severe and is hardening and subsequently causing extreme discomfort when wearing shoes, surgery is usually required to correct the deformity.
Correction of the deformity depends on the flexibility of both joints of the big toe and the presence of arthritis. Typically, a tendon transposition is performed, where the tendon is transferred around the big toe to enhance its stability and flexibility. One common procedure is to reorient a small tendon in the big toe (transposition of the short toe extensor tendon). If the toe is severely arthritic, sclerotic or deformed, we cannot perform a tendon transposition and the patient will usually need a fusion.
Bunion Correction: General
This procedure is used to correct a deformity of the big toe. To correct this deformity, we often tighten the ligaments on one side of the big toe joint and loosen the ligaments on the other side.
However, tightening or repairing the ligaments is not enough to maintain the big toe in its corrected position, so we must perform a tendon transposition, which involves transposing a small tendon (the short extensor tendon) on the side of the big toe.
The big toe will not return to normal, although it will retain some flexibility, but there will always be some hardening of the interphalangeal joint.
After surgery, the patient will be more comfortable in shoes. However, this does not mean that the patient can wear narrow, tight shoes.
General recovery.
After surgery, patients may experience moderate pain, which may last for several days.
One day after surgery, patients may walk. However, many patients are reluctant to walk on their feet because of pain.
Patients may use crutches if support is needed.
The affected foot will need to be bandaged for approximately 3-4 weeks.
During the bandage period, the foot should be kept dry.
At about 4 weeks, the patient is able to start exercising.
At about 4 weeks, the patient can wear athletic shoes.
During the recovery period, do not take off the shoes and walk.
The affected foot will be swollen for 4-6 months.
Special post-operative course.
Day 1.
Apply a bandage to the affected foot.
Apply cold compresses, elevate the affected foot, and use pain medication.
After surgery, the foot may be numb for 12-24 hours, followed by moderate pain.
There may be a small amount of blood leakage; do not change the bandage.
Week 1.
If moderate pain is present, continue to take pain medication.
Apply cold compresses to the affected foot and elevate the foot as high as possible.
Walk in post-operative shoes.
Day 14.
First visit to outpatient clinic.
Dressing is changed and the big toe is wrapped with a bandage.
Full weight bearing in post-operative shoes.
Week 4.
Start wearing athletic shoes.
Orthotics in shoes are very important.