Hallux valgus surgery (bunion)
Last update: 10 April 2020
Hallux valgus surgery (bunion)
Bunions, also called hallux abductovalgus, are a common problem. If not treated promptly, this foot disorder can cause a lot of pain. Bunion surgery is often required.
What is hallux abductovalgus (bunion)?
Bunions are a bony deformation of the forefoot that usually forms between the big toe and the second toe. This deformation can increase with time, causing inflammation in the foot. A hump can also develop inside the foot, causing increased pain.
It is very important to schedule an appointment with your podiatrist without delay if you think you have this condition.
How do you choose the right foot surgeon?
Ensure your podiatric surgeon meets the following:
- Experience and recognition:
A podiatrist with a good reputation, who has practised under all kinds of conditions, who has experience in hospitals or who is certified by organizations is often a professional worthy of your trust.
It is important for the surgeon who will treat you to be able to understand your situation and know how to handle it. Each surgical case is specific, so being multi-skilled is important to properly care for you. This is a crucial point to avoid your feet becoming worse.
- The ability to put themselves in your place:
The podiatrist must show compassion and adopt a humane approach with you throughout all stages of your care. This is the very basis of the relationship of trust that binds you together.
If you have significant foot complications and require urgent attention, your podiatrist must intervene quickly. It is therefore important for them to be available to help you to recover properly.
Choosing a PiedRéseau podiatrist meets all these criteria!
How do we evaluate whether a patient requires surgery for bunions?
With a quick consultation at a PiedRéseau clinic, you will obtain a customized surgical plan without delay. Your podiatrist will evaluate your condition and determine whether you are a candidate for bunion surgery.
You will be provided a detailed account of your condition and thus be able to make an informed decision.
Patient history: an essential criterion
What are your daily activities? What kind of lifestyle do you lead? What are your health issues? These are relevant questions that your podiatrist can ask you to have a better understanding of your situation. The history of the deformation can also explain why the bunion appears on your foot.
Many causes can explain the appearance of bunions:
- Trauma to the toes
- Foot type
- Type of shoes worn
It is important to know the cause in order to treat the problem properly. To succeed, a bit of research is required.
Naturally, as a patient you will have certain expectations. You will want to be treated well and you will need a bunion treatment plan that fits your condition. The podiatrist must listen to you and know how to understand your expectations.
However, it is important to understand that in some cases, even with the best intervention, your foot may not regain its full autonomy. However, the goal of surgery is to completely eliminate the pain caused by a bunion.
The clinical examination is used primarily to assess whether you are a candidate for surgery. Your medical and surgical history will be reviewed, as will your medication and any allergies you may have. A vascular assessment of your feet will also be conducted to ensure optimal healing.
In order to properly assess your condition, the podiatrist will need to be aware of the functional limitations of your joints and foot. The treatment plan will be based on this data.
A proper review of the functional limitations of your foot will allow you to maximize recovery from bunion symptoms.
X-ray and ultrasound evaluation of the deformation
An initial bone evaluation will be conducted with an X-ray and sometimes an ultrasound for your surgical plan to reposition the joint and foot. Sometimes bunion repositioning requires secondary intervention steps in order to avoid creating lesions elsewhere on the foot. Following this X-ray evaluation your podiatrist can inform you about the complexity of your case and any additional procedures required for functional rehabilitation.
Your joint movement capacity is also studied before proceeding with bunion surgery. You can then find out if you need to realign the big toe or remove one movement in favour of another, for example.
Although surgery is beneficial, it often comes with its small share of short-term drawbacks. It is important to choose the treatment plan that least hinders your daily routine.
When should a patient elect to seek surgery for bunions?
If your bunion prevents you from wearing your shoes, performing your daily activities or walking normally, you are probably a candidate for surgery.
You can try conservative treatment methods, like those mentioned above, but don’t wait until the condition worsens!
Initial conservative treatment methods
Bunion surgery is not the only way to treat your condition. Sometimes more conservative treatment methods can be tried. However, some extreme cases make surgery the only option.
Several examples of conservative treatment methods for bunions include:
- Wearing wide, flexible shoes
- Wearing plantar orthotics
- Various exercises to increase joint flexibility
- Using cushions to avoid joint friction
- Applying ice and taking anti-inflammatories
When you speak with your podiatrist, you will be informed of the treatment options available to you depending on your condition.
Why choose surgery performed by a podiatrist?
A podiatrist is your best choice to treat your bunion! They have been especially trained for this type of intervention. They can evaluate your foot, recognize any abnormalities or deformations and know which procedure to select for each case.
They also offer several other benefits:
- Foot care management from A to Z
- Targeted intervention
- Personalized follow-up (before, during and after the procedure)
- The ability to provide maximum autonomy to your foot
How can we recognize possible biomechanical complications and other special cases?
The slightest imbalance in the foot can cause new problematic pathologies. Knowing your medical history and that of your foot can help to predict any possible complications, such as calluses, capsulitis or stress fractures.
Expectations and risks are better controlled if a complete pre-surgical evaluation is performed.
Procedures for correcting your bunion
Many procedures can be chosen, including:
- Toe procedure:
The goal of this procedure is to have your big toe straightened by itself using certain bone angulation procedures. This technique is often preferred when there is strong friction between the big toe and the adjacent toe.
Using this approach often prevents future problems, such as calluses.
- Metatarsal head procedure:
The metatarsal head procedure is used in cases where the bunion deformation has not reached a very advanced stage.
Operating at the metatarsal head to remove a bunion usually results in faster healing. The recovery time is also shorter. In some cases, you can even walk out of the surgery room with a surgical shoe!
- Metatarsal base procedure:
For more advanced cases or for more flexible feet, this procedure will often be chosen. It provides better stability with regard to the correction of the deformation angle of your foot. The metatarsal base procedure is often used to treat bunions in children, as well as in more severe cases.
However, recovery with this type of bunion operation takes longer than average. In addition, you will not be able to support weight on your foot for some time.
On the other hand, a longer convalescence period gives better long-term results for very active people. So the wait is worth it!
- Complex procedure:
Complex procedures are reserved for multiple or major deformations. They may include the reconstruction or fusion of certain joints of the foot. These are therefore very special cases with regard to bunions and the toe.
Chronological steps of surgery:
5 steps are required to treat bunions:
- Pre-surgery assessment:
This step can be performed several weeks before the procedure. You will be informed about the proposed treatment plan, whereupon you may choose the best option.
- Surgical preparation:
Surgical preparation begins several weeks before the surgery:
- You must obtain medical clearance from your doctor for outpatient surgery.
- In some cases, blood samples and/or pre-surgery antibiotics will be necessary.
- A period of convalescence and rest will be required after surgery.
- It is important to be accompanied by someone for the surgery; they must be available to take you home and stay with you during the day following bunion surgery.
- Your foot must be properly cleaned before surgery.
- In rare cases, it may be necessary to fast before surgery.
Normally, no local anaesthesia or IV sedation is required.
- The day of your surgery:
If instructed by your podiatrist, you must take any pre-surgery medication as per the instructions provided. You will then be cared for by the surgical team and made comfortable.
In most cases, this surgery requires a local anaesthesia. You will be given an oral sedative to reduce any possible stress.
- Back home:
You will return home the same day as your operation, but there are several things you must do:
- Take your pain medication (to be taken while still under the effects of anaesthesia to avoid any pain).
- Keep your foot elevated and apply ice compresses.
- Keep your foot dry.
It is especially important not to touch your bandages, unless otherwise directed by your surgeon.
- Follow-up visits and home care:
Each procedure requires special care at home. This is why you will be given a personalized home care plan provided by the clinic’s team. A follow-up appointment will also be scheduled with your surgeon within 3 to 7 days following the operation.
Stitches will normally be removed within 14 to 21 days.
What is the convalescence period for bunion surgery?
The convalescence period depends on the type of procedure performed. Some procedures require only a few weeks, while others can require several months of convalescence.
When will I be able to recommence my daily activities?
Again, it varies according to each case. Various factors come into play, such as the speed of healing, type of procedure performed, and the type of activities you engage in. Your podiatrist will be able to tell you how long the average convalescence period is.
Post-surgical plantar orthotics
Bunions develop mainly on feet with common biomechanical deficiencies. This type of condition often requires wearing foot orthotics following bunion surgery.
These orthotics greatly reduce the risk of recurrence and allow your foot to heal properly.
Importance of following the surgical recommendations to the letter
Even with the best podiatric intervention, if you do not follow the instructions you risk compromising your chances of healing properly.
Help promote the success of your procedure by closely following the advice of your foot expert!