Type of Procedure: Outpatient
Length of Procedure: 1-1.5 hr
Anesthesia: Regional nerve block with general anesthesia or sedation
Medications: Oxycodone or Norco for pain, aspirin 81 mg twice daily for 3 weeks to lower risk of blood clots, ondansetron for nausea
Follow-up appointments: 2 weeks, 6 weeks, 12 weeks
Time Non Weight Bearing: 2 weeks no weight, 2 weeks heel weight bearing in post-op shoe, 2 weeks full weight bearing in post-op shoe, full weight bearing in gym shoe at 6 weeks
Time to Driving: When off narcotics for left foot unless you have a clutch, 7-8 weeks for right foot
Hallux valgus (Bunion): General facts
- Significantly more common in females
- There is a genetic predisposition (70% have family history) but shoewear (ie high heels and narrow shoes) influences the development of bunions
- Caused by an angular deformity (zig-zag) between the big toe metatarsal and big toe proximal phalanx, overgrowth of the metatarsal bone on the inside of the foot, and a widened angle between the first and second metatarsal
- Patients often get pain on the inside of the foot with shoewear
- If left untreated, it can cause deformity and pain in the smaller toes
Treatment of Hallux valgus (bunion)
- Nonoperative treatment includes anti-inflammatories, widened shoes, and various pads that prevent rubbing against the shoes
- There is no non-surgical way to reverse the bunion
- Surgery is recommended in patients who have continued pain despite non-surgical treatment, rapidly progressive deformity, or painful changes in the smaller toes
- Bunions can be corrected in many ways, and the surgical recommendation made by Dr. Dean is based on subtle difference in your exam and x-rays
- For patients with a flexible bunion without evidence of an unstable joint, Dr. Dean will recommend a minimally invasive bunionectomy
- A minimally invasive bunionectomy uses small “keyhole” incisions and specialized instruments and cutting tools called burrs to correct your bunion
- You will have several small incisions where Dr. Dean cuts your metatarsal bone and shifts it towards the outside of you fit before fixing it with screws
- Usually, an extra cut in the proximal phalanx called an Akin is used to better align your bunion. This is also done through “keyhole” incisions
- Minimally invasive bunions allow for faster recovery and better range of motion after surgery
Before Surgery:
- No restrictions
- You may walk as tolerated in comfortable shoes
After Surgery:
- Immediately after:
- In a post-op shoe for 2 weeks with a dry dressing
- Elevate the leg, ice, take pain medication
- No weight (use crutches, walker, knee scooter, or wheelchair)
- 2 week appointment:
- Stitches come out and steri-strips placed
- Dr. Dean will tape your toe in the proper position (you may remove this in 2 weeks)
- A toe spacer will be placed between your 1st and 2nd toe
- You may weight bear in the post-op shoe through your heel for 2 weeks
- At 4 weeks, you may begin weight bearing normally in the post-op shoe
- 6 week appointment:
- Toe spacer stays in
- Transition to weight bearing in normal shoe
- Start range of motion exercises at big toe
- Physical therapy started if needed
- 12 week appointment:
- Can discontinue toe spacer
- Begin low impact exercise
- May resume high impact activity at 3-3.5 mos if cleared by Dr. Dean
