FOOT & ANKLE

Bunion Surgery

Bunions are characterised as a bony prominence at the base of the big toe and the big toe deviating towards the lesser toes. It is caused by abnormal bone alignment called Hallux Valgus. As a result of your bunion/s you may experience redness, stiffness, swelling, and pain preventing you from completing daily activities and limiting your footwear options. Surgery may be recommended when non operative treatment has been ineffective and pain continues to limit your everyday life. The goal of surgical intervention is to restore the normal shape and biomechanics of the foot to reduce pain and allow return to normal footwear.

Procedure

Osteotomy (bone cuts) is a common type of bunion surgery that involves the surgical cutting and realignment of the bones around the big toe. Dr du Sart chooses to perform minimally invasive (keyhole) bunion surgery for most of his patients as it allows for less scarring, soft tissue damage, pain and swelling than traditional techniques requiring larger incisions. This usually means a faster recovery for most patients.

During the operation the following steps occur:


1..Minimally invasive surgery is performed through small incisions in the skin

2. During an operation, under X-ray guidance, Dr du Sart will use special cutting burrs  through these keyhole incisions to create corrective bone cuts of the 1st metatarsal and 1st proximal phalanx bones

3. The bone cuts are shifted to improve alignment of the big toe (metatarsophalangeal MTP) joint and the correction is held in place with zero-profile screws to reduce the amount that you feel the hardware.

4. These changes allow overall cosmetic and mechanical improvement of your foot, while potentially improving range of motion at your big toe joint.

After Your Operation

Pain Management

Post operation the foot is elevated to reduce swelling and local anaesthetic will provide pain relief and make the foot and toes temporarily numb. During your inpatient stay you will be given pain relief and either medication or prescriptions to go home to keep pain within comfort. Usually patients will initially require regular pain relief consisting of paracetamol and anti-inflammatories if indicated. Stronger medications may be given and helpful in early stages however are phased out as comfort levels increase. 


Mobility

After your operation you are able to walk as tolerated with a surgical shoe with optional crutches if needed. It is important to keep the foot elevated as much as possible to manage pain and swelling. You will continue to walk with a surgical shoe for approximately three weeks, then progress to a stiff-soled sneaker which is straight over the inner aspect of the foot (ie. the shoe does not taper and push the big toe towards the little toes). You will also be given some stretches and exercise to complete as part of your rehabilitation.


Return to Work and Sport

Return to work will vary on the nature of your work and what was done at surgery. In general, you should plan to have at least two weeks off work to allow your wound adequate time to heal and elevate your leg. You may be able to return to light duties after two weeks, but if you are on your feet at work, it may take up to 4 to 6 weeks.  If you are very physically active in your job, it may take 8 to 12 weeks. Dr du Sart will discuss this with you at your post-op check.

Returning to sport such as jogging may take 3 to 6 months however this is dependent on the type and level of activity. The bone cuts take approximately 12 weeks to fully heal, and most swelling diminishes by 3 to 4 months. By 6 months most patients have returned to their normal activities without pain, however full recovery can take up to 12 months.


Driving

Times to return to driving will vary. If you have an automatic car and your left ankle was operated on, your return to driving may be faster. However, in general, plan to avoid driving for two weeks after surgery. However if your right ankle has been operated on it is recommended to return to driving after approximately 6 weeks. If you have concerns, you can discuss this with Dr du Sart.


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