Bunionectomy
A bunionectomy is a surgical procedure to excise, or remove, a bunion. A bunion is an enlargement of the joint at the base of the big toe and is comprised of bone and soft tissue.
A bunionectomy is performed when conservative means of addressing the problem are unsuccessful. As the big toe moves sideways, it can push the second toe sideways as well. This can result in extreme deformity of the foot, and the patient may complain not only of significant pain, but of an inability to find shoes that fit.
Once surgery has been decided on, the type of the procedure will depend on the degree of deformity that has taken place. There are several different surgical techniques, most of which are named after the surgeons who developed them, such as McBride, Chevron, and Keller. The degree and angle of deformity as well as the patient’s age and physical condition play a significant role in the surgeon’s choice of technique, which will determine how much tissue is removed and whether or not bone repositioning will occur. If bone repositioning is done, that part of the surgery is referred to as an osteotomy (osteo means bone).
The type of anesthesia, whether ankle block (the most common, in which the foot is numb but the patient is awake), general, or spinal, will depend on the patient’s condition and the anticipated extent of the surgery. These surgeries are typically done on an outpatient basis at Mississippi Valley Surgery Center. The procedure itself may take about an hour.
The surgeon will make an incision over the swollen area at the first joint of the big toe. The enlarged lump will be removed. The surgeon may need to reposition the alignment of the bones of the big toe. This may require more than one incision. The bone itself may need to be cut. If the joint surfaces have been damaged, the surgeon may hold the bones together with screws, wires, or metal plates. In severe cases, the entire joint may need to be removed and a joint replacement inserted. If pins were used to hold the bones in place during recovery, they will be removed a few weeks later. In some mild cases, it may be sufficient to repair the tendons and ligaments that are pulling the big toe out of alignment.
When finished, the surgeon will close the incision with sutures and may apply steri-strips as an added reinforcement. A compression dressing will be wrapped around the surgical wound. This helps to keep the foot in alignment as well as help reduce postoperative swelling.
While the patient can expect to return to normal activities within six to eight weeks after the Bunionectomy surgery, the foot is at increased risk for swelling for several months. The patient is advised to keep the foot propped up and protected from pressure, weight, and injury while it heals. When the patient can expect to bear weight on the operated foot will depend on the extent of the surgery. The milder the deformity, the less tissue is removed and the sooner the return to normal activity level. During the recovery period, a special shoe, boot, or cast may be worn to accommodate the surgical bandage and to help provide stability to the foot.
