"Are You Ready for Bunion Surgery?" Healthy Cells Magazine, February 8th, 2016

Many patients try a variety of conservative treatments to tolerate their bunions and to avoid surgery as long as possible. Who can blame them? Unfortunately, when treatments stop working and severe pain and swelling begin to interfere with daily activities, they find themselves at a crossroad. This is when the realization sinks in that the time has come to consider bunion surgery. Many of them are at a point where they want surgery sooner than later but they are still confused and anxious. Many even avoid surgery because misconceptions guide their decision. Here are the common questions that I discuss with my patients.

What are the goals of surgery?
The goals of surgery are to relieve pain, to remove the bunion and keep it from returning, and to correct the alignment and mechanics of the foot. It will often improve the appearance of the foot.

Are there different types of bunion surgery?
There are different types of surgery. Each type depends on a combination of factors such as the severity of the deformity, a person’s age, health, activity level, and condition of the bones, muscles, tendons, and ligaments in the foot. Various procedures are used to correct mild, moderate, severe, and arthritic bunions or big toe joints. Your surgeon will select the best procedure for your condition. These may include one or a combination of the following procedures: an Osteotomy — breaking the metatarsal (toe bone) to correct the alignment problem, repairing the tendons and ligaments around the big toe, and removing the damaged joint surfaces. Screws, pins and plates are used to stabilize the bone as it heals. Fusion of the big toe joint or mid-foot area is considered for the most severe cases.

What are the risks?
Possible complications may include: a recurrence of the bunion, an overcorrection of the problem, stiffness, swelling, numbness, infection, nonunion, and arthritis. Consult with your physician to review all the pros and cons of surgery a well as the consequences of delaying or not having surgery.

Is surgery painful?
Post-operative pain is generally mild, and can include throbbing, swelling, and discomfort. Most patients tolerate pain with medications, rest, and icing. Laser therapy is also available to reduce pain and inflammation, and to promote healing.

What can I expect after surgery?
Stitches are removed within 7-14 days. Patients are limited to a walking boot or a surgical shoe for 10 days. Most simple bunionectomies allow for return to a running shoe after 10 days barring any complications. Regular shoes may be worn in 6 weeks as long as they provide a larger toe box and more arch support. Dress shoes may be worn in 3 months. Fusions require 6 weeks of non-weight bearing followed by 4 weeks in a protected walking boot. Physical therapy may be prescribed for a couple of months. Most activities may be resumed within 6-8 weeks but it may take 6 months for full recovery. Patients will have driving restrictions if the right foot is repaired for the first 10 days. Surgical correction generally increases patient quality of life through an increase in function and reduction of pain.

When can I return to work?
Your return to work depends on the type of surgery performed and demands of the job. If you have a desk job, you can return within a couple of days. If your job requires excessive walking or standing, it may take a couple of months.

Will the bunion come back?
Recurrence is possible but not likely if the correct procedure is tailored to resolve the severity of your bunion. The majority of patients are satisfied with their outcome.

Will I have unsightly scars?
Your surgeon may be able to minimize the incision by using alternate surgical approaches and closure techniques. Laser technology is also available to reduce scars after surgery.

How do I select a surgeon?
Select a surgeon who understands all of the variables of bunion surgery and experience to perform each procedure. Your surgeon should be certified by the American Board of Foot and Ankle Surgery (ABFAS) in Foot Surgery or Foot and Ankle Surgery; and preferably board certified in Reconstructive Rearfoot/Ankle Surgery.