Bunions

What is it?

A bunion is a bump that forms at the base of the big toe, causing a bulge along the side of the foot. The bump is actually additional bone formation in the joint that causes a mechanical mal-alignment of the big toe. The bunion will cause the big toe to angle toward the small toes. In some cases, the bunion will cause no pain, but most of the time, patients will complain of intermittent pain to the base of the big toe, that with time can become more persistent. Pain is usually exacerbated with walking or wearing shoes that put pressure on the area. The bunion can also appear red or swollen and become tender to the touch.

Bunions tend to affect women more than men, with the greatest cause being tight-fitting and high-heeled shoes. Bunions can also be congenital or result from rheumatoid arthritis or nerve injuries.

In order to diagnose you properly, your doctor will consider your symptoms, examine your feet, and take X-rays to get a clear view of the alignment of your toes and the condition of the joints in your feet.

What are the treatment options?

Bunions do not always cause problems, but they are permanent unless surgically corrected. Treatment will depend on the severity of the bunion and the amount of pain that is present.

Nonsurgical treatments include taking over-the-counter pain medication, icing, receiving a cortisone injection, changing shoes, adding padding or a shoe insert, or taping or splinting the pad or your foot into a normal position.

If nonsurgical treatment options do not provide relief, surgery may be necessary. There are many options from which your surgeon will choose; they include: removing swollen tissue, straightening the big toe by removing part of the bone, realigning the metatarsal bone or joining the bones of your affected joint permanently.

Procedure Goals

The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position.

Risk Factors

Various factors may increase your risk of bunions including:

High heels
Ill-fitting shoes which are too tight, narrow or pointed
Arthritis
Genetic predisposition

What to Expect

Full recovery can take weeks to months, and is dependent on the type of bunion repair, the degree of deformity, the quality of tissues and the presence of arthritis. It is crucial you were proper shoes to aid in the recovery process.

Before Procedure

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants and a t-shirt for surgery.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

If crutches or a walker are needed, please rent or borrow them prior to your surgery.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

After the procedure, you may be placed in a splint or post-operative shoe to protect the surgical site. It is also possible that you will have weight bearing restrictions, but this will be discussed with you by your surgeon.

Discharge Instructions

Diet

You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Ankle Care & Bathing

Use your crutches and do not place any weight on your operated leg! This is important!
Keep your ankle elevated above heart level as much as possible for the first five days, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing.
Keep your splint clean and dry all the time.
It is ok to shower or sponge bathe 2 days after surgery but you must keep your splint clean and dry at all cost! This usually entails wrapping your ankle in a plastic garbage bag to keep it dry.

Cold Therapy

To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
It is not necessary to use ice while sleeping.
We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48-96 hours after surgery. Do not take any additional Tylenol.
While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
No driving while taking any narcotic pain medication!
The pain medication may cause some nausea so take it with food.
The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

Watch for temperature > 101.5F, persistent numbness and tingling in the foot, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan- Exercises

Formal rehabilitation after a bunionectomy is not often necessary. However, you may need to do range or motion exercises to restore normal mobility. Your surgeon will determine your need for formal therapy.