A bunion (hallux valgus) is a progressive deviation of the big toe towards the second toe and development of a knot on the ball of the big toe. This inherited deformity is very common and effects women more than men. Bunons occur can occur at any stage of life, but are more common in those over 50 years of age.
The cause is due to an imbalance of the tendons attached to the base of the big toe. Like reigns on a horse, if one reign is pulled tighter than the other, the horse turns. Similarly, the inherited discrepancy of tension between the two sides of the great toe gradually cause the toe to drift towards the second toe.
Development of a bunion is primarily genetic and prevention is aimed at reducing the forces causing the big toe to lean towards the second; such as avoidance of narrow toed shoes.
Treatment options involve accommodative padding, wide shoes to reduce the pressure against the ball of the big toe, or surgery.
Surgical treatment varies widely by physician, as does the level of mobility allowed after surgery. Also, the actual techniques used to correct the bunion can also vary by provider and can alter the amount of mobility permitted in the post-operative period.
Most bunion surgeries are performed as an outpatient, where the patient arrives to the hospital or surgical center, has the procedure, and goes home all in the same day. The surgery is also frequently performed under IV sedation, also called "twilight anesthesia". This involves insertion of an intravenous (IV) line into the arm or hand. Medications to make the patient dose off to sleep will then be administered allowing pain free injection of local anesthetic into the surgical site. The patient does not feel the injections, does not inhale gas, have a tube down their throat, nor do they experience the nausea and vomiting often associated with a general anesthetic.
The surgery takes an average of 30-60 minutes. Depending upon the severity of the bunion, the amount of activity permitted after the surgery may range from walking in a removable walking boot to a below knee cast, complete nonweight bearing, and use of crutches.
Typically, bunion surgery involves use of a walking boot, where the patient is allowed to walk on a limited basis beginning the same day of surgery. This involves walking to the restroom, kitchen, car, etc. Prolonged walking or standing is not advised. Primary bone healing occurs in 4-6 weeks, and may extend to 8 weeks for smokers. The patient is allowed to return to a large tennis shoe at about four weeks, pending everything looks good both clinically and on x-ray. The foot will continue to be wrapped with a compressive wrap in the shoe for up to two more months to minimize swelling.
During the first four weeks after surgery, the bones are healing, but not fully healed. Like glue partially dried, the bones that were corrected are fragile. If the foot is not sufficiently splinted or stabilized, and should the foot be jarred or a toe be stubbed, the surgical site can become dislodged and positioned out of alignment, resulting in a return of the deformity, continued pain, or a return to the operating room for repairs.
Virtually all insurance plans cover elective bunion surgery and verification of benefits for this surgery is performed prior to your surgery.
If you suffer from foot pain, give us a call at 270-684-5252. Treatment options are available!
Dr Block is an excellent podiatrist. The staff is friendly and very professional.