Do I need bunion surgery?

Although your surgeon has recommended an operation for your bunion to improve the function of your foot and reduce pain, it is your decision if you go ahead with the operation or not.

The bunion is often progressive and once the second toe overlies or underlies your first toe, additional operations are required to address the deformed lesser toes.

What does the operation involve?

There are around 130 different procedures for bunion surgery. Your surgeon will decide what procedure is performed depending on your bunion, but it typically involves;

  • Removal of bunion
  • Releasing tight ligaments, capsule and tightening loose ligaments
  • Cutting and realigning first metatarsal bone with fixation(K-wire or screws)
  • Additional procedure may be warranted to correct the big toe

 

Dr Kim offers six different surgical techniques depending on what would warrant the best outcome.

  • MICA (Minimally Invasive Chevron + Akin)
  • Distal Chevron Osteotomy + Akin Osteotomy
  • Scarf + Akin Osteotomy+ Akin Osteotomy
  • Proximal Chevron Osteotomy + Akin Osteotomy
  • Lapidus Bunionectomy + Akin Osteotomy
  • First metatarsophalangeal joint arthrodesis

 

Various anaesthetics are available for bunion surgery. Your anaesthetist will discuss this with you. (General anaesthesia or spinal block or local anaesthesia with sedation)

The operation usually takes an hour or slightly more, and at the end of the operation, your foot is dressed with a bandage or plaster cast.

What medications will I take, and does it affect my medications?

If you have local anesthesia;

You will first be given to take antibiotics 1 hour before the operation, and if needed, you will also take a sedative medication 90 minutes before the operation if you decide to have local anaesthetics.

If you have general anesthesia

All medications will be delivered intravenously.

 

You will also be given post-operative analgesics for pain reduction.

 

Your surgeon also asks what medications you are on during preoperative consultation and give you an instruction;

  • If you are on beta-blockers for your high blood pressure, you should continue to take them.
  • If you are on warfarin or clopidogrel, you may need to stop prior to surgery
  • If you are diabetics, you should continue to take diabetic medications and make sure your blood sugar is under control before surgery.
  • You may stop your oral diabetic medication on the day of surgery and talk to your treating surgeon that your surgery is scheduled early in the morning

What if I am a smoker?

If you are a smoker, you need to stop the habit of smoking four to six weeks before your operation for normal healing and reduce postoperative complications. Nicotine is known to stop bones from healing.

What can go wrong with bunion surgery?

As with any surgical procedure, bunion surgery also carries complications. The complications fall into three categories.

  • Complications of anaesthetics
  • General complications of any operations
  • Specific complications of bunion operation

Complications of anaesthetics

The anaesthetist will discuss with you the possible complications of having anaesthetics.

General complications of any surgery

  • Pain: Your surgeon or anesthetist will give you scripts for pain medication.
  • Bleeding: surgery is usually done under ankle tourniquet to minimise bleeding during the procedure.
  • Infection: soft tissue infection could happen after the operation and it is usually managed well with oral antibiotics.
  • There is a slim risk that bone infection (Osteomyelitis) could happen and this usually requires intravenous antibiotics for a period of time.
  • Surgical site scarring: If you are prone to hypertrophic scar (Keloid), Dr Kim can arrange scar reduction cream for the operation.
  • Blood clot (Deep Vein Thrombosis) in the leg: This could happen 1 in 100 but your surgeon can assess you for risk factors such as blood disorder, previous history, smoking, edema of the legs

Specific complications of bunion surgery

  • Delayed bone healing: Osteotomy (Bone cutting) site usually takes 8 to 12 weeks to heal but sometimes it could take a long time up to 6 months and sometimes further surgery is required to address this problem (risk:1 in 50)
  • Stiff joint: Due to soft tissue swelling, the movement of joint may be slightly restricted but this usually resolves with time.
  • Nerve Damage: You could experience numbness near the operation site but this usually resolves with time.
  • Recurrence of the deformity: This could happen if the underlying cause is not addressed after the operation. Recurrence is usually higher if you are young or have hypermobile joints. Dr Kim will choose the right bunion procedure to minimise the recurrence.
  • Overcorrection: If the deformity is overcorrected, your big toe may go outward

 

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner

 

  • By – Dr Ji Soo Kim
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