The bunion (Hallux valgus) is a disease that may be treated with surgical and medical techniques. The main principle of the treatment is to correct the stepping defect which is damaged because of the deformity of the thumb. The main principle of the medical treatment for the patients is to try to correct the mechanical balance of the foot damaged by the big toe deformity with various orthopaedic devices. Here the interdigital silicone, the reels put in the night may reduce the pain by relaxing the tissue around thanks to maintaining the toe at the right position. The wrong stepping caused by the big toe deformities of the patients are corrected by the specially designed insols and it is tried to turn the balance of the areas which bear too much load turned into a normal level. For the patients who did not benefit from these orthosis, surgical treatment techniques are planned to suppress the pain and to help the patient to wear shoes more easily.
What is a Bunion?
Bunion is the name given to the swelling around the big toe caused by the hallux valgus deformity in the foot. The fat pad which is responsible of protecting the articulation around the big toe articulation becomes the area under pressure in the shoe because of the deformity and a reactive growth results depending on this situation. As the tissue gets bigger the shoe pressure increases and the swelling and redness become permanent.
What are the causes of bunions?
The cause the most seen in the formation of bunions is the wearing a long time specially narrow and pointy-toed shoes which are not appropriate to the foot, tightening the big toe in a position which is not natural. Besides this, the bunions also appear in diseases such as arthritis and polio. Genetics play frequently a role in the formation of bunion. But all these causes only cover a very little percentage of bunions. The bunions are proportionally nine times more present in women than in men, which is not shocking.
Is it possible to prevent the bunions? When the bunions are not treated they frequently become painful. But all the bunions are not progressive. Many bunions problems may be treated without surgery.. Generally the bunions without pain do not need surgical correction.. That is why the orthopaedists do not advice "PROTECTIVE Surgery" for bunions which do not hurt. In a large part of the cases the bunion pain may be suppressed by wearing appropriate shoes.
The characteristics that must be present in appropriate shoes:
- Your shoe size may show some difference according to the model of the shoe. For each new model buy your shoes after having tried them.
- Choose a shoe which suits your foot structure as much as possible.
- The size of your feet may change as your age passes by.
- Measure your two feet. One foot is bigger than the other in many people. Try the shoe on your foot which is the biggest.
- Try the shoe at the end of the day when your feet are the biggest.
- Stay standing during the trial and control that in both shoes there are enough distance for your longest toe.
- Be sure that your metatarsus fit the largest part of the shoe (ball pocket).
- To be sure that the shoes fit your foot and is appropriate to your foot walk with your shoes.
Some shoes may be modified by changing the part which makes pressure on your toes. The athels and orthosis (special shoe insols shaped according your shoes) used in the repositioning of the big toe may also attenuate your pain.
Is the bunion surgery appropriate to your situation?
If a successful response is not taken by the medical treatment, you may want to think about the surgical technique. Many research found out that the results of the 85%- 90% of the patients who went to the bunion surgery are satisfying.
The indications for the bunion surgery:
- Serious foot pain which limits your walking and daily activities despite the appropriate shoes.
- Chronic inflammation and swelling of the big toe which do not disappear with rest and medicine.
- Small toe deformities developed in addition to the big toe deformity formed because of the big toe pushed by the other small toes.
- Hardness- deficiency in the movements of your thumb.
- When no advantage is seen from the nonsteroid and anti-inflammatory drugs in the attenuation of the pain
- The advancement of the big toe deformity despite the other treatments such as making changes in the shoes and the anti-inflammatory treatment
The most important feature of the bunion operations is to understand well the period after the operation. According to the surgical operation made, during the postoperative period, there is a period about 4-6 weeks with no load on the foot and then approximately until the end of the 3rd month there is a period of wearing shoes chosen with large and comfortable features. Besides, the total recovery of the patients after this surgery will include a period of about 6-9 months of time of recovery. During this period, it may question of swelling and difficulty to wear shoes. That is why; bunion surgery is an important surgery. Beware of the wrong assertions saying that the surgery will provide you a perfect foot. The aim of the surgery is to reduce as much as possible the pain, and to correct realistically as possible the deformity. It must not be seen as cosmetic surgery.
Bunion surgical Types:
Many different surgical techniques are used to treat the bunions in Orthopaedics
Correction of the tendon around the big toe and ligament:
A high tension develops in the tissues inside the articulation in relation with the deformity developed at the big toe articulation. This is one of the most important reasons of the development of this pain. The balance of the articulation may be provided thanks to this operation made in addition to the bone operation which will be made. The balance of the articulation is provided by cutting the tissues which are stretched.
Arthrodesis:
In cases which are very advanced, if there is no possibility left to correction, the big toe articulation is immobilized at 10 degrees and ravaged surfaces are erased. Screw, cable or a plaque is put to maintain the surfaces until symphysis is finished. It is a technique used in patients with serious bunions, serious arthritis and for whom the other techniques did not succeed.
Eks Osteotomy:
In the result of the deformation of the big toe articulation, the outside of the 1st metacarpus is the area which shows reaction and causes pain. It leads to a physical change of the bone. The Taper and growth of the bone is visible. Eks Osteotomy is the operation of taking out this part which has developed. It is a surgical operation made in addition to the main bone operations.
Resection arthroplasty:
It is a technique specially preferred for old patients and for individuals who are not active. In this operation the damaged parts of the articulation are cleaned and a false articulation is made by sliding the joint capsule on these surfaces. It is a surgical operation which has an easier recovery period and which shows convalescence at the end of 6 weeks. It is a surgical operation preferred for old patients because of the rates which are high again in long periods whereas the cosmetic results are good for the patients.
Osteotomy:
It is the operation of sliding the metacarpus on its reverse side of the deformity by cutting the metacarpus in the appropriate angle, measuring the degree of the deformity which has developed. You may analyse the different and various types of the operation of sliding the metacarpus in the videos.
The orthopaedic evaluation
:
The preparations concerning the bunion surgery may be listed as below.
The orthopaedic evaluation involves three components.
Medical history: your orthopaedic surgeon increases his knowledge on your general health and will ask you how long does your pain last and your ability to find shoes which do not hurt your foot. He will also ask you the other conditions that may affect your surgical result. For example, diabetes and rheumatoid arthritis may increase the risk of infection and block your correct recovery. The problems of circulation may increase the postoperative pain and block your recovery.
The physical examination is evaluated according the presence of other foot deformities such as wrong range degree and flexible tissue destruction, hammer toe and callus.
The radiograph determines the deformity at the toe articulation and the size of the destruction.
The orthopaedist will review your evaluation results with you one more time and will present you the most appropriate treatment for you. All the treatment choices will be told you with the positive and negative sides of them. This discussion is very important to have a realist expectation after the operation.
The realist expectations concerning the bunion surgery:
An important factor in the decision making is to understand what will be done and not by the technique which will be applied in the bunion surgery. The patients who go to the bunion surgery are facing in general a rapid reduction of the pain after the operation and a visible correction of the big toe line.
The bunion surgery will not allow you to wear smaller and narrow pointy-toed shoes. You will even have a limitation for some shoes for the rest of your life.
Remember that the most frequent cause of the bunion deformity is the shoes which are worn tightly. If you wear that kind of shoes again, so your bunion will appear again.
The preparation to the surgery:
If the decision for the bunion operation is taken, you will be taken with your family doctor to a total physical examination before the operation to evaluate the general health conditions.. If you have heart, lungs and other chronic diseases, your family doctor will evaluate these problems before the operation.
Tell your orthopaedist the medicine you take before the operation. He will tell you which you will take and which you will not before the operation.
Tests which will be helpful for the planned technique such as blood samples, electrocardiography, chest X-ray, urine specimen and special foot X-ray may be wanted by the orthopaedist.
Your operation:
You will be probably asked to come one or two hours before the operation to the hospital or surgery centre.
After having made your entry to the hospital, you will be evaluated by a member of the anaesthesia team. In many bunion operations the anaesthesia is made under the ankle joint by blockage. Sometimes, general or spinal anaesthesia may be used. The anaesthetist will stay with you from the beginning of the operation to the end in order to give the other medicine when necessary and to relax you.
The operation lasts approximately 2 hours. Then, you will be taken to the recovery room. One day after, you will be ready to go home.
The possible complications after the operation:
Complications in less than 10% of patients may be seen after the bunion operation. The possible complications are infection, repetition of bunion, nerve destruction and an ongoing pain.
If complications appear these complications may be treated but it will extend your recovery time.. Your orthopaedist will explain the various choices for the treatment of these complications.
Recovery at home:
The biggest part of the success of the operation will be related to your degree of following the advices of your orthopaedist at home, during the first weeks after the operation. To be sure that your foot will recover correctly, you will see your surgeon regularly during the following months.
Care of foot wearing:
You will be discharged from the hospital with the band holding your big toe at the corrected position. At the same time, you will wear a special after operation shoe or your foot will be plastered in order to protect it. The sutures will be taken off about two weeks after the operation, but your foot will need a support with a dressing or brace. The important points to guarantee a correct recovery; to keep dry the support applied and to use it correctly. Don’t forget to put a plastic bag on your foot during the shower.
The importance of the body position:
Your orthopaedist may suggest you a walker, walking stick or crutches after the operation during the first weeks. You may put weight little by little on your foot with the recovering wound. Besides this, you must walk only short distances during the first weeks following the operation. You will be probably able to walk again in about one week.
Swelling and wearing shoe:
Some days after the operation, maintain as far as possible your feet very high and in order to reduce the pain and the swelling put ice as your orthopaedist suggested you. You will have some swelling at your foot during six months. After your bandage are taken off, for the first months until the operation place recovers totally, wear only athletic shoes or soft leather shoes such as Oxford type. Do not wear trendy shoes with high heel until after six months. Follow the shoe types presented before in this brochure when choosing your shoes. This will prevent the recurrence of your bunion.
Exercises which reinforce your foot:
Some exercises or physiotherapy may be suggested after the operation to take back the strength of your foot and the movement to its past situation. Your surgeon may give you some exercises with a ball to give your toes their past movement ability using a surgical bandage which reinforce your ankle. Always start slowly to these exercises and perform the information ordered by your physiotherapist with your surgeon by repeating them.
Medical Treatment:
Your orthopaedic surgeon may give you antibiotic for a while in order to prevent from infection after your operation. The pain treatment is applied quite a long time to reduce the pain caused by the operation.
Problems to avoid after the operation:
Even if it is not common, complications may occur after the bunion operation. When those listed below occur contact your orthopaedist: if your bandage unfastens, get off or dampen
if your bandage dampen with blood or flix
the side effect of the drugs taken after the operation
Besides this, if you have observed the symptoms listed below which announce an infection, call your orthopaedist urgently: fever
shivering
obstinate redness and heat around your bandages
an obstinate pain which increases gradually
a significant swelling on the upper part of the foot which has been treated, on the calf
Foot activities and guide of exercises:
Regular exercise and returning step by step to daily activities are very important for your total recovery. Your orthopaedic surgeon and physiotherapist may suggest you to practice approximately 20-30 minutes two or three times a day, after taking off your postoperative bandages. This guide may help you to better understand the program of exercise/activity controlled by your orthopaedic surgeon and physiotherapist.
The early postoperative exercises:
Walking- it is important to walk correctly with postoperative shoe. At the beginning you must walk with walker or crutches. Your surgeon or physiotherapist will tell you how much load you will put on your shoe. Remain standing freely stabilizing your weigh with your crutches or walker. Walk on a short distance your crutches or walker; then step on your operated foot, and put first your ankle on the ground. The most of your weigh will stay on your ankle when you will move forward. Later, you will be informed on when you will put the totally of your foot on the ground and when you will not need any longer your crutches or walker.
Ankle pump- Move your foot up and down by flexing your calf and shank muscles rhythmically. Practice this exercise in the recovery room periodically 2-3 times per hour for 2-3 minutes.
Advanced exercises:
Towel curls - place a small towel on the floor and curl it toward you using only your toes. You can increase the resistance by putting a weight on the end of the towel. Relax and repeat this exercise 5 times.
To raise toe, to curve toe- keep 5 seconds in each position and repeat 10 times.
Big toe pulls- place a rubber around toes of both feet and pull your two big toes away from each other by stretching the elastic. Hold for 5 seconds and repeat 10 times.
Toe pulls- put a thick rubber band around all of your toes and spread your toes. Hold for 5 seconds and repeat 10 times.
Toe squeeze- place small corks between your toes and squeeze for 5 seconds. Repeat 10 times.
Marble pick up- Place 20 marbles on the floor. Pick up one at a time with your foot and put in a bowl. Repeat with 20 marbles.
Activity:
After the operation start walking short distances little by little and practice your daily activities every day. This early activity helps to your recovery and will you make gain back your mobility.
Walking- you may start walking when you achieve wearing the athletic shoes for the first time. Your orthopaedist and physiotherapist will determine the time for this and will inform you.
Running- when you are able to walk for the first time without pain, it is the mobility of your big toe which will recover. Your surgeon and physiotherapist will inform you the time for this.
The other sports- when you run for the first time without pain, you may also go back to race sports such as many patients. This includes team sports, aerobics and step, and climbing.
Swelling and pain after exercises or activities (movement) - a moderate pain or swelling may occur on your foot after movement and exercise.
Raise your feet high and put ice enveloped in a towel. The exercise and activity will continuously advance your strength and mobility.
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