WHAT IS A BUNION?

It is important to know that typically a bunion ( known medically as Hallux Valgus) is not just a bump that can be shaved away. Instead, it is a widening of the forefoot where your normal bones shift out of place. This can cause a painful prominence. There are various things that can lead to a bunion but it is primarily an inherited problem. A tight calf muscle, flat feet can contribute as well.

A bunion is typically painful due to external pressure. Your forefoot is larger now so there is pressure on this area with shoes. It is easier to change the shoe than it is to change the foot so we typically start with this. Options like toe spacers or orthotics may or may not help your pain. The goal of these easy treatments is to improve your pain. It is important to know that they will not help change the shape or the look of your foot.

Learn more at FootcareMD.org

Treating bunion pain before surgery

Surgery for a bunion can take various forms. The overall goal of bunion surgery is to correct the shift that's occurred through the metatarsals and to make them parallel again. Soft tissue balancing is also needed at the toe to fully correct the problem. Any excess bone at your bunion bump is also shaved away but the primary goal is to realign the forefoot to correct the underlying deformity causing your bunion.

If you have a bunion with no arthritis present, then the bone can be realigned from the joint above (the tarsometatarsal [TMT] joint) through a corrective fusion or, through a controlled cut and realignment through the metatarsal itself (osteotomy).

If there is arthritis of the sesamoids or the big toe joint itself (MTP joint), then this must be addressed as well. This is typically achieved through an MTP fusion. Read more about MTP fusion below.

Osteotomy

Lapidus

1st MTP Fusion

SURGERY FOR BUNIONS

LAPIDUS BUNION CORRECTION

A Lapidus Bunion correction involves correcting the malalignment of the metatarsals from the base of the problem at the level of the TMT joint (Tarsometatarsal joint). The correction is made through the TMT and then fused in place. Often Dr. Roberts takes a small amount of bone graft from your heel bone (calcaneus) to help the bones at the TMT joint unite. Any excess "bump" by your big toe is shaved away as well (medial eminence resection). Soft tissue balancing is also performed at the 1st MTP (Big toe joint) to realign the big toe straight.

LAPIDUS POST OP INSTRUCTIONS

FOLLOW UP:

First appointment: approximately 2 weeks from surgery, usually at the Burnaby Hospital Fracture Clinic.
Prior to your surgery, you should have received dates for your 6 week and 3 months follow up visits.
If you still have concerns at the 6 month mark, you are welcome to call to book additional follow up as needed.

EXPECTED RECOVERY TIMELINE:

Swelling and pain is normal and expected in the first two weeks. Rest, elevation and pain medication are important to help manage this.
If your pain is severe and you aren't managing with the instructions and pain medication provided, call or go to the Burnaby Emergency Department.
Ideally by 3 months following surgery, you are walking not necessarily far, or fast but able to get back to your normal day to day in a more normal shoe.
Swelling is normal and not a concern and can last for up to 6-12 months. Some swelling doesn't always resolve fully.
If all is healing well, you can progress your walking and other physical activity as your symptoms allow.
You will not know full recovery (pain, swelling, strength) until 9-12 months following surgery.

DRESSING:

You will go home from surgery with a bulky but soft dressing on your foot and ankle and your post operative sandal in place. This can remain as is until your first 2 week appointment.

WOUND:

Your wound(s) are closed with sutures, some of which will need to be removed.
Do not get the dressing or wound wet for the first 2 weeks. To ensure this, a bag should be placed over the let to avoid anything getting wet.
The dressing/splint should remain on until your first appointment. Do not remove this. It will be changed at the first 2 week appointment
Sutures are removed typically at the 2 week mark. Its not uncommon if you have a fair amount of swelling, to have them removed at 3 weeks.
After your sutures are removed, you can shower 2-3 days later and allow clean water to run over the wounds. Pat this dry and reapply a dressing if it is your preference. It is not required. The steristrip tapes on your wound can get wet. Just pat them dry.
Steristrips should stay on for about 10-14 days usually. If they fall off prior to this, they do not need to be reapplied. If they are still on after 14 days, ensure you please remove them yourself.
Do not immerse the wound in a bath, hot tub or pool until the scar is fully healed with no scabs. This is often 4 weeks.
No lotions or creams should be used until the wound is fully healed, often 4-6 weeks.

WEIGHTBEARING

You may not put any weight on your foot until 2-3 weeks from surgery.
At the 2-3 week mark, you may begin bearing weight through your heel and progress to normal walking as you feel able.
You may start taking your sandal off at night after 4 weeks if you feel able and can wean off it in the day as your symptoms and swelling allow.
At 6 weeks from surgery you can transition to a shoe as able. Keep in mind some people still have too much swelling at this point to be able to get into the shoes they want just yet.

PHYSIOTHERAPY:

At the 2-3 week mark, if you feel able, you may begin physiotherapy. Prior to this due to swelling, wounds and dressings, possibly therapy will be limited.
Dr. Roberts will provide you a custom physiotherapy prescription to help guide your therapist in your recovery.

DRIVING:

You are not able to drive if you are still taking Opioid (Narcotic) pain medication
Left foot surgery: beginning at least 2 weeks post op, once you are able to comfortably remove the sandal/boot while driving. Contact your insurance for further recommendations.
Right foot surgery: You can drive once you are walking fully in a shoe.
Try practicing in a parking lot first to ensure your reaction/strength/motion is adequate

FLYING:

If possible, you should consider avoiding long haul flights for the first 4-6 weeks from surgery.
If you must fly before this there is an increased risk of blood clot. Try to keep moving on the flight, stay hydrated, avoid alcohol, consider compression socks. Discuss with Dr. Roberts if you require a blood thinner to keep your risk as low as possible.

WORK:

You should arrange to be off of work for the first 2 weeks after surgery to allow for rest and recovery.
If you are working from home or can get to work safely and work in a flexible seated job, you could return to work after the first week if you so choose, provided you are off opiod (narcotic) pain medication. You will need to elevate the foot and allow for more breaks. More commonly, most patients take 6 weeks off work.
Any work should be sedentary for the first 8-12 weeks.
Typically a return to more physical duties can begin gradually at the 12 week mark from surgery.
You may discuss your return to work plan with Dr. Roberts if you still have questions.

METATARSAL OSTEOTOMY BUNION CORRECTION

The term osteotomy, refers to a controlled cut of the bone through which the bone is then realigned. Dr. Roberts offers a scarf or a chevron osteotomy for some patients with a more mild bunion to correct the malalignment of the metatarsals. There are pros and cons to this approach and an osteotomy isn't an option for everybody. Dr. Roberts will examine you and your imaging to determine which technique is best for you.

OSTEOTOMY POST OP INSTRUCTIONS