Mild bunion deformities which require surgery usually are treated by shaving off the bump of bone on the inside of the foot where the bunion is. This procedure is almost always done as an out-patient, so that you go home the same day of the surgery.
The Most Common Type of Bunionectomy Used Today Is the Modified Austin Bunionectomy, Used for Mild to Moderate Bunions. The Austin procedure is actually a combination of procedures used to remove the bunion and correct the mal-alignment of the joint, all at the same time.
The first step is to shave off the bump, as described above.
The second step is to make a cut in the metatarsal bone just behind the toe and realign the metatarsal and re-establish its normal alignment. Pins or specialized bone screws are used to hold the bone
The third step is to balance the pull of tendons and ligaments around the joint in order to straighten the toe. All of this is accomplished at the same time, and is usually done as an out-patient.
In more severe bunion deformities, I may need to perform several different procedures to obtain a good result. These may include removing the enlarged portion of the bone on the side of the metatarsal, cutting the metatarsal bone at the back end of the bone to realign the metatarsal and re-establish its normal alignment, and in some cases, cutting a wedge from the big toe bone to straighten the big toe. Again, pins or specialized bone screws are used to hold the bone in its proper position while healing is occurring.
The Most Severe Bunion Deformities Have Significant Alteration of the Bone Structure and in Addition Have Developed Arthritis of the Big Toe Joint. When arthritis occurs in the big toe joint, the cartilage wears out. The cartilage is the cushion between the bone ends, and when it wears out, bone rubs directly against bone. Hence, the pain of arthritis. Bunions with severe arthritis generally require a joint replacement, much like a knee joint replacement to replace the damaged joint surface of the metatarsal.
I always perform a thorough evaluation of your foot to determine if you have adequate circulation and check to see if various other systems are functioning properly to allow for healing of the tissues after your operation. However, even after the most thorough pre-operative evaluations, there is always the risk of infection in the area of surgery. If infection is suspected after the operation is performed, prompt treatment usually resolves this problem in a short period of time. Additionally, there is a risk of delay in bone healing. You will most likely need supplemental calcium, and I will follow your healing progress very closely, usually with X-ray studies, to follow the bone healing occurring in your foot. This way, if I see any evidence of a problem, it can be identified early and treatment can begin promptly. Undercorrection, overcorrection, and blood vessel damage are infrequent complications. Most people will have temporary numbness in a section of the big toe, as well as firm scar tissue, until healing is complete. Finally, there may be stiffness in the joint that may require multiple physical therapy sessions to overcome. Specific exercises will be prescribed for you to do at home.
Recovery for the Austin-type procedure will be described, since it is the most common type of bunionectomy performed.
From the very day of surgery, you are able to walk and get around by wearing a special post-operative shoe on your foot (feet), but for the first week after surgery, you are limited to walking only 10 minutes per hour in order to avoid excessive swelling. The rest of the time, you will keep you foot (feet) elevated, but you are not confined to bed, and you are not required to use crutches.
Certain bunion procedures may require you to wear a surgical shoe, wear a cast, or use crutches. I will prescribe appropriate medication to be taken, if needed, for pain. I may also prescribe custom made orthotics to increase your comfort and help to prevent a recurrence of the deformity.
During the second week after surgery, you may generally be up and around for 20 minutes per hour, depending on the progress of your healing at your first dressing change. This increases to about 30 minutes per hour during the third week of healing. By the end of the fourth week after surgery, the metatarsal bone is generally healed well enough to begin wearing athletic shoes, SAS, or similar style oxford shoes, and you are allowed to return to regular activities, provided they are not strenuous or athletic.
Most people need to be off work for a bare minimum of 3 weeks. People whose jobs are mostly sedentary can sometimes return then, and people whose jobs require very much standing or walking may need to be off work for 4-6 weeks. Returning to work too soon is the leading cause of post-operative complications, ranging from prolonged pain and swelling, to abnormal healing of the metatarsal bone.
Most people are pleasantly surprised at how LITTLE pain is involved with today's surgical techniques. Many people have heard the horror stories from many year ago when people stayed in the hospital for 3-5 days, needing shots of morphine to control their pain.
Most of my patients today take one pain pill the night of surgery, and then one or two the next day, and then convert to Extra Strength Tylenol thereafter.
How can this be? At the end of the operation, I put into your foot some long-acting numbing medicine (similar to Novocaine) that keeps your foot numb for an average of 10-12 hours, and sometimes even longer. This allows the healing to get started before the pain ever has a chance to occur.
As a result, most people need very few pain pills, and many folks take none after the first night.
Remarkable advances have been achieved in the past decade with instrumentation and space age technology improving medical and surgical procedures. Additionally, I have a wide range of non-surgical treatments, as well as sophisticated surgical procedures, from which to custom design a treatment program that is best suited to your needs and your particular situation. These treatments and surgical techniques are available thanks to advanced research and scientific study of many different foot deformities. Many of the surgical procedures described in this brochure can be performed in an out-patient hospital setting. Remember, both your and your doctor are a team working toward a common goal, comfortable feet, so that you can remain active and fit in today's fast-paced lifestyle. My nurse and I will be happy to answer any questions you may have concerning your bunion problem or the various treatments I may recommend to you.
Each doctor develops a favorite treatment, and probably has the best percentage of results with that approach. Complete cooperation between you and your doctor is essential for a satisfactory result.
DR. CHRIS ALBRITTON
2501 S. Willis
Abilene, TX 79605
325-695-8990