Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is greatly recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. We also know from experience that the deformity is progressive, that is, it becomes worse with time. So often people are told: "don't have anything done until the pain is so bad that you can't stand it." This is wrong! The sooner we can correct the deformity, the easier it is and the more rapid the recovery! Our advice is that when it becomes obvious that you have a bunion, that is the time to correct it.
WHAT IS THE PROBLEM?
On the surface, a bunion is composed of two parts: first there is the bump on the side of the foot and secondly, there is a movement of the great toe towards the lesser toes. When we look at the normal skeleton of the foot, we see that all of the long bones (the metatarsals) are in straight allignment. With a bunion deformity, the first metatarsal begins to move away from the lesser metatarsals, widening the forefoot and causing the end of the bone to protrude on the inside of the foot. Eventually, pressure on this bone causes a calcium deposit to form. Oftentimes a sac of fluid will then form overlying this as a protective measure. This is called a bursa sac. When shoes are worn that irritate the "bump", the area becomes red, swollen and painful. This then is a bursitis.
WHAT CAN BE DONE?
One of the greatest hurdles that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering in many instances that bunions came back.
The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro saws and precise cuts in the bone that correct the deformity, thus limiting the rate of re-occurrence. Gone are the days of casts and crutches and wheel chairs post operatively. Only in the most severe cases does the patient need to be "non-weight bearing". In most cases, the patient can resume a fairly normal lifestyle including returning to work in a matter of days rather than months.
At the Ford Center for Foot Surgery the procedure is done with I.V. sedation and a regional anesthetic. We also do not use a tourniquet when we do the surgery, which eliminates much of the post operative discomfort. The net result of this is that the patient is alert and able to walk within minutes following the surgery, but the foot is anesthetized for approximately 20 hours following the surgery.
The procedure is accomplished through an incision of the side of the foot overlying the bunion . This incision is deepened and the joint opened. We then expose and remove the overgrowth of bone on the side of the metatarsal bone. Once this is removed, a very precise horizontal "V" cut is made in the bone from one side to the other. The end of the bone is then moved towards the lesser toes and is then fixated with a small screw. This then narrows the foot. Some of the tissues surrounding the joint are loosened so that the toe can resume its normal position. We then close the capsule with dissolvable sutures and the skin with small sutures. The foot is then dressed is sterile dressings and placed in a post-op shoe that you will wear from two the four weeks. As a general rule, you will need to be off of work for a week or two in most cases.