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Bunions(HalluxValgus)Bunionsareacommonfootdeformityofthebigtoe.Theyareoftenaninheritedcondition.Footweardoesnotdirectlycausebunionsbutmaycontribute.Bunionscanoccurinadolescenceordevelopasyougetolder.Thedeformityofabuniontendstoworsenovertime.
Whatsymptomsdobunionscause?Bunionscancausepainfulrubbingoverthebonyprominenceinfootwear.Thismakesfindingfootweardifficultandmaylimitactivities.Theycanalsobeassociatedwithpainelsewhereinthefootduetoalteredweightbearingcausedbythebigtoedeformity.Whatisthenon-surgicaltreatment?Youcantryshoemodificationwithwidershoestolimittherubbing.Splintsandspacersmaybehelpfulwhenworntopreventrubbing.Theywillnotcorrectthedeformitypermanentlyorpreventprogression.Whatisthesurgicaltreatment?Surgeryisthemostreliableandpermanentwaytocorrectyourbunion.Therearemanyoperationsusedforbunioncorrection.TheoperationusedbyMr.CurryistheScarf-Akinosteotomy.ThisoperationthewidelyusedinEuropeandAustraliaandavoidsmanyoftheproblemsassociatedwithotherbunionoperations.
Theoperationcomprises5parts
• Anincisionovertheinsideofthebigtoeismade.Thetissuesholdingthebigtoearereleased.
• Thebonyprominencefromthemetatarsalisremoved.
• Themetatarsalboneiscut(Scarfosteotomy)torealignthejoint.Thisisfixedwith2screws.
• Theproximalphalanxboneisthencut(Akinosteotomy)tocompletethecorrection.Thisisheldwithastaple.
• Thefinalpartoftheoperationistorepairandtightenthecapsulewherethebunionhasstretchedit.Thishelpstopreventrecurrence.
Whatisthesuccessrate?90%ofpatientsachieveasuccessfuloutcomeafterbunionsurgery.
Whatdoestherehabilitationinvolve?
• Youareinhospital1nightforonebunion
• Forthefirst2weeksyoushouldkeepyourfeetelevatedasmuchaspossibletominimizeswelling
• Youareabletobeginweightbearingimmediatelyinastiffsoledshoe.Hisshoeistobewornfor4-6weeks.Thereisnoplasterrequired.
• By6weeksyoucanbeginwearingwideoropenshoesandshouldbecomfortablewalkingaroundyourhouse.
• By3monthsyoucanbeginwearingnormalshoesandshouldbebacktorecreationalwalking.
• Swellingcantake6-9monthstoresolveandtightshoesmaybedifficultforthisperiod.
WhatifIhavebothfeetcorrected?Recoverytimeis50%longerwhenyouhavebothbunionscorrectedatthesametime.Willtheoperationbepainful?Youroperationwillusuallybedoneundergeneralanaesthetic.Toprovideongoingpainreliefyouranaesthetistwillperformanerveblockwhilstyouareasleepwhichnumbsthefootfor8-16hours.Sowhenyouwakeupyouwillhaveminimalpain.Astheblockwearsoffyouwillbegivenoralpainrelief.HowlongwillIbeoffwork?Thisisdependentuponyouroccupation
• Seatedjob 3-4weeks• Standingjob 6-8weeks• Heavyliftingjob 8-12weeks
WhencanIdrive?• Manualcar
o Nodrivingfor6weeks• Automaticcar
o Leftfootnodrivingfor2weekso Rightfootnodrivingfor6weeks
Whataretherisksoftheprocedure?Generalrisksofsurgery• Infectionandwoundhealingproblems• Nerveinjuryandscarsensitivity• Bloodclotstotheleg• Anaestheticproblems• Incompleteresolutionofsymptoms
Specificrisksforbunionsurgery• Stiffness• Recurrenceofdeformity
o 1%chanceperyearo 10%overyourlifetimeo Recurrenceisneverasbadasthe
originaldeformityandoftendoesn'trequiresurgery.
• Underorovercorrectionofthetoe• Painifarthritisispresent• BonesnothealingThisinformationisanoverviewofthemanagementofbunionsandisnotallinclusive.IfyouhaveanyquestionsregardingthispleasecontactMr.Curry’sroomson(03)99286188.