Preparing for Surgery

 

Medical Evaluation

 

Before your surgery, you may be asked to visit your family doctor for a complete physical examination. He or she will assess your health and identify any problems that could interfere with your surgery. If you have a heart or lung condition or a chronic illness you will need a preoperative medical clearance from your family doctor.

Medications

 

Tell your doctor about any medications you are taking. He or she will tell you which medications you can continue taking and which you should stop taking before surgery.

 

Tests and X-rays

You may require several preoperative tests, including blood counts, a cardiogram, and a chest x-ray. You may also need to provide a urine sample.

 

To help plan your procedure, your doctor may order special foot x-rays. These x-rays should be taken in a standing, weight bearing position to ensure your doctor can clearly see the deformity in the foot. These x-rays assist your doctor in making decisions about where along the bone to perform an osteotomy in order to provide enough corrective power to straighten the toe.

 

 

Your Surgery

In planning your surgery, your doctor will consider several things, including how severe your bunion is, your age, your general health and activity level, and any other medical issues that may affect your recovery. Almost all surgery is done on an outpatient basis. You will be asked to arrive at the hospital or surgical center one or two hours before your surgery.

 

ANESTHESIA

After admission, you will be evaluated by a member of the anesthesia team. Most surgery is performed with anesthesia that numbs the area for surgery but does not put you to sleep.

 

Local anesthesia: An ankle block numbs just your foot.

 

Regional anesthesia: A popliteal block works for a longer period of time compared to an ankle block and numbs more of the leg. The numbing medicine is injected behind the knee.

 

Spinal anesthesia: This injection will numb your body below your waist.

 

General anesthesia: This form of anesthesia will put you to sleep.

 

The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.

 

Complications

As with any surgical procedure, there are some risks associated with bunion surgery. These occur infrequently and are usually treatable — although, in some cases, they may limit or extend your full recovery. Before your surgery, your doctor will discuss each of the risks with you and take specific measures to avoid complications.

 

The possible risks and complications of surgery include:

• Infection

• Nerve injury
• Failure to relieve pain
• Failure of the bone to fully heal
• Stiffness of the big toe joint
• Recurrence of symptoms or pain

 

Recovery at Home

The success of your surgery will depend in large part on how well you follow your doctor's instructions at home during the first few weeks after surgery. You will see your doctor regularly for several months — occasionally up to a year — to make sure your foot heals properly.

 

Dressing Care

You will be discharged from the hospital with bandages holding your toe in its corrected position.

Because keeping your toe in position is essential for successful healing, it is very important to follow your doctor's directions about dressing care. Do not disturb or change the dressing without talking to your doctor. Interfering with proper healing could cause a recurrence of the problem.

 

Be sure to keep your wound and dressing dry. When you are showering or bathing, cover your foot with a plastic bag.

Your sutures will be removed about 2 weeks after surgery, but your foot will require continued support from dressings or a brace for 6 to 12 weeks.

 

Swelling

Keep your foot elevated as much as possible for the first few days after surgery, and apply ice as recommended by your doctor to relieve swelling and pain. Never apply ice directly on your skin. It is common to have some swelling in your foot from 6 months to a year after surgery.

 

Bearing Weight

Your doctor will give you strict instructions about whether and when you can put weight on your foot. Depending upon the type of procedure you have, if you put weight on your foot too early or without proper support, the bones can shift and the  correction could be lost.

 

Some procedures allow you to walk on your foot right after the surgery. In these cases, patients must use a special surgical shoe.

 

Many surgeries require a period of no weightbearing to ensure bone healing. Your doctor will apply dressings, a brace, or a cast to maintain the correct bone position. Crutches are usually used to avoid putting any weight on the foot. A newer device called a knee walker is a good alternative to crutches. It has four wheels and functions like a scooter. Instead of standing, you place the knee of your affected foot on a padded cushion and push yourself along using your healthy foot.

In addition to no weightbearing, driving may be restricted until the bones have healed properly — particularly if the surgery was performed on your right foot.

 

No matter what type of surgery you have, it is very important to follow your doctor's instructions about weightbearing. Do not put weight on your foot or stop using supportive devices until your doctor gives approval.

 

Physical Therapy and Exercise

Specific exercises will help restore your foot's strength and range of motion after surgery. Your doctor or physical therapist may recommend exercises using a surgical band to strengthen your ankle or using marbles to restore motion in your toes.

 

Always start these exercises slowly and follow instructions from your doctor or physical therapist regarding repetitions.

 

Medications

In addition to pain medicine, your doctor may prescribe antibiotics to help prevent infection in your wound for several days after surgery.  Your doctor will prescribe pain medication to relieve surgical discomfort. The most effective medications for providing postsurgical pain relief are opioids. These medications are narcotics, however, and can be addictive. It is important to use opioids only as directed by your doctor.

 

As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

 

 

Shoe Wear

It will take several months for your bones to fully heal. When you have completed the initial rehabilitation period, your doctor will advise you on shoewear. Athletic shoes or soft leather oxford type shoes will best protect the bunion correction until the bones have completely healed.

 

To help prevent your symptoms from recurring, do not wear fashion shoes until your doctor allows it. Be aware that your doctor may recommend that you never return to wearing high-heeled shoes.

 

Avoiding Complications

Though uncommon, complications can occur following bunion surgery. During your recovery at home, contact your doctor if:

Your dressing loosens, comes off, or gets wet.

Your dressing is moistened with blood or drainage.

You develop side effects from postoperative medications.

 

Call your doctor immediately if you notice any of the following warning signs of infection:

• Persistent fever
• Shaking chills
• Persistent warmth or redness around the dressing
• Increased or persistent pain, especially a "sunburn" type pain
• Significant swelling in the calf above the treated foot, especially if there is a "charley horse" pain behind the knee, or if your develop shortness of breath.

 

Outcomes

The length of your recovery will depend upon the surgical procedures that were performed, and how well you follow your doctor's instructions.