Examples Of Before And After Bunion Surgery By Dr. Hines

What is a bunion? A bunion is an enlargement of the first toe joint (known as the first metatarsal phalangeal joint). The enlargement of this joint is a result of deviation of the bones which create the joint. Bunions result in pain from shoe pressure since shoes are designed for feet without this deformity. When a bunion is present on one foot, it is very difficult to find shoes to fit since the foot with the bunion is wider than the foot without the bunion. The picture on the left illustrates what a bunion looks like. The picture on the right shows the same foot after surgery by Dr. Hines.

What causes a bunion?

• Arthritis, especially rheumatoid arthritis can cause bunion deformities.
• Injury (such as a fracture of the toe or metatarsal bone) can cause mal alignment resulting in a bunion deformities.
• Most bunions are caused by inherited faulty foot mechanics which put abnormal stress on the front of the foot.
• Contrary to popular belief, bunions are aggravated, not caused, by shoes.  The late anthropologist Margaret Meade observed many members of a South Sea island tribe had bunions, yet they had never worn shoes!  Studies have shown that shoes actually help prevent bunions by supporting the arch, thereby preventing the chain of events described above.

What Treatments Are Available For Bunions? For the sake of this discussion I will classify bunion deformities as mild, moderate, and severe.

• Mild or beginning bunion deformities are best treated non-surgically.  Wearing a good supportive type of shoe such as an oxford lace-type shoe, walking shoe, or a casual shoe with a custom made orthotic (a type of arch support) inside the shoe can slow down the progression of the deformity. Mild or beginning bunion deformities should be observed to determine the rate of progression, if any, of the deformity. Since the bunion deformity is progressive (that is, it starts out mild and becomes severe with time), it is very important to perform corrective surgery early before the deformity becomes severe. This will avoid a more involved surgery and a longer recovery associated with surgery necessary for the severe deformity.
• Moderate bunion deformities.  Most bunion deformities fall into this category. I recommend surgery for this level of involvement. At this stage of deformity, it is difficult to find shoes that fit comfortably, due to the difference in the width of the forefoot compared to the width of the heel. If the shoe fits in the forefoot , the heel of the shoe slips up and down. If the heel is fitted properly, the forefoot is cramped. It is even more difficult to find comfortable shoes when a bunion is present on only one foot. In this case, you have a choice of fitting the foot with the bunion and having the other shoe being to large, or fitting the foot without the bunion and having the foot with the bunion being cramped in the shoe.  I have developed surgical techniques utilizing the following:
  • Precise preoperative evaluation both clinically and radiographically to insure proper procedure selection and enhanced outcome.
  • Specialized surgical instruments to insure precise cuts and angles to maximize the correction with the least amount of trauma and shortest possible recovery time.
  • A new titanium screw that is used to fixate the osteotomy (cut in the bone).  I have worked with one of the major equipment manufacturers to develop this new screw.  As opposed to traditional screws, this screw has a threaded head allowing it to be buried into the bone.  The screw does not penetrate the bone at the point of the screw.  Most screws have a head that protrudes above the bone and a tip that must protrude outside of the bone. The head and tip of these screws can become an irritant resulting in the need for their removal at a later date.
  • Special post-operative boot that is worn for 3 weeks after the surgery while the bone heals.  This new low profile boot allows patients to walk more comfortably and helps to control swelling.

            SURGICAL PROCEDURE FOR MODERATE BUNION DEFORMITIES

       Moderate Bunion Deformity Before Surgery                After Surgery By Dr. Hines                                    X-ray Before Surgery           After Surgery By Dr. Hines

Surgery here involves shaving off the portion of bone on the side of the bunion as shown in the diagram on the left.  An osteotomy (cut in the bone) allows the 1st metatarsal to be shifted back into proper alignment as shown in the diagram on the right.  The bones are held in place with a small titanium screw. With this procedure, patients can walk on the operated foot without the need for crutches, non-removable casts, and wheel chairs.  A comfortable post-operative walking boot is worn for three weeks. This allows the patient to walk more normally during the healing process.

• Severe bunion deformities require a surgery at the base of the metatarsal.  Because of the location of the osteotomy (cut in the bone) patients are not allowed to walk on the operated foot for several weeks.  Crutches, cast, and sometimes a wheel chair are needed during this non-weight bearing period.

               SURGICAL PROCEDURE FOR SEVERE BUNION DEFORMITIES

        Severe Bunion Deformity Before Surgery                    After Surgery by Dr. Hines                                                                                        

Frequently Asked Questions About Bunions:
1) Where is the surgery performed? I do most bunion surgeries at various free-standing surgery centers. Insurance coverage frequently determines where the procedure is performed.

2) Do I have to spend the night at the surgery center? No, most surgeries do not involve spending the night before or after the surgery. 

3) Is the surgery painful? The perception of pain is different for everyone. Most patients need little medication for discomfort with the new procedure.

4) Will my bunion come back? With the newer procedures I use now, the incidence of recurrence is very low.

5) What kind of shoes will I wear during the healing period? You will be provided with a soft, comfortable walking boot.

6) How long before I can wear regular shoes? At three weeks from the surgery most patients can start wearing a soft tennis shoe or walking shoe. Between the fifth and sixth weeks, most patients can start wearing a variety of shoes. There is considerable variance among patients however.

7) How long will I be off my feet? The first week after surgery, it is best to stay in the house. You may walk to the bathroom and back, and do what walking is necessary. Otherwise, your feet should be elevated. Most patients can return to a sitting job in 2 weeks and to a standing position in about 3 weeks.

8) What kind of anesthetic is used? Usually we use a general anesthetic (you are asleep). This is a light anesthetic so you can awaken and be able to go home soon after your surgery. You must have someone drive you home after the surgery.

9) Will my insurance cover the surgery? Most all insurance plans provide coverage for bunion surgery. My office will pre-certify your surgery with your insurance company.

To schedule an appointment, please call (405) 751-6152