Understanding the Potential Risks of Bunion Surgery

Bunion surgery, also known as bunionectomy or hallux valgus correction, is a common procedure used to correct deformities of the big toe joint. While this surgery can provide significant relief for individuals suffering from bunion-related pain and discomfort, like any surgical procedure, it carries certain risks. Understanding these potential risks is essential for individuals considering bunion surgery.

1. Infection

One of the primary risks associated with any surgery is the possibility of infection. Although steps are taken to minimize the risk, such as sterile operating environments and antibiotics, infections can still occur. Symptoms of infection may include redness, swelling, warmth, and discharge at the surgical site. Prompt medical attention is necessary if infection is suspected. Note that we recommend patients scrub the foot with chlorhexidine the night before surgery and the morning of surgery. Prophylactic antibiotics are often given during the surgery via intravenous route to help reduce the risk. Leaving the initial dressing intact and making certain that it does not get wet are also very important.

2. Nerve Damage

During bunion surgery, there is a risk of nerve damage, particularly to the nerves surrounding the big toe joint. This can result in numbness, tingling, or altered sensation in the toes or foot. In most cases, nerve damage is temporary and resolves over time, but in rare instances, it may be permanent. With the Lapidus or Lapiplasty surgery the dorsal medial cutaneous nerve of the foot is often encountered. It is not always possible to retract the nerve and therefore this nerve may have reduced function or sensitivity after surgery.

3. Delayed Healing

Some individuals may experience delayed healing after bunion surgery. Factors such as age, overall health, and the extent of the surgical procedure can affect healing time. Delayed healing may result in prolonged pain, swelling, and limited mobility in the foot. Delayed healing can relate to the incision itself, the subcutaneous layers and capsule – soft tissue, and finally bone. Anyone of these layers can be affected by delayed healing. In general the most critical is bone healing because once the bone healing is adequate and stable then protected and/or limited weight-bearing is not necessary.

4. Recurrence

While bunion surgery aims to correct the misalignment of the big toe joint, there is a risk of recurrence. Factors such as genetics, foot structure, improper footwear, and post-operative care can contribute to the recurrence of bunions over time. Additional surgical interventions may be necessary if a bunion returns after initial correction. The more severe the bunion, and the younger the patient is at the onset of the bunion (juvenile bunion) may also make the patient more prone to reoccurrence. Therefore it is critical to make sure that your surgeon that is the most correct the procedure possible in these cases.

5. Stiffness and Reduced Range of Motion

After bunion surgery, some individuals may experience stiffness and reduced range of motion in the affected toe or foot. Physical therapy and exercises may be recommended to improve flexibility and mobility. In severe cases, stiffness may persist despite rehabilitation efforts. The more work that is done directly involving the great toe joint and the first metatarsal phalangeal joint (first MTP joint) and its capsule, the more tendency there will be to have stiffness of the great toe joint here. In some cases such as with the Lapidus or Lapiplasty procedure it is possible to have excellent correction with minimal surgical involvement or dissection of the first MTP joint capsule. These patients seem to have better flexibility postoperatively.

6. Blood Clots

There is a risk of developing blood clots (deep vein thrombosis/DVT) after any surgical procedure, including bunion surgery. Blood clots can be dangerous if they travel to the lungs (pulmonary embolism). To reduce the risk of blood clots, patients may be advised to move their legs regularly after surgery and wear compression stockings. In addition there are a number of other factors that can make patients prone to a DVT. Some examples are estrogen medications and/or supplements, genetic history of bleeding disorders, smoking, the use of the tourniquet during surgery are all examples of risk factors.

7. Allergic Reactions

Rarely, individuals may experience allergic reactions to medications, anesthesia, or materials used during bunion surgery. It is essential to inform your healthcare provider of any known allergies before the procedure to minimize this risk.

8. Unsatisfactory Results

Despite the best efforts of the surgeon, some individuals may be dissatisfied with the results of bunion surgery. This can occur if the desired correction is not achieved, or if complications arise during the healing process. Revision surgery may be considered in such cases.

Reducing Risks and Ensuring Successful Outcomes

While the risks associated with bunion surgery cannot be entirely eliminated, there are steps individuals can take to reduce these risks and improve the likelihood of a successful outcome:

Choose a Qualified Surgeon: Select a board-certified surgeon with experience in bunion surgery.
Follow Preoperative Instructions: Adhere to preoperative instructions provided by your surgeon, such as avoiding certain medications and fasting before surgery.
Understand the Procedure: Take the time to understand the bunion surgery procedure, including potential risks and expected outcomes.
Follow Postoperative Care Guidelines: Follow your surgeon's postoperative care instructions, including medication management, wound care, and rehabilitation exercises. Make sure you get clear postoperative instructions and really plan out your postop help and routine. For example how will you get around and who will help with food. First 48 hours postoperatively, it is critical to have somebody immediately available.

Attend Follow-Up Appointments: Attend scheduled follow-up appointments with your surgeon to monitor healing progress and address any concerns promptly.

By being informed about the potential risks of bunion surgery and taking proactive measures, individuals can help minimize complications and achieve a successful outcome from their surgical procedure. Consulting with a qualified healthcare professional is crucial for personalized advice and guidance regarding bunion surgery and its associated risks.

If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young
Foot & Ankle Surgeon
Issaquah's Top Podiatrist

Bunions can be quite painful and become a hindrance to everyday life.  While there are some conservative measures that may provide some temporary relief the only long term solution is surgery. 

First it is important to understand what a bunion is.  A bunion is when the 1^st metatarsal shifts out of place.  This shifting gets worse with time and the bunion gets bigger.  The visual result is the big toe starts to overlap the 2^nd toe and the protuberance you see at the base of the big toe is the 1^st metatarsal.  To fix the bunion the 1^st metatarsal needs to be realigned. 

The realignment of the 1^st metatarsal can happen in two ways.  The first being you cut the bone and reposition it anatomically.  This is probably the most common bunionectomy performed in the United States.  It usually involves about 4-6 weeks in a walking boot and has great outcomes for smaller bunions.  The next most common would be a fusion of the tarsometatarsal joint.  This is a procedure that is for larger bunions or people with unstable foot structures.  This surgery usually requires a period of non-weight bearing for 3-6 weeks.  Both of these procedures can have great outcomes when utilized appropriately.

How do you know which bunion surgery is best for your foot?  There are many factors to take into account.  The overall foot structure, any other foot pathologies, lifestyle, recovery and age.  I recommend seeing a foot and ankle doctor that operates on a lot of bunions. 

If you have a bunion and would like a consultation I can help.  Please call 425-391-8666 or make an appointment online with Dr. Nelson.

Sincerely,

Brandon Nelson

Board Certified Physician & Surgeon

Issaquah’s Top Podiatrist & Foot/Ankle Surgeon

If you have any questions or would like a consultation please call 425-391-8666 and make an appointment online.

Dr. Timothy Young
Foot & Ankle Surgeon
Issaquah's Top Podiatrist

Bunions are often looked at as just a cosmetic concern however this is not true.  They can cause pain and discomfort and lead to more foot problems in the future.  Today I will discuss bunions, what they are, their cause, symptoms and what we can do to treat them.

What is a bunion?

A bunion is a bony protrusion of the 1^st metatarsal.  It occurs as the 1^st metatarsal shifts out of place and the big toe begins to drift towards the second.  This begins as a small misalignment of the joint and grows larger and more malaligned as time and mileage increase. 

Causes of bunions:

There are many causes of bunions and from long term research we know the following are the most common. 

-Genetics plays a large role in the development of a bunion.  You inherit your foot structure and this can predispose you to a bunion. 

-Another source cited is footwear.  Anything that puts more forefoot pressure like a high heeled shoe can accelerate bunion formation. 

-Systemic causes can be attributed to bunions.  Conditions like Rheumatoid arthritis or other arthropathies that attack joints. 

Symptoms:

These are what usually bring patients into the office.  These are things like having a hard time fitting shoes, rubbing the big toe on the 2^nd toe.  Another common symptom is pain or swelling and redness of the big toe joint. 

Treatment:

I usually break the treatment up to conservative and surgical.  The conservative measures include, no bare feet and wearing a wider shoe.  Save your money no splints or stretching devices of the big toe work.  Remember this is a bony malalignment and you can not move bones from the outside of your foot.  Surgery is the only long term fix.  The surgical correction depends on the size, age and overall foot structure. 

If you have a bunion and would like a consultation I can help.  Please call 425-391-8666 or make an appointment online, and ask for an appointment with Dr Nelson.

Sincerely,

Brandon Nelson

Double Board Certified Physician & Surgeon

Issaquah’s Top Podiatrist & Foot/Ankle Surgeon

Bunions are present in many different sizes and shapes.  I see bunions on the inside of the foot, the outside of the foot and both.  It is important to remember that some small ones can be painful, and some large ones can be pain free.  It often seems to be dependent upon activity levels and shoe gear.  If they hurt or limit your lifestyle then maybe it is time to fix them. 

Fixing your bunion

Bunion surgery has two main procedures that are done.  One is what is called a head procedure.  This is basically cutting the bone and realigning it through transposition of the bone.  Usually fixated with one or two screws.  The other involves fusion of a joint, specifically the joint that is involved with the creation of the bunion.  This procedure is called a Lapidus bunionectomy. 

Bunion recovery

Recovery really depends on the procedure that is performed.  Head procedures recover faster and usually involve no periods of non-weight bearing.  The fusions often involve a period of crutches or knee scooters.  This can be as short as 3 weeks or as long as 10 weeks.  The weight bearing status can be dictated by other procedures that are done as well. 

Which bunion surgery is right for me?

This is a hard question to answer.  I believe this is where your consultation with your surgeon is extremely important.  Other factors like lifestyle, recovery support, expectations and experience can play a major role.  I think it is important to get an entire overview of the process and have a discussion with your surgeon.   

If you would like a consultation for your bunion I can help.  Call to make an appointment with me at 425-391-8666 or make an appointment online.

Sincerely,

Dr Brandon Nelson

American College of Foot & Ankle Surgeons

Most bunion surgeries require screws or plates (or a combination). It’s important during bunion surgery, in order to get full correction and realign the bones and joints, the bone is typically resected or effusions are done to realign the first metatarsal.  This requires hardware such as plates and screws. Once the hardware has done his job and the bone has healed and maintained the new corrected alignment and position, many of our patients elect to have hardware removed. The hardware can be medical grade stainless steel or titanium. These are the most common metal/metallic implants used. 

Sometimes the head of the screw causes minor irritation or part of the threads protrudes enough that there is irritation with some of the adjacent soft tissue. 

In other instances some patients seem to be sensitive to having a foreign body or a non-human item in the body. Some patients have minor skin manifestations although this isn’t common.  In general patients feel better once the hardware is out. 

If you are experiencing bunion pain, give us a call at 425-391-8666 or make an appointment online today. 

People with a painful bunion often begin to contemplate bunion surgery. Bunion surgery is a great option for patients who are wish to relieve symptoms cause by bunions.

There are many different types of bunion surgeries. Bunion surgeries are based on the size of the bunion and the individual foot structure. The majority of bunion surgeries require and incision on the top of the big toe joint. The procedure then involves removing and realigning bone and soft tissue of the big toe joint. If any other foot issues are present, like a flatfoot, these should be fixed at the same time.

Scheduling an appointment to have your bunion evaluated is the first step. Dr. Nelson will discuss your x-rays and all of your options. He will present both conservative and surgical and help you determine what is best. Some common questions include:

-Surgery is done one foot at a time

-The majority of bunion surgeries are less than 2 hrs

-Patients are sedated during the procedure and this is done in the office

-Pain medication will be prescribed for when the nerve block wears off

-Walking without crutches is possible for most people

The recovery can vary from patient to patient. However, most people can bear weight after the procedure. It is important to follow all post-op instructions carefully. If you have a painful bunion and want to know what options are available and live in Issaquah, Sammamish, Snoqualmie, Bellevue, Seattle, Kirkland or Maple Valley give us a call so we can help.

Give us a call today at 425-391-8666 or make an appointment online. 

Most bunion problems involve an alignment issue with the underlying bones. The first metatarsal and the great toe become out of typical alignment. The joint itself become subluxed and is then prone to arthritis and adaptive changes.

Bunions can develop an early age. This is called juvenile onset. This involves the first metatarsal shifting away from the adjacent second metatarsal and the foot becomes wider.  In some cases this involves a splayfoot. Also there is more risk of bunion formation when there is underlying metatarsus adductus.  This is a genetic inherited foot structure.  It is common to see other family members that have a bunion. Often times you can look to let say your mother or grandmother and find that they also have a bunion, because of this genetic pattern.

Tight shoes can speed the process up and make things worse!  However, in general, you are born with a foot type that is prone to a bunion. 

If you have concerns about a bunion, give us a call at 425-391-8666 or make an appointment online! 

Dr. Timothy Young and Dr. Brandon Nelson.

Bunion surgery in the past was only performed in a hospital setting and patients often stayed the night at the hospital. Things have really changed and now patients do not stay the night in a hospital and most bunions are performed in a surgery center. The average bunion surgery takes less than 2 hours and patients will only require IV sedation as opposed to general sedation. This type of sedation makes for a much quicker recovery from anesthesia and often less side effects. I like to provide all my patients with a nerve block so they will get a good night's sleep the evening of surgery.  The majority of patients will be pain free the first night. 

The next day most patients will have pain that is well controlled with pain medication. Often patients will just take prescription pain medication for the first 24-48 hours and then switch to over the counter pain control.  We utilize advanced techniques that allow all our bunion patients to walk after surgery thereby minimizing down time and speeding recovery.  We have protocols to help get your ankle and toes moving right after surgery to decrease stiffness and swelling. Additionally, we will provide patients with exercise guidelines to help them stay fit and active during the recovery phase. One of the best aspects of our practice is we perform bunion surgery every single Monday and have fixed 1000’s of bunions.  Another enormous advantage of our clinic is an onsite surgery suite that will save patients thousands of dollars on the surgery as we have special discounted pricing compared to other doctors that must take you to a hospital or surgery center. Do not let your bunion keep your from wearing a normal shoe or enjoying the activities you love give us a call at 425-391-8666 or make an appointment online so we can help.