Hallux Valgus (Bunions).
Edited By: Sigvard T. Hansen, Jr., M.D.
Last updated Friday, November 11, 2005
Figure 1 - X-ray view of foot with hallux valgus Figure 2 - X-ray view of foot after surgery for hallux valgus AboutBasics of hallux valgus (bunions) Hallux valgus is a condition in which the big toe migrates laterally toward the second toe. This results in a bump on the inner side of the foot, know as a bunion. It is related to a combination of genetic factors, activities, and inheritance. Some patients who have this condition do not have symptoms. Sometimes symptoms can be relieved just by modifying the shoe to have enough room in the forefoot to accommodate the changed shape.
Diagnostic tests Examination by a qualified physician is important if the problem hurts or is worsening. Diagnostic tests may include:
-
Physical examination to determine if there are tendons, such as the Achilles,
that are too tight or if there is instability in a joint or joints that
contribute to the problem.
- X-ray of two views of the foot while you are standing on it.
- Specialty studies may be involved if there are unique aspects to the problem.
Surgery The goal of surgery is to remove any predisposing conditions such as
an excessively tight Achilles tendon, straighten the metatarsal, and
straighten the toe.
There are a variety of surgical techniques that accomplish these
goals. The surgical technique chosen should be individualized to the
specific type of deformity. Many of the procedures can be done as an
outpatient. The more involved procedures may require a hospital stay of
one to three nights.
Some of the surgical procedures will require that either the bone is
cut and returned to a normal position, or that a joint undergoes a
procedure known as arthrodesis. This means that a small joint is
bridged by bone in order to maintain the position of the bones in
relation to one another.
Often there are other associated deformities with hallux valgus such
as toes that are too curled or overloading of the metatarsal head,
sometimes known as the ball of the foot. These issues can be addressed
simultaneously.
There are over 150 different surgical procedures described for
correction of these forefoot problems. It�s best to meet with a
qualified physician to discuss options for your foot.
UW team for surgery The UW Department of Orthopaedics is composed of many different health
care experts who function as a team to make surgery safe and effective.
This team includes senior and more junior physicians, physician
assistants, nurses, physical therapists, and support personnel. Office
visits are scheduled through the office staff. Surgery is scheduled
through a patient care coordinator, and various aspects of your care
are provided by other personnel. Surgery is under the care of surgeons.Hospital stay and discharge Surgery is usually scheduled as an outpatient or a same-day
admission-type surgery. This means that you will come to the hospital
on your day of surgery and either go home the same day or be admitted
to the hospital. Depending on the type of surgery done, the hospital
stay may be one night or two. If extensive reconstruction is done in
other parts of the foot a third night may be necessary. In general, you
will be protected in some type of boot or cast and using crutches for
about six weeks.Pain management For the first 24 to 48 hours you will receive parenteral pain medicine.
This means medicine injected with a syringe. After that oral narcotic
medication will be provided. Please follow the recommendations on the
pain prescription.Follow-up You will return to the outpatient center two weeks after the surgery
for removal of your sutures and a wound check. During that time you
will need to keep the dressing dry and your foot elevated. Four weeks
after this first outpatient visit a second outpatient visit will be
scheduled, at which time x-rays will be performed. Based on the x-rays
the activity will be determined.Wound Care The bandage will have to be kept clean and dry. You may shower with a
plastic bag securely draped over the dressing. It is recommended that
you obtain a plastic shower chair to avoid falling in the shower.Rehabilitation Rehabilitation with a physical therapist will begin immediately
after surgery with crutch training and extend to full recovery. You
will use crutches for a period of time, specified by your physician. A
brace or cast will be worn.
You will also be asked to do straight leg raising and quadriceps
sitting exercises. For quadriceps sitting you lie on your back with
your knees straight, legs flat and arms by your sides. You tighten the
muscles on the top and the front of the thigh, called the quadriceps,
and at the same time push the back of the knee down into the bed and
raise only the heel. Hold for five seconds and relax for five seconds.
Repeat this exercise 10 times on a firm surface once per hour during
the first postoperative day and at least four times a day thereafter.
Straight leg raising involves lying on your back with arms and legs
straight. With one knee bent and the foot flat, slowly raise the
operative side about six inches off the floor, keeping the leg as
straight as possible. Hold for a five-second count, then lower the leg.
Repeat this exercise 10 times for each leg. Surgery for Hallux Valgus (Bunions) at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-731-4830 to make an appointment.
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