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    Bunion and hammertoe surgery

    What are bunions and hammertoes?

    A bunion is a bony prominence from realignment of the joint at the base of the big toes. Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards towards, and sometimes under or over, the other toes (angulation).

    The tailors bunion, on the outside of the foot, is created when the fifth toe is forced in under the fourth toe, and the head of the fifth metatarsal is forced into the outer aspect of the shoe, sometimes causing pain, swelling or bursa formation.

    Hammertoes are another forefoot deformity that generally represent a tendon imbalance in the toes caused by one of the toe tendons getting an advantage over another toe tendon. Most commonly, it is one or all of the long extensor tendons on the top of the foot that gets an advantage over one or all of the flexor tendons on the bottom of the foot, to cause the first joint in the toe to be elevated above the ground. This occurs because most footwear has heel elevation and a feature called toespring, which holds the ends of the toes above the ground, in relation to the ball of the foot.

    What causes bunions and hammertoes?

    Bunions are sometimes genetic and consist of certain tendons, ligaments, and supportive structures of the first metatarsal that are positioned differently. This bio-mechanical anomaly may be caused by a variety of conditions intrinsic to the structure of the foot – such as flat feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions. Although some experts are convinced that poor-fitting footwear is the main cause of bunion formation, other sources contend that footwear only exacerbates the problem caused by the original genetic structure.

    Hereditary and shoe gear are probably the most likely reasons to develop a hammer toe. Hammer toes most frequently result from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problems (e.g, a bunion can force the big toe to turn inward and push the other toes).

    Why is bunion and/or hammertoe surgery needed?

    Toe deformities (contractures) come in varying degrees of severity – from slight to severe.  The can be present in conjunction with a bunion, and develop onto a severe disfiguring foot deformity.  Advanced cases, the toe can dislocate on top of the foot.

    Toes can be surgically realigned and made straight again, they can even be made shorter.  The good news is that toes can be corrected. Surgical procedures can correct deformity and relieve pain, leading to improved foot function.

    For those whose bunions and/or hammertoes cause persisting pain, a surgical operation is considered for correction. Bunion surgery, by an orthopedic surgeon or a podiatric surgeon, may be necessary if discomfort is severe enough or when correction of the deformity is desired. Currently there are many different surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure.

    How does the procedure work?

    There are different types of surgeries to correct a bunion, e.g. bringing the big toe back to its correct position may involve realigning bone, ligaments, tendons, and nerves. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint.

    correct a bunion

    Hammer toe surgery is often synonymous with “toe shortening”, “toe job” and/or “toe augmentation”.  Depending on the severity and length of the toe, there are several methods to surgically correct a hammer toe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe.

    Hammer toe surgery

    What are the benefits and risks of bunion and hammertoe surgeries?

    Benefits

    As a result of foot surgery patients experience less pain and improved mobility. After having treated the foot deformities people can enjoy better comfort, improved appearance and confidence in public. People with foot issues either find that shoes bother their condition or they can’t fit into most shoes, therefore greater footwear selection can be another benefit of the surgery.

    Considering the response to treatments, surgery is often used as the last resort for people who show limited or no response to other treatments, and recovery is just a few weeks. Some conditions also require surgery to prevent future foot deformation.

    Risks

    Surgery is a complex decision that is truly unique to each individual. Our surgeon will be able to discuss the pros and cons of surgery for your condition in great depth and detail, given your physical health history.

    The possible complications include: asymmetrical gait, nerve damage, complex regional pain syndrome, infection, vascular injury, and wound healing problems.

    Am I a good candidate for the operation?

    Bunion surgery candidates commonly have:

    • Significant foot pain that limits their everyday activities, including walking and wearing reasonable shoes. They may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain.
    • Chronic big toe inflammation and swelling that does not improve with rest or medications
    • Toe deformity—a drifting in of the big toe toward the smaller toes, creating the potential for the toes to cross over each other.
    • Toe stiffness—the inability to bend and straighten the big toe
    • Failure to obtain pain relief with changes in footwear

    Good candidate for hammertoe surgery:

    • There are several treatment options that you should explore. Wearing comfortable shoes, stretching and strengthening exercises and orthopedic inserts may help relieve your pain.
    • If you’re still experiencing significant discomfort after exhausting all non-surgical options, surgery may be the right choice for you. The best candidates are also healthy and possess realistic expectations.

    How should I prepare for the surgery?

    You’ll need to undergo a few medical tests to check your overall health before scheduling bunion or hammertoe surgery. You may need to stop taking medications a few days before surgery, particularly if you take aspirin or other blood-thinning drugs.

    Your surgeon will determine how long you should fast before the surgery based on your surgery time. Always ask your surgeon for complete pre-operative preparation instructions and follow them carefully to avoid possible complications.

    What shall I do after the surgery?

    The foot is bandaged and a protective surgical shoe is worn to allow weight-bearing movement after surgery. After surgery, there may be stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk moderate distances while the toe heals, and you should keep your foot elevated as much as possible.

    If you experience persistent numbness, tingling, or burning sensations in your foot or ankle, it may be due to a cast or surgical dressing that is too tight. Elevate your foot, and if this does not resolve the problem, call your doctor.

    Ask your surgeon for complete post-operative instructions. Healing usually requires three to six weeks.

    Why is regular check-up important after the surgery?

    At two weeks the wounds should be checked and bandages has to be changed. You should continue with the shoe until six weeks post-operatively.

    You will require a check x-ray to ensure that bone has shown evidence of adequate healing. You may come out of your post-operative shoe so bring a loose fitting shoe to wear home.

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