28295 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method

Name of the Procedure:

Correction, Hallux Valgus (Bunionectomy), with Sesamoidectomy, when performed; with Proximal Metatarsal Osteotomy, any method.

Summary

This procedure, commonly known as a "bunionectomy," involves surgical correction of a bunion, which is a bony bump on the joint at the base of the big toe. The surgery often includes the removal of small bones (sesamoids) and the realignment of the proximal part of the metatarsal bone to straighten the toe.

Purpose

The primary purpose of this procedure is to address hallux valgus, a deformity causing the big toe to lean towards the second toe, leading to pain, swelling, and difficulty in walking. The goal is to alleviate pain, correct the toe alignment, and improve foot function and appearance.

Indications

• Persistent pain and inflammation not relieved by conservative treatments
• Severe toe deformity affecting daily activities
• Chronic bunion causing other toe problems like hammertoe
• Failure of non-surgical treatments such as orthotics or medications

Preparation

• Patients may need to fast the night before surgery.
• Adjustments to medications, especially blood thinners, following physician guidance.
• Pre-surgery assessment, including blood tests, X-rays, and a physical examination.

Procedure Description

1. The patient is given anesthesia, typically regional (spinal or epidural) or general, depending on the case.
2. An incision is made over the bunion.
3. The bunion is removed by excising the bony prominence.
4. If necessary, sesamoidectomy is performed to remove small bones beneath the big toe.
5. A cut (osteotomy) is made in the proximal metatarsal bone.
6. The bone is realigned to correct the toe's position and held in place with screws, pins, or plates.
7. The incision is closed with stitches, and the area is bandaged.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

The surgery is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Blood clots
• Nerve damage causing numbness or tingling
• Recurrence of the bunion
• Stiffness or restricted movement in the big toe

Benefits

• Relief from pain and discomfort
• Improved toe alignment and foot function
• Better walking ability and range of motion
• Enhanced quality of life and foot appearance

Recovery

• Keep weight off the foot for a prescribed period using crutches or a walker.
• Follow post-surgery care instructions, including wound care and pain management.
• Physical therapy may be required to regain mobility and strength.
• Full recovery typically takes about 6 to 12 weeks, with gradual return to normal activities.

Alternatives

• Conservative treatments such as anti-inflammatory medications, orthotic devices, or physical therapy.
• Less invasive surgical options like minimally invasive bunion surgery.
• Pros and cons include varying effectiveness, recovery times, and risk profiles.

Patient Experience

• Patients may feel discomfort or pain immediately post-surgery, managed with prescribed pain medications.
• Swelling and bruising are common and gradually subside.
• Regular follow-up appointments ensure proper healing and progress.