28297 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method

Name of the Procedure:

Correction of hallux valgus (bunionectomy) with sesamoidectomy, including first metatarsal and medial cuneiform joint arthrodesis (any method).

Summary

In this procedure, a surgeon corrects a bunion (hallux valgus) by realigning the big toe, removing part of the sesamoid bone, and fusing the bone of the first metatarsal with the medial cuneiform joint. This aims to correct deformity and alleviate pain.

Purpose

The medical condition or problem it addresses:

• Hallux valgus (bunion) with deformity and associated pain.

The goals or expected outcomes of the procedure:

• Correction of the toe alignment.
• Pain reduction.
• Improved foot function and ability to walk comfortably.

Indications

Specific symptoms or conditions that warrant the procedure:

• Severe pain or discomfort caused by a bunion.
• Difficulty walking or wearing shoes due to the deformity.
• Inflammation and swelling that do not improve with conservative treatment.

Patient criteria or factors that make the procedure appropriate:

• Failure of non-surgical treatments like orthotics, medication, or physical therapy.
• Significant structural deformity.
• Desire to improve foot function and aesthetics.

Preparation

Pre-procedure instructions for the patient:

• Fasting for a specified period before surgery, usually starting the night before.
• Adjusting medications as directed by the healthcare provider.
• Arranging for someone to drive the patient home post-procedure.

Any diagnostic tests or assessments required beforehand:

• X-rays or other imaging studies of the foot to assess the severity of the deformity.
• Blood tests to check overall health status.
• Preoperative assessment by an anesthesiologist.

Procedure Description

Detailed step-by-step explanation of what the procedure involves:

1. Administering anesthesia (general or regional).
2. Making an incision near the bunion.
3. Removing or realigning the sesamoid bones beneath the big toe.
4. Cutting and realigning the bones in the toe and foot.
5. Fusing (arthrodesis) the first metatarsal and medial cuneiform joints using screws, plates, or other fixation devices.
6. Closing the incision with sutures.

Tools, equipment, or technology used:

• Surgical scalpel, bone saw, fixation devices (screws, plates), sutures.
• Imaging equipment for ensuring precise alignment.

Anesthesia or sedation details, if applicable:

• General anesthesia or regional anesthesia (e.g., spinal block) may be used.

Duration

• The procedure typically takes around 1 to 2 hours.

Setting

• Hospital or outpatient surgical center.

Personnel

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

Risks and Complications

Common and rare risks associated with the procedure:

• Infection.
• Bleeding.
• Blood clots.
• Nerve damage or numbness.
• Nonunion or improper fusion of the bones.
• Recurrence of the bunion.

Possible complications and their management:

• Infections treated with antibiotics.
• Nonunion may require additional surgery.
• Pain managed with medications and physical therapy.

Benefits

Expected benefits:

• Relief from pain.
• Correction of toe alignment.
• Improved ability to walk and wear shoes.

How soon they might be realized:

• Initial relief from severe pain within weeks.
• Full benefits after recovery period, generally a few months.

Recovery

Post-procedure care and instructions:

• Keeping the foot elevated.
• Using a special postoperative shoe or boot.
• Avoiding weight-bearing on the operated foot for a specified period.

Expected recovery time:

• Typically around 6 to 12 weeks before returning to normal activities.
• Regular follow-up appointments for monitoring progress.

Any restrictions or follow-up appointments:

• No driving until cleared by the surgeon.
• Limiting physical activities as advised.
• Follow-up appointments to remove stitches and check bone healing.

Alternatives

Other treatment options available:

• Conservative treatments (orthotics, pain medication, physical therapy).
• Less invasive surgical options (e.g., bunionectomy without arthrodesis).

Pros and cons of alternatives compared to the described procedure:

• Conservative treatments may not be as effective for severe deformities.
• Less invasive surgeries may not provide long-term correction.

Patient Experience

What the patient might feel or experience during and after the procedure:

• Anesthesia avoids pain during the procedure.
• Postoperative pain managed with medications.
• Swelling and discomfort in the initial weeks.
• Gradual improvement in foot function and comfort.

Pain management and comfort measures:

• Pain medications.
• Ice packs to reduce swelling.
• Elevation of the foot to promote healing.