28298 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method

Name of the Procedure:

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

Summary

A bunionectomy with sesamoidectomy and proximal phalanx osteotomy is a surgical procedure to correct a bunion, which is a bony bump at the base of the big toe. This involves realigning the toe by removing part of the bone and sometimes the sesamoid bones.

Purpose

This procedure addresses hallux valgus, commonly known as a bunion. The main goals are to relieve pain, improve walking ability, and correct the deformity of the foot.

Indications

• Significant pain and discomfort in the big toe joint.
• Difficulty walking or wearing shoes.
• Progressive worsening of the bunion.
• Failure of conservative treatments like orthotics, medications, and physical therapy.

Preparation

• Follow fasting instructions prior to surgery (usually no food or drink after midnight).
• Stop certain medications as advised by the healthcare provider.
• Pre-operative imaging tests such as X-rays to assess the severity of the bunion.
• Blood tests and a physical exam to ensure fitness for surgery.

Procedure Description

1. Anesthesia: The patient is administered local or general anesthesia.
2. Incision: A small incision is made over the bunion.
3. Bone Removal: The surgeon removes part of the big toe bone (osteotomy) and may also remove the sesamoid bones.
4. Realignment: The remaining bone is realigned and fixed using screws or plates.
5. Closure: The incision is closed with sutures, and the foot is bandaged.

Tools include surgical knives, osteotomes for cutting bone, and fixation devices like screws or plates. Anesthesia may be local with sedation or general anesthesia, depending on the case and patient health.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital or a specialized outpatient surgical center.

Personnel

• Orthopedic or podiatric surgeon
• Anesthesiologist
• Nursing staff
• Surgical technician

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Recurrence of the bunion
• Poor wound healing
• Pain or stiffness in the toe

Benefits

• Relief from pain.
• Improved alignment of the big toe.
• Enhanced ability to walk and wear shoes comfortably.
• Long-term prevention of further deformity.

Recovery

• Keep the foot elevated and apply ice to reduce swelling.
• Follow weight-bearing restrictions as recommended.
• Wear a special surgical shoe or boot for several weeks.
• Physical therapy may be required to restore mobility.
• Complete recovery usually takes about 6-12 weeks, depending on the individual.

Alternatives

• Non-surgical treatments: orthotic devices, toe spacers, anti-inflammatory medications.
• Minimally invasive bunion surgery, which might have a shorter recovery period.
• Pros and cons should be discussed with the healthcare provider to determine the best option.

Patient Experience

• During the procedure: Patient will feel no pain due to anesthesia.
• After the procedure: Some pain and swelling are expected, managed with medications.
• Pain management may include prescribed analgesics and non-steroidal anti-inflammatory drugs (NSAIDs).
• Postoperative instructions are crucial for a smooth recovery.