Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type procedure)
CPT4 code
Name of the Procedure:
Correction, Hallux Valgus (Bunion), with or without Sesamoidectomy; Simple Exostectomy (e.g., Silver Type Procedure)
Summary
This surgical procedure aims to correct a bunion, which is an enlargement of the joint at the base of the big toe. The surgery involves removing the bony bump (exostectomy) and possibly more extensive bone reshaping to realign the toe.
Purpose
The primary purpose of this surgery is to alleviate pain and restore normal alignment and function to the big toe joint. It addresses the deformity caused by a bunion, which can result in discomfort, difficulty walking, and other related foot problems.
Indications
- Persistent pain and swelling at the base of the big toe
- Difficulty walking or performing daily activities due to the bunion
- Ineffective relief from non-surgical treatments like orthotics or footwear changes
- Severe angular deformity of the big toe
Preparation
- Follow the surgeon’s instructions about fasting before surgery, usually no eating or drinking for at least 8 hours.
- Medication adjustments, including stopping blood thinners if advised by the doctor.
- Pre-operative tests may include blood work, X-rays, and a physical examination.
Procedure Description
- Anesthesia: The patient is typically given regional anesthesia, numbing the foot and sometimes combined with sedation.
- Incision: A small incision is made over the bunion area.
- Exostectomy: The surgeon removes the bony bump from the base of the big toe.
- Sesamoidectomy (if needed): If necessary, the sesamoid bones around the joint may also be removed.
- Realignment: The big toe is aligned correctly, sometimes with temporary pins, screws, or plates.
- Closure: The incision is closed with sutures or staples, and a bandage is applied.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This surgery is commonly performed in an outpatient surgical center or a hospital.
Personnel
- Orthopedic surgeon or podiatric surgeon
- Anesthesiologist or nurse anesthetist
- Surgical nurses and operating room technicians
Risks and Complications
- Infection at the surgical site
- Nerve damage leading to numbness or tingling
- Blood clots
- Recurrence of the bunion
- Stiffness or restricted movement of the big toe
- Adverse reactions to anesthesia
Benefits
- Relief from pain and discomfort
- Improved alignment and function of the big toe
- Enhanced ability to walk and participate in daily activities
- Long-term correction of the bunion deformity
Recovery
- Keep the foot elevated and avoid weight-bearing activities for the first few days.
- Use of crutches or a special boot may be recommended.
- Follow specific instructions for wound care to prevent infection.
- Physical therapy may be necessary to restore movement and strength.
- Full recovery usually takes 6 to 12 weeks, with gradual resumption of normal activities.
Alternatives
- Conservative treatments such as orthotic devices, anti-inflammatory medications, and changes in footwear.
- Minimally invasive procedures are available but may not be suitable for all patients.
- Compared to surgery, non-invasive treatments have fewer risks but often provide only temporary relief.
Patient Experience
During the procedure, patients will be under anesthesia and should not feel pain. Post-surgery, there might be some discomfort, which is managed with prescribed pain medications. Swelling and bruising are common and can be alleviated by elevating the foot and applying ice packs.
Please follow your healthcare provider’s detailed instructions for the best outcomes and contact them with any concerns or unusual symptoms.