28292 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method

Name of the Procedure:

Correction, Hallux Valgus (Bunionectomy), with Sesamoidectomy, when performed; with Resection of Proximal Phalanx Base, when performed, any method

Summary

A bunionectomy with sesamoidectomy and resection of the proximal phalanx base is a surgical procedure to correct a bunion deformity in the big toe. It involves removing part of the bone at the base of the toe, possibly including the sesamoid bones, to realign the toe and alleviate pain.

Purpose

The procedure addresses hallux valgus, a condition where the big toe deviates towards the other toes, causing a bunion. The goal is to realign the toe, reduce pain, and improve foot function.

Indications

• Severe pain and discomfort in the big toe
• Difficulty walking or wearing shoes
• Inflammation and swelling not relieved by conservative treatments
• Progressive worsening of the toe deformity

Preparation

• Fasting typically required for 6-8 hours before surgery
• Adjustments to certain medications as advised by the healthcare team
• Pre-surgical blood tests and imaging (X-rays) of the foot

Procedure Description

1. Administering anesthesia (local, regional, or general).
2. Making an incision over the bunion.
3. Removing or realigning the sesamoid bones, if necessary.
4. Resection of the proximal phalanx base to correct the deformity.
5. Realigning and securing the bones with screws, pins, or plates.
6. Closing the incision with sutures and applying a bandage.

Duration

Approximately 1-2 hours.

Setting

Typically performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technologists

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Nerve damage leading to numbness or tingling
• Recurrence of the bunion
• Delayed healing of the bone

Benefits

• Relief from pain and discomfort
• Improved alignment and function of the big toe
• Ability to walk and wear normal shoes comfortably Benefits can usually be realized within a few weeks to months post-surgery.

Recovery

• Keep the foot elevated and apply ice to reduce swelling
• Use crutches or a walker to avoid bearing weight on the foot
• Follow dressing and wound care instructions
• Attend follow-up appointments for monitoring and stitch removal
• Gradual return to normal activities within 6-8 weeks

Alternatives

• Conservative treatments (e.g., orthotics, pain relief medications, physical therapy)
• Less invasive surgical options Pros of conservative treatments include avoiding surgery, but they may not provide long-term relief. Less invasive surgery may involve a shorter recovery but might not be suitable for severe deformities.

Patient Experience

• During the procedure: Patient will feel sedation or anesthesia and should not feel pain.
• After the procedure: Initial swelling, bruising, and pain managed with medications.
• Pain management includes prescribed pain relievers and over-the-counter options as pain reduces.
• Comfort measures involve wearing a surgical shoe or boot and keeping the foot protected.