28293 Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant

Name of the Procedure:

Correction, Hallux Valgus (Bunion), with or without Sesamoidectomy; Resection of Joint with Implant

Summary

In this surgical procedure, a bunion deformity at the base of the big toe is corrected. The operation may involve removing part of the joint and inserting an implant to restore normal foot structure. Sometimes, small bones under the toe, called sesamoids, may also be removed.

Purpose

This procedure addresses the pain and deformity caused by hallux valgus (bunion). The goals are to alleviate pain, improve foot function, and restore the normal alignment of the toe.

Indications

• Persistent pain and discomfort in the big toe joint.
• Difficulty walking or wearing shoes due to the bunion.
• Failure of non-surgical treatments, such as orthotics or pain medications.
• Severe toe misalignment.

Preparation

• Fasting for a specified period before the surgery, usually starting midnight before the procedure.
• Adjustments or temporary cessation of certain medications as directed by the physician.
• Preoperative imaging, such as X-rays, to assess the extent of the deformity.
• General medical clearance and possibly blood tests.

Procedure Description

1. Anesthesia: Often general anesthesia or a regional block is administered.
2. Incision: An incision is made on the side or top of the big toe joint.
3. Bone Resection: Part of the protruding bone is removed.
4. Implant Insertion: An implant may be placed to maintain the new alignment and support joint movement.
5. Sesamoidectomy: If necessary, sesamoid bones are removed.
6. Closure: The incision is closed with sutures, and a sterile bandage is applied.

Duration

Typically, the procedure lasts 1 to 2 hours.

Setting

This surgery is generally performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic Surgeon or Podiatric Surgeon
• Anesthesiologist or Nurse Anesthetist
• Surgical Nurses and Technicians
• Postoperative Care Team

Risks and Complications

• Infection
• Blood clots
• Adverse reactions to anesthesia
• Persistent pain or discomfort
• Nerve damage or numbness
• Implant-related issues, such as loosening or failure
• Recurrence of the bunion

Benefits

• Significant pain relief
• Improved alignment of the big toe
• Enhanced functional ability and ease of walking
• Better fit and comfort in shoes Benefits are typically realized a few weeks to months after surgery as recovery progresses.

Recovery

• Keeping the foot elevated and applying ice packs to reduce swelling.
• Use of crutches or a walker for the initial days or weeks.
• Wearing a specialized surgical shoe or boot as advised.
• Follow-up appointments for wound checks and suture removal.
• Physical therapy may be recommended to restore strength and flexibility.
• Recovery generally spans from 6 weeks to several months, depending on the extent of surgery and patient healing.

Alternatives

• Conservative measures: Orthotics, footwear modifications, physical therapy, and pain management.
• Other surgical options without implants: Osteotomy or arthrodesis. Pros of these alternatives include avoiding implant-related issues, but they may have less predictable outcomes regarding pain relief and functional restoration.

Patient Experience

During the Procedure:

• Patients will be under anesthesia, so they will not feel pain during the operation.
• Some IV lines or monitors will be in place to track vital signs.

After the Procedure:

• Mild to moderate pain is expected, manageable with medications.
• Swelling and bruising of the foot.
• Instructions on pain management and comfort measures, including elevation and icing.
• Gradual return to normal activities as guided by the healthcare team.