28299 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method

Name of the Procedure:

Correction of Hallux Valgus (Bunionectomy) with Sesamoidectomy and Double Osteotomy

Summary

This surgical procedure involves correcting a bunion (hallux valgus), a deformity of the big toe, by removing part of the bone and realigning the toe. It includes removing the sesamoid bones if necessary and creating two bone cuts (osteotomies) to correct the alignment.

Purpose

The procedure mainly addresses hallux valgus, a condition where the big toe deviates towards the second toe, causing a bony bump (bunion). Goals include relieving pain, improving foot function, and enhancing cosmetic appearance.

Indications

• Persistent and severe bunion pain unresponsive to conservative treatments (e.g., orthotics, pain medication).
• Significant deformity affecting walking or wearing shoes.
• Inflammation and swelling around the big toe joint.
• Difficulty performing daily activities due to bunion discomfort.

Preparation

• Preoperative fasting for 8-12 hours if general anesthesia is planned.
• Adjustment or cessation of certain medications, particularly blood thinners, as advised by the surgeon.
• Preoperative diagnostic imaging (X-rays) to assess the extent of the deformity.
• Blood tests and cardiac evaluation might be required.
• Arrange for transportation and assistance post-surgery.

Procedure Description

1. Anesthesia: Typically, general anesthesia or regional anesthesia (nerve block) is used.
2. Incision: A surgical cut is made along the inner side of the foot near the big toe joint.
3. Bone Removal: The surgeon removes the bunion (bony bump) and may excise the sesamoid bones if they are contributing to the deformity.
4. Osteotomies: Two bone cuts (osteotomies) are made to realign the big toe. The bones are repositioned and fixed using screws or pins.
5. Closure: The incision is closed with stitches, and a bandage is applied to protect the area.

Duration

The procedure typically takes around 1.5 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or podiatric surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Nerve damage resulting in numbness or tingling
• Recurrence of the bunion
• Delayed bone healing or non-union
• Stiffness or limited range of motion

Benefits

• Relief from pain and discomfort
• Improved toe alignment and foot function
• Enhanced ability to wear footwear comfortably
• Better cosmetic appearance of the foot
• Outcomes are often realized within a few months post-surgery

Recovery

• Initial recovery involves rest and limited weight-bearing on the operated foot.
• Pain management with prescribed medication.
• Elevation of the foot to reduce swelling.
• Use of a special surgical shoe or boot for several weeks.
• Physical therapy may be recommended to restore mobility and strength.
• Full recovery typically takes 6-12 weeks, but swelling and discomfort can persist longer.

Alternatives

• Non-surgical options such as orthotic devices, toe splints, anti-inflammatory medications, and lifestyle modifications.
• Pros of alternatives include avoidance of surgical risks and immediate recovery; cons include less effective relief and temporary solutions.

Patient Experience

• Patients can expect to experience some pain and swelling after the procedure, which is generally managed with medication.
• Walking might be challenging initially, requiring the use of crutches or a walker.
• Discomfort should gradually decrease over the weeks following surgery, with noticeable improvements in walking and footwear comfort. Pain management, elevation, and cold therapy will aid in recovery.