Bunion surgery is almost always elective.  Surgery is indicated for pain and/or progressive deformity that interferes with shoe wear and activities, and when non-surgical measures have failed.  Cosmetic correction, while generally achieved with surgery, is usually a secondary consideration.  Other considerations as to the timing of bunion surgery include age, general health, and foot circulation, as well as setting aside dedicated time for recovery.  While shoewear options are improved with bunion surgery, predictable decreases in overall shoe size cannot be guaranteed, and studies have shown that up to one-third of patients still cannot wear some types of shoes.

No.  Bunion correction with Lapidus fusion must be performed one foot at a time.  The other foot may be corrected generally three to six months later.

Yes, that is usually not a problem.  However, they must be evaluated carefully.  Make sure you schedule another appointment before surgery.  Do not wait until the morning of your surgery to mention it.

Your surgery generally takes place at an outpatient surgical center.

Download the Lapidus Fusion Bunion Realignment Post-Operative Guidelines for full details.

You will have general anesthesia with a popliteal block.  The popliteal block is a nerve block that occurs behind the knee of the surgical side just prior to surgery.  It provides numbness from the knee down for ~24 hours post-surgery.

Yes.  You will get a dose of antibiotic before.  Also, due to a length of time being immobilized, patients are started on one 325 mg aspirin once a day for 4 weeks.

No.  Bleeding is minimal with use of a tourniquet during surgery.

Read carefully all the handouts in the surgical folder.  You can also go online to www.aofas.org to learn more about treatment of bunions.  FootcareMD.com is another reputable online source.

After surgery, you will be placed in a bulky non-weight-bearing splint.  Crutches will be provided. When you have adequately recovered in the outpatient post-anesthesia area and have passed the criteria, you will be discharged home with outpatient instructions.  You will be non-weight-bearing in the post-op splint and must keep it dry.

For the first two weeks you must rest, get sleep, eat well, and drink plenty of water.  Your body will have greater metabolic demands on it to heal.  If you are a poor eater, I strongly recommend drinking one or two medical protein shakes per day for the week before surgery and for two weeks after.  Keep the bandage or splint clean and dry, keep your foot elevated to the level of your heart, and take pain medicine as prescribed.

Discuss this with your rheumatologist, but it is generally recommended that you stop immune suppressive modulators (e.g. Methotrexate, Enbrel, Humira) for two weeks before and two weeks after surgery.

Small spots may appear on the bandage.  You may reinforce the dressing with an ace wrap obtained from a pharmacy.  While highly unlikely, excessive bleeding through the bandage is of concern and you should call the office to be seen.

Regardless of the procedure, if surgery was on your left foot, you may drive as soon as you are off the pain medication.  For surgery on the right foot, you may drive after eight weeks.

That depends on what you do and the procedure performed.   Sedentary desk workers may return as soon as one to two weeks.   On the other end of the spectrum, construction laborers are typically out of work for three to four months.  You will be provided out of work notes, or restricted duty notes, as necessary during your recovery.  Family leave paperwork can also be submitted.

About ten percent of patients will have a delayed union or non-union.  This can be even greater in patients who have additional medical problems, have poor bone healing factors, or are smokers.  To enhance your chances of healing, you should not smoke.  For a delayed union you may be prescribed bone healing adjuvants, such as a bone stimulator, and prolonged immobilization.   For an established non-union, you may require revision surgery and bone-grafting to try to get the bones to heal.

Like any surgery, complications can develop.   Fortunately, they are rare for most patients, but not zero.  These include infection, bleeding, numbness, blood clots, tendon injury, delayed union, non-union, malunion, or chronic pain and swelling.  Appropriate recognition and medical treatment of these complications generally will allow for a satisfactory outcome.

Recurrence of the bunion deformity can occur in ten to fifteen percent of patients. It can recur early, within a few weeks if the soft tissues fail, or the osteotomy or fusion fixation fails.  In these situations, prompt revision surgery can allow for a satisfactory outcome.  The bunion can also recur later on, many months to years later, and if symptomatic, usually can be corrected with surgery.

Get ready for it!   Optimize your physical and mental state, and make sure you have allowed yourself the time necessary for recovery.  Certainly, call us if you have any questions. More information can be obtained from the American Orthopedic Foot and Ankle Society website (www.aofas.org).