Questions about the bunion (hallux valgus) condition



#1:

What can I do to help prevent my bunion from getting worse?



A:

Wear whenever possible only shoes feel comfortable.

Use bunion-specific foot orthoses for possible protection and comfort.

Try silicon toe spreader or night splint but their effectiveness is not known.

Physiotherapist-instructed foot and toe exercises.


#2:

If I have a family history of bunion condition, what is the chance of me developing it?



A:

Gene plays a strong role in majority of bunion patients. There are no tests yet to tell if you have inherited the bunion gene(s) or not. Female hormones (estrogen) is actually responsible (not high heels) for the gender bias of 9 times more common among female than male.


#3:

When do I need to start considering surgical treatment?



A:

Usually when conservative measures have failed to control bunion related pains and activity limitations. To avoid advanced cartilage degeneration and arthritis of the big toe joint, surgery can be considered earlier for severe bunion deformity of a relatively young and active person.


Question about the surgery



#1:

Can both feet be corrected at same time??



A:

Yes, this is usually the preference by patients with the bunion condition in both feet.


#2:

What are the possible complications?



A:

Please refer to the section of “Possible complications relating to syndesmosis procedure.”


#3:

Do health insurances cover bunion surgeries?



A:

Yes, they do because bunion surgery is considered necessary for pain relief and function improvement of the foot. It is always advisable to obtain written approval ahead of surgery.


#4:

Can same surgery be repeated if necessary?



A:

Syndesmosis procedure does not burn bridges and if necessary it can be repeated.


#5:

How long does the surgery usually take?



A:

About 60 ± 15 minutes for each foot.


#6:

Can the surgery be done under local anesthesia?



A:

Yes, and also general and spinal anesthesia.


Questions about “after” surgery



#1:

Is hospital stay necessary?



A:

It is not absolutely necessary but most people prefer staying overnight for their peace of mind and own comfort.


#2:

How much surgical pain is there usually and for how long?



A:

Due to the less traumatic nature of non-bone-breaking surgery, post-operative pain is generally not severe. Some usual moderate wound pain can be expected for the first 24 hours and non-narcotic oral pain killer is often sufficient for pain relief.


#3:

When will I be allowed and able to walk?



A:

Walking is allowed and possible any time after surgery, although there may be slightly more pain for the first week.


#4:

Do I need crutches?



A:

Crutches may not be felt necessary after the first week for indoor walking but still recommended for outdoor walking to help minimize unnecessary stress and movement of the surgical site and understanding of other pedestrians on the street.


#5:

How do I take shower after surgery?



A:

You will be provided a watertight plastic foot cover to keep your foot dry. Sitting down on a stool or chair for safety is recommended.


#6:

What restrictions do I need to observe?



A:

You need to wear a protective forefoot cast for walking and standing for 3 months. You should also avoid walking too fast and more than 5,000 steps a day.


#7:

Why do I need to restrict my walking initially?



A:

This is to protect the internal holding sutures from early loosening and breakage and also to avoid interfering with formation of the ligament bridge by your body.


#8:

Can the progress of this ligament formation be monitored?



A:

Although there are no ways yet to assess the progress of this new ligament, its estimated completion time from past experience is about three months.


#9:

Do I need physiotherapy?



A:

Physiotherapy is not usually needed because all necessary exercises are easy but need be carried out by patients themselves frequently daily from day one after surgery. Patients are always pleasantly awarded by much decreased pain in 1-2 days as joints regain their movements.


#10:

When can I drive safely again?



A:

About one month and only when normal feelings and reaction has returned to the driving foot.


#11:

When can I return to normal walking safely for the newly formed ligament?



A:

About 3-4 months after surgery.


#12:

When can I return to unrestricted usage of my feet?



A:

One can gradually and safely return to all activities and shoes as desired and tolerated, such as running and high-heel shoes, after 6 months of surgery.


#13:

Why can high-heel shoes be allowed after syndesmosis procedure but may not after bone-breaking surgeries?



A:

Bone-breaking bunion surgeries do not incorporate any means to stabilize first metatarsal bone to prevent bunion deformity from recurring but the syndesmosis procedure does. The new ligament by the latter is made up of biological material and thus like all living structures such as healed skin wounds and broken bones would not break down by normal activities.


#14:

What is the chance of deformity recurrence after syndesmosis procedure?



A:

It is low (≈5%) and partial. It happens only in early stage before the mighty ligament having a chance to establish itself. Once it is fully consolidated in six months, there has been virtually no known recurrence in Dr. Wu’s 25 years of its practice yet.


#15:

Would everybody be able to form this ligament?



A:

Yes, virtually anyone, including diabetics, with normal healing ability of skin wounds will probably be able to do so.