Background Information:

What are the other Names for the Procedure?

• Bunionectomy
• Hallux Valgus Correction Surgery

What is Bunion Removal surgical procedure?

A Bunion Removal procedure is the surgical removal of a bunion or a deformity in the bone and/or tissue, found at the joint of the big toe.

What part of the Body does the Procedure involve?

The parts of the body involved in a Bunion Removal procedure are the joints, tissues, and bones around the big toe (the first metatarsal bone and the sesamoid bones), along with the cartilage around the joint.

Why is the Bunion Removal surgical procedure Performed?

Bunion Removal procedure is performed when the bunion becomes painful and cause discomfort while walking.

What are some Alternative Choices for the Procedure?

The patient may wear spacers between the first and second toe of the foot, or wear wide toed shoes as an alternative. However, if the bunion begins to cause discomfort and become painful; then, Bunion Removal procedure remains the gold standard technique.

What are the Recent Advances in the Procedure?

A Bunion Removal surgical procedure is one of the best procedures to cure severe cases of bunion where the patient experiences acute pain and is unable to walk properly.

What is the Cost of performing the Bunion Removal surgical procedure?

The cost of Bunion Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Bunion Removal surgery and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/002962.htm

Prior to Bunion Removal surgical procedure:

How is the Bunion Removal surgical procedure Performed?

• An incision is made over the bunion and the joint at the base of the toe is opened to isolate the first metatarsal bone
• A small part of this bone is cut and removed along with a sesamoid bone
• The tendon around the joints, especially the one close to metatarsal bone is cut to aid in straightening the bone as it heals
• In some cases a metal rod may be positioned at the base of the toe for the same purpose
• After the surgery, the skin is sutured and bandaged

Where is the Procedure Performed?

The procedure is usually performed in an out-patient surgery facility or a hospital, and the patient can usually go home the same day. However, the physician may keep them under overnight observation, if necessary.

Who Performs the Procedure?

The procedure is performed either by an orthopedic surgeon, a general surgeon, or a podiatrist assisted by an anesthesiologist.

How long will the Procedure take?

The entire procedure takes less than an hour. However, if necessary, the physician may ask the patient to wait for a longer period of time at the healthcare facility for observation.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• Similarly if the patient suffers from any other medical condition, the physician may insist on getting it treated
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• The physician will request your consent for the Bunion Removal procedure using an informed Consent Form.

What is the Consent Process before the Procedure?

The physician will request your consent for the Bunion Removal procedure using an informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Bunion Removal surgical procedure?

Before the procedure, an x-ray of the foot is taken. The physician may suggest additional blood tests that are required, prior to the procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Bunion Removal surgery?
• Why is this procedure necessary? How will this procedure help?
• What does this procedure involve?
• Will I be able to walk comfortably after the procedure?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Bunion Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered either local anesthesia, spinal anesthesia, or general anesthesia. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally minimal since the procedure requires only a small incision. But, if complications arise during the procedure, it could lead to further loss of blood.

What are the possible Risks and Complications during the Bunion Removal surgical procedure?

The possible risks or complications that may arise during the surgery are:

• Infection
• Accidental injury to the neighboring tissue, nerve, or bone
• Excessive bleeding
• Anesthetic complications, like respiratory depression, need for mechanical ventilation, allergic reactions, etc.

What Post-Operative Care is needed at the Healthcare Facility after the Bunion Removal surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Bunion Removal surgical procedure:

What are the possible Risks and Complications after the Bunion Removal surgical procedure?

The possible risks and complications that may arise after Bunion Removal surgery are:

• Numbness in the toe
• Slow healing
• Failure of the surgery
• Stiffness in toe
• Pain

What is the Prognosis after the Surgery?

• The general prognosis post Bunion Removal procedure, is excellent
• Almost immediately after the surgery, the pain begins to reduce and the patient is able to walk better
• The surgery ensures correction of the deformity in the toe bone

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling and redness
• Bleeding or fluid drainage
• Fever
• Dizziness
• Signs of infection

What Post-Operative Care is needed at Home after the Bunion Removal surgical procedure?

At home, the following post-operative care is recommended, after a Bunion Removal procedure:

• Use heat to relieve the incisional pain (or follow the physician’s advise)
• Wash the surgical wound with mild soap while bathing; keep it clean and dry thereafter
• Resume regular/daily activity only after there is a complete recovery
• Complete the course of prescribed medication
• Avoid taking non-prescribed medications
• Keep the wound bandaged for 2-3 days post-surgery

How long does it normally take to fully recover, from the Procedure?

It may take about 6 weeks to completely recover from the Bunion Removal surgical procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Bunion Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• The orthopedic surgeon, a podiatrist, or a general surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Bunion Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA