• Bunion or Hallux Limitus is a term that indicates prominence of bone at the big toe joint. With bunion deformity, the first metatarsal bone has spread upward. The big toe is displaces upward and jams on the first metatarsal head. The entire ray becomes bent and crooked. This displaced joint can become arthritic, stiff and painful.
  • The influence of pathomechanics and foot gear on the deformity was explained. Pronation of the rearfoot during walking causes instability at the base of the first metatarsal allowing it to move up and out of position. The big toe joint then becomes progressively more and more subluxed. Recommend use of sneakers and accommodative footgear including customized innersoles and orthotics. It was explained that orthotics address the biomechanical cause of problem, pronation of the rearfoot. Control of pronation reduces the deforming forces that make bunions worse.
  • Non-surgical remedy includes, padding, accommodative shoe gear, orthotics to control pronation, and padding. These options were offered to the patient. Cutting Edge laser therapy can be applied to the joint to reduce inflammation and pain. It will not remove bone spurs. Steroid injections are sometimes used but have only temporary effect and weaken the joint capsule.
  • Surgery is always an elective procedure for bunions or hallux limitus.
  • Surgical correction was explained. Under sedation and local anesthesia at the hospital an incision is made on the top of the joint. Excessive bone is removed from the metatarsal head. Removing the bone spurs and remodeling the top of the first metatarsal bone is sometimes enough to relieve symptoms. It has the advantage of being a more conservative operation. It has the disadvantage of not correcting the arthritic joint surface that may still cause pain. To remedy the joint surface, removal of the joint and making a pseudojoint out of joint capsule is a reliable surgical option. The base of the big toe bone is removed essentially removing have of the big toe joint. This makes the joint more flexible and allows greater motion in the big toe during walking.
  • The patient is usually permitted to walk using a surgical shoe or cam walker boot and that healing usually takes 2 to 4 months.
  • Potential risks and complications were explained including, infection, thick or ugly scarring, numbness, failure to heal, fixation failure and removal by another operation, over correction of the hallux, abnormal position of the hallux, stiffness of the big toe joint, continued pain in the big toe joint, pain under the second metatarsal and recurrence of deformity or pain.

Surgical Counseling

  1. It was explained to the patient that the foot is a structure that constantly changes with time. Just like the hands that change with time and develop arthritic joints and misaligned bones, the feet change in an even more extreme manner. Increased forces are transmitted through the feet by walking and will deform feet with time. It is likely that more foot deformities will develop in the future. Uncontrolled flatfoot significantly increases the chance that feet that are corrected today will deform tomorrow.
  2. It was explained to the patient that surgical intervention involves numerous risks and possible complications. These risks and possible complications include but may not be limited to the following list:
  • Scar tissue or adhesions around the surgical site. These can pull bones and or joints out of place and cause further deformity. These can press on nerves and cause numbness, or sharp pains, or continuous aching pain.
  • Nerve damage of large or small nerves at the surgical site can also cause numbness, sharp pain, or continuous aching pain. On rare occasions a condition caused reflex sympathetic dystrophy occurs where chronic pain, and swelling occur in the limb and may require intervention and chronic treatment by a pain management specialist.
  • Delayed healing of skin incisions or ulceration of surgical sites. If this should occur, surgical intervention to repair skin, including but not limited to skin grafting, skin rotation flaps, or application of human cultured skin may be required.
  • Orthopedic or positional deformities of the foot: If this should occur, the involved toe, or adjacent toes could be pulled out of normal position, protrude in abnormal directions, curl abnormally, or become more prominent. Metatarsal bones may become more prominent in the sole of the foot causing pain or callous formation that would require further surgery.
  • Failure to heal soft tissue or bone: When soft tissues fail to heal wounds develop. Sometimes bone healing problems causes fractures, other times a more serious condition called pseudo-arthrosis, a painful condition that causes unstable bone fragments to shift and hurt.
  • Circulation problems: like phlebitis also called inflammation of veins, or blood clots in the legs sometimes called deep vein thrombosis.
  • Loss of life or limb or permanent disability: this could occur from stroke, heart attack, allergic reaction to anesthesia.
  • Although the proposed procedures are expected to provide the intended results, the results of any operation can never be guaranteed. If the proposed surgical procedures fail to provide the intended results, or if surgical complications should occur, further surgery will be necessary. This will likely result in an indeterminate increase in healing time. Minimum expected healing time is 4 months.

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