Bunion Surgery – Shaft Procedures
Hallux valgus or bunion deformities have may different surgical techniques for their correction. One group of procedures that your surgeon may use is the shaft osteotomies. These osteotomies are different from the head osteotomies and also the procedures performed at the base of the metatarsal or at the metatarsocuneiform joint, because they are performed in the middle of the first metatarsal.
The shaft osteotomies were designed to use internal fixation (screws) and to correct larger deformities. In most of these cases, your surgeon will use 2 screws to fixate the osteotomy. The osteotomy is longer than the head procedures and has more inherent stability because of more bone contact. Also these procedures can correct larger deformities then the head procedures and about the same deformities as the base procedures.
There are two basic shaft osteotomy procedures that your doctor may talk to about: The Z bunionectomy or the offset V bunionectomy. These osteotomies are very similar and are used interchangeably, based on different patient characteristics, by most surgeons that perform these procedures. The decision to use these procedures over other procedures is typically surgeon preference. In most cases, these procedures are used for patient with mild to severe structural bunions without hypermobility. In old patients with poor bone stock, the surgeon may opt for other procedures.
What is the post-operative course?
Typically, the patient is allowed to bear weight immediately after surgery in the a surgical shoe. Some doctors may have you use crutches for one to two weeks or use a slipper cast. This is surgeon’s preference. It is not unusual for the front part of your foot to look bruised after the surgery. So at the first dressing change, do not be surprised if your toes and the top of your foot are bruised. This will dissipate in 3-6 weeks. At two weeks after surgery, the sutures are typically removed and at three weeks most patients are advanced into a surgical shoe. After the first or second week, your surgeon may have you start range of motion of your big toe joint. It is important that you follow your doctor’s instructions on all range of motion exercises to help return motion to the operative foot. As with all surgery on the foot and ankle, the limiting factor to advance into different shoe gear is swelling. This swelling can last up from 6 months to one year after surgery. Typically most patients returned to pre-operative dress shoes in 6 to 8 weeks after surgery.
With any surgery, complications are possible. Every procedure has unique complications and your surgeon will discuss these with you before surgery. Make sure that you ask any questions that you have about the surgery with your surgeon.