Chai Kulsakdinun, M.D.
Montefiore Medical Center
Department of Orthopedic Surgery
1695 Eastchester Road, 2 nd Floor
Bronx, NY 10461
718-920-2060 www.orthodoc.aaos.org/kulsak
Post-operative Course:
After surgery, you’ll be in a post-operative shoe(a big sandal) and crutches and will have pain medication. You will be able to put weight on the heel and outside portion of the foot immediately after surgery . Your foot will be quite sore for the first week or so. You will need to elevate your foot almost continuously for one week to minimize swelling. This will help reduce infection and increase range of motion. You will return to the office at one week for a dressing change and x-rays and then at 10-14 day intervals for 6 weeks for dressing changes. At 6 to 8 weeks, another set of x-rays will be needed to assess healing. If the bone is healed, you’ll be in tennis shoes for a few months with a toe spacer. Most patients are back in normal shoes by 4 to 5 months. Swelling may recur with activity for the first 6 months. Dress shoes should be avoided for the first 6 months. A toe spacer or night splint may be used in certain cases for 6 months to maintain correction.
1.
Distal chevron osteotomy or Akin bunionectomy
This operation is usually done through a single incision and use absorbable pins or small screws to hold the bones together in the corrected position. This is done for mild and moderate bunions and recovery is relatively quick. But you still will be in a postop shoe for 6 weeks and be on crutches for 3 to 4 weeks.
2.
Proximal Osteotomy/shaft osteotomy
This operation is a big deal! We cut the metatarsal bone and put it in a corrected position. It requires 2 or 3 incisions and it is used for severe bunions. The recovery is longer and you will be on crutches for 6 weeks or more. The swelling after surgery will also be a factor and you need to elevate your foot for the first week (Toes above the Nose).
The osteotomy is held with screws and wires in some combination.
The pins will be removed in the office under novocaine. You’ll be in a postoperative shoe for 8 to 10 weeks and then you will go into a sneaker. Most patients are back in normal shoes by 4 to 5 months.
Swelling may recur with activity for the first 6 months. Dress shoes should be avoided for the first 6 months. A toe spacer or night splint may be used in certain cases for 6 months to maintain correction.
3.
1 st TMT Fusion : this surgery is a bigger deal!! Some patients may need a fusion of the 1 st tarsometatarsal joint. With this surgery, the patient will be in a cast for 6 weeks and minimal weight bearing during that period. After the cast comes off, the postoperative course will be similar to the above procedures.
4. Other associated procedures: patients may get other related procedures at the same time,i.e. hammertoes, neuroma, callous surgery that will increase recovery time and change above plan.
Shoewear: Before surgery, one-third of the patients with a bunion can wear any shoes they want. After surgery, studies have shown that two-thirds of patients can wear any shoes they want. This is an improvement, but still leaves one-third of patients with some limitations of shoewear.
Back to Work: This depends on your age, job, and commute. If you are young, work at a desk, and live close to work, you can probably return to work in approximately 2 weeks. If you have to take public transportation or have to drive to work, you’ll need to be out longer.
Back to Sports: Patients may return to sports at about 5 to 6 months following surgery. This means running, tennis, etc. Exercise such as bicycling, stairmasters, etc., you can return within 2-3 months.
Both bunions at one time:
Technically, this can be done, but patients are quite limited for 3-4 weeks after surgery. For patients with the proximal osteotomy, you’ll need to be in a wheelchair for a few weeks because
Driving: of the pain.
If you have an automatic transmission and only have surgery done on your left foot, you could probably return to driving after you are no longer taking narcotic pain medications (percocet, vicodin, demerol, etc.) If you have a standard transmission or are having your right foot operated upon, you will probably not be able to drive for 2 months or longer. www.orthoinfo.org
www.footcaremd.com
www.alimed.com
www.hapad.com