Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Bunion Surgery/Hallux Valgus in India


Bunion
 

A bunion or hallux valgus is a swelling on the inner border of the foot affecting the base of big toe. It is at the level of the 1st metatarso-phalangeal (MTP) joint. This is because of the underlying prominent first metatarsal head. With a bunion the first metarsal head becomes more prominent as the bone itself deviates away from its immediate neighbour the 2nd metatarsal. This widens the forefoot thus producing the bunion.

 
 
Hallux Valgus
 
Pre operative picture showing Hallux Valgus Deformity
Post operative picture showing correction of Hallux Valgus Deformity
   
     
 
     
       
   

The symptoms of bunions include redness, swelling of the foot, and foot pain at the site of the enlargement.
These symptoms occur when foot shoes rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation. Hallux Valgus does not need surgery unless they are producing pain in the foot and interfering with daily activities. Recent advances in surgical techniques have led to a very high success rate in treating bunions.

As the deformity worsens big toe develops rotational deformity. Combination of deformities leads to change in the direction of pull of various muscles controlling the big toe and this eventually causes dysfunction of big toe. Once this happens load is transferred to other toe causing pain and deformities of other toes as well metatarsals. Once condition has progressed to this stage it is best treated with surgery.

Hallux Valgus is often associated with mild Hallux Rigidus.

 
    Case 1    
       
   
This 55 years old lady presented with severe Bunion or Hallux Valgus deformity of her toes. Note that her Left Big Toe is badly deformed and it was pushing on the left second toe and causing severe pain and inabilty to walk and wear normal shoes. She had similiar deformity of the other side where some surgeon had done amputation of her right second toe. 
 
       
   
She was so unhappy with the result of amputation surgery that she did not consult any doctor again for 10 years till her left big toe became non-functional and she could not walk at all. Look at the distal joint of the Big Toe which has subluxated due to rupture of plantar plate secondary to pull of Big Toe EHL tendon.
 
       
       
   
 
Severe Hallux Valgus Pre operative picture
 
Severe Hallux Valgus Post Operative X-Ray
 
         
 

She had corrective surgery to her left big toe at two levels.

         
 
Severe Hallux Valgus showing Post operative correction of left foot
 
Severe Hallux Valgus showing post operative correction of left foot on X-Ray
 
 

 

 
 
       
 
The picture of left foot at the bottom is taken 3 months after Bunion Surgery at Delhi Foot and Ankle Clinic. At that time she has been walking in her normal shoes for last 6 weeks. She was so pleased with the result of her surgery that she requested Dr Bhargava to do corrective surgery of her Right Big Toe despite all her bad past experience.
 
   

Case 2

 
This 35 year old lady presented with pain over her Bunion and inability to wear shoes.
 
   
  Bilateral moderate Hallux Valgus picture  
Bilateral moderate Hallux Valgus X-Ray
 
         
 

The deformity was corrected with a small day case operation which can be done under local anaesthetic block. She had Scarf Osteotomy of First Metatarsal shaft and Akins Osteotomy of proximal phalynx.

 
 
Bilateral moderate Hallux Valgus picture after surgical correction
 
Bilateral moderate Hallux Valgus X-Ray after surgical correction
 
         
 
 
Bunion or Hallux Valgus surgery is a reliable surgery which effectively treats your foot pain and improves your choice of Foot Wear.  
   
Patient can walk immediately after this surgery and remains in special shoe for 6 weeks after surgery. After 6 weeks patient can expect to walk back in her own shoes and can return to all day to day activities in a step wise fashion.  
 
   
Tailor's Bunion (Bunionette)  
   
Tailor's bunion is an enlargement of the fifth metatarsal bone at the base of the little toe. The symptoms of tailor's bunions include redness, swelling, and pain at the site of the enlargement (see picture). These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.
 
Surgery is often considered when pain continues despite wearing comfortable shoes. Surgery is highly successful in the treatment of tailor's bunions. Procedure for surgery and recovery is same as Hallux Valgus or Bunion operation.
 
   
  X-Ray showing Taylors Bunion  
X-Ray showing correction of Taylors Bunion
  Picture showing correction of Hallux Valgus and Taylors Bunion
           
 
 
   
Here is an example of another 45 year old woman who works as a bank manager. She has  bunion deformity of big toe, clawing of second toe due to pressure from big toe and bunionette deformity of fifth toe. She has typical splay foot and she get pain on the inside of big toe, outside of fifth toe and top of second toe and is unable to wear shoes. Note the correction of deformities in the x-ray taken 6 weeks after surgery. Also note in the picture below that she is now able to go to office in normal shoes.
 
   
   
Bunion or Hallux Valgus Surgery  
   
At the delhifootankleclinic bunion surgery is carried out as a day case procedure. Bunion surgery is most comfortably done under a general anaesthetic with patient asleep but can also be done under regional nerve blocks. Nerve block gives patient gives patient a high degree of post-operative pain relief which helps them to return home on the same day as of surgery.
 
   
   
What to expect after surgery?  
     
The foot  
This will be in a post-operative bandage.  
The foot should be kept elevated as much as possible when resting for the first 48 hours. Try to avoid letting it hang down when sitting and elevate up on two pillows while sleeping at night.  
   
Post operative bandage for Hallux Valgus Surgery
 
   
Mobility  
You will be walking after surgery putting full weight through your foot but in a special shoe.  
   
Length of stay in Hospital  
You can go home same day after your operation.  
   
At two weeks  
The patient will require an outpatient review and wound check. Stitches are dissolvable and do not need removing. The dressings will be removed and the patient may now get the foot wet. You continue to walk in the special shoe.
 
   
At six weeks  
Patient will be reviewed again. Special shoe discarded and now you can walk in your own shoes. The patient will be instructed on exercises.  
   
How likely is it going to work?  
Bunion surgery is a reliable operation. In well trained hands success rate is better than or equivalent to any other orthopaedic operation.Patients are generally so happy with the surgery that they prefer to walk in normal shoes and do not like to take help from Podiatry services.