Understanding Wrist Arthritis

The main two types of arthritis in the wrist are osteoarthritis and rheumatoid arthritis.

Osteoarthritis (OA) is the most common type of arthritis and is also known as degenerative arthritis. OA usually develops slowly over several years. It occurs when there is a systematic loss of cushioning cartilage in the joints and the bones in the joint rub against one another. This can be very painful and reduce movement drastically in the joint.

Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. A typical joint in the body is made up of bones that move against each other. These two bones are held together by ligaments and a sheath (called a capsule) that surrounds the entire joint. The inner lining of the capsule is called the synovium. In rheumatoid arthritis, the synovium of the joint becomes inflamed and enlarged so that it erodes the neighboring bones, ligaments, and cartilage. The end result is damaged and painful joint surfaces.

Arthritis forms in the wrist from multiple causes, but most commonly due to either a bad sprain or a fractured scaphoid that doesn’t heal properly. It will weaken your wrist and you will have difficulty bearing weight across the wrist.

Symptoms

Some first signs of wrist arthritis are:

• Difficulty bearing weight on wrist
• Pain in the wrist
• Progressive weakness of the wrist
• Stiffness in the wrist

These symptoms may make it difficult to complete simple daily tasks such as opening a jar or holding a coffee cup.

Treatments

If diagnosed with wrist arthritis your doctor would typically start with conservative, non-surgical treatments that include:

• NSAIDS
• Wrist splinting
• Corticosteroid injections

When non-surgical treatments are no longer effective, your doctor may recommend surgery. Surgical options include:

Joint replacement: This is where a portion of the damaged bone is removed and replaced with a metal or plastic implant.

Removal of arthritic bone: This procedure, referred to as a Proximal Row Carpectomy or PRC, involves the removal of the scaphoid, lunate and triquetral bones, eliminating the arthritic surfaces. Potential problems include shortening of the wrist and loss of grip strength.

Joint fusion: The arthritic joints within the wrist are fused together, eliminating the bone on bone contact that causes pain. This does affect the flexibility of your wrist somewhat, but maintains wrist length and grip strength.

Fusion Options: There are multiple options for fusions within the wrist. The procedure best suited for you will be determined by which of your joints are arthritic, the extent of the damage, and your surgeon’s preference. Popular options include the 4-Corner Fusion, which fuses the lunate, capitate, hamate and triquetral; as well as the STT Fusion, which fuses the scaphoid, trapezium and trapezoid.

Why the BioPro Clover Staple?

The BioPro® Clover Staple is an excellent option for fusions within the wrist. It is available in three and four-leg versions, allowing surgeons to fuse either three or four bones with one device. The Clover Staple is made from Nitinol, which is a memory alloy that compresses when exposed to normal body temperature. The device is designed to continually compress the bones against each other, helping speed the healing process. Additionally, the device is very low profile, allowing for minimal bone removal without affecting wrist motion.

What to expect during and after surgery

After the joints are prepared for fusion, the Clover Staple is implanted, compressing all of the bones together. After the procedure, a splint or cast will be applied to restrict motion while the wrist heals. Post-operative protocols including physical therapy will be prescribed at the discretion of your surgeon. Healing times vary based on multiple factors, but typically range from 6-8 weeks.

Understanding Knee Pain

The knee is a complex, hinged joint. With support from cartilage, ligaments, and muscles, the two bones at the joint move over each other so you can straighten and bend your leg. A knee that becomes stiff and painful may be replaced with a knee prosthesis, which will allow you to walk without pain.

In a healthy knee , the surfaces of the thigh and shin bones are smooth so they can glide easily over each other. Cartilage covers the bones evenly, allowing smooth movement. Protected by the kneecap and held in place by muscles and ligaments, the joint bends freely.

In a problem knee, the surfaces of the bones may become rough, causing pain when they rub together. The cartilage may wear away, becoming rough and no longer allowing easy movement of the joint bones. Because of arthritis, the joint may be swollen and inflamed, resulting in stiffness and pain.

Your damaged knee joint can be replaced with new, smoothly surfaced components. The lower knee component will replace the rough surface of the shin bone, while the upper knee component will replace the surface of the thigh bone. The kneecap component will cover the underside of your kneecap.

Symptoms

Knee arthritis symptoms progessivly worsen over time. A painful knee can keep you from doing the things you enjoy in your life. The most common symptoms of knee arthritis are:

• Stiffness of the knee
• Swelling of the joint
• Pain in the knee
• Limited range of motion
• Tenderness along the joint

Treatments

One solution is a decision to replace your knee and is your first step toward regaining control of your life. Technical advances have given us new materials to replace your problem knee. Therefore, when lesser methods are no longer able to control the pain and disability to your satisfaction, knee replacement becomes a reasonable option.

• Pain is severe enough to restrict work, recreation, and the ordinary daily activities.
• Pain is not relieved by anti-inflammatory medicine, the use of a cane, and other restricting devices.
• There is a significant stiffness of the knee.
• X-rays show advanced arthritis or other knee problems.

Knee replacement is an elective operation and there are always nonoperative alternatives. The decision to have the operation is not made by your doctor, but by yourself. The doctor may recommend the operation; however, your decision must be based upon weighing the benefits of the operation against the risks. You may wish to discuss the surgery with your own doctor or even get another opinion so all your questions are answered before you decide to have the operation.

Why the BioPro Knee Implant?

The BioPro® TKO (Total Knee Origin) implant is one of the more conservative knee implants available today. The TKO not only conserves bone by being one of the thinnest implants, but is one of the only implants that conserves all of the normal structures that Mother Nature put in place for very good reasons. The TKO retains all ligaments, including the ACL and PCL, restoring your post-operative knee to a more natural acting and responsive state.

The Surgical Procedure

Knee replacement is one of the most common forms of total joint replacements. To begin the surgical procedure, the patient will be given an anesthetic (usually a spinal unless contraindicated). The surgeon will then make an incision and prepare the knee for implantation of the prostheses by reshaping and resurfacing the bones of the arthritic knee joint. The surgeon will then place and secure the implants in the appropriate areas to replace the joints. Ultimately, the damaged and rough surfaces of the knee joint will be replaced with new, smooth-surfaced components. The lower knee component will replace the roughened surface of the shin bone. The upper knee component replaces the roughened surface of the thigh bone. The kneecap component covers the underside of your kneecap. When the surgery is finished, the incision will be closed and a small tube (called a hemovac) will be placed in the incision to help drain fluid from the operative area for the first day or so.

Complications of Knee Replacement Surgery

Most complications that occur after knee replacement are successfully treatable. Possible complications after knee replacement include:

Infections: Any infection in your body can spread to your joint replacement. Infections may occur while you are in the hospital of after you go home. Minor infections can be treated with antibiotics, while major infections may require surgery and removal of the prosthesis.

Blood Clots: If there is a severe pain and / or swelling that develops in your calf or thigh, you may have developed a blood clot. Blood clots result from several factors, including decreased mobility that causes a slow movement of the blood through your leg’s veins. Your doctor may take preventative action to reduce the possibility of blood clots, such as blood thinning medications, elastic stockings, exercises that increase the blood flow in the leg muscles, or plastic boots that inflate with air to compress the muscles in your legs.

Loosening: Loosening of the prosthesis within the bone may occur after knee replacement. If the loosening is significant and there is a large amount of pain, a revision surgery to correct the loosening may be necessary.

Wear: Wear can be found in several joint replacements. Excessive wear can lead to loosening and pain and may require revision surgery.

Prosthetic Breakage: Breakage of a knee replacement is extremely rare, but it can occur. If this case does occur, a revision surgery will be needed.

Nerve Injury: Nerves in the vicinity of the total joint replacement can be damaged during the total replacement surgery. This type of injury is not common and may often improve and/or completely recover after some time.

Stiffness: In some cases, the ability to bend the knee does not return to normal after an artificial knee replacement. Increased scarring after surgery can lead to an increasingly stiff knee. If this occurs, your surgeon may manipulate the knee to regain motion without injuring the joint.

It is also important to notify your surgeon or nurse if you experience any of the following symptoms:

1) Pain, soreness, swelling, or redness in the calf muscles of either leg.

2) Unexplained, increased pain in the operative area.

3) Redness, swelling, or puslike drainage from the area around the incision

4) Cough, high fever, or chills.

5) Chest pain, shortness of breath, or difficulty breathing.

What to Expect After Knee Replacement Surgery

After surgery, you will be taken to the Recovery Room for a period of close observation. Your blood pressure, pulse, and temperature will be monitored and close attention will be paid to the circulation and sensation in your legs and feet. Post operatively, you may have temporary nausea and vomiting due to anesthesia or medications. (Anti-nausea medication may be given to you when you are in your room to minimize nausea and vomiting.) It is also important to tell your nurse if you experience any numbness, tingling, or extreme pain in your legs or feet. When your condition is stabilized, you will be transferred to your hospital room.

When you wake up from surgery, you will rest in bed with your bandaged leg slightly raised by a pillow. A tube (called a hemovac) that may have been placed in you during surgery will drain excess fluid to keep swelling down, while an intravenous (IV) line may be used to provide fluids for nourishment, medication to prevent blood clots, and antibiotics to prevent possible infection. You may also have a catheter placed to aid in urination. To relieve pain, you can be attached to a special device that will allow you to get pain medication when you feel it is necessary.

At first, you will be restricted to ice chips and clear liquids, but your diet will be allowed to progress as your condition permits. Meanwhile, the surgeon and physical therapist will work together to set movement guidelines for you. The physical therapist may also recommend some gentle exercises that will help strengthen your new knee.

After total knee replacement surgery, it takes only a few months to regain strength and confidence in your new knee. With the help of your orthopedist and physical therapist, activities that you were not able to do before surgery can be enjoyable again.

Understanding Hip Pain

Your hip is a simple ball and socket joint, where your thigh bone joins with your pelvis. Surrounded by cartilage, muscles, and ligaments, your hip is one of your largest weight bearing joints in your body. Smooth cartilage and bone help you walk easily and without pain.

In a healthy hip, smooth cartilage covers the ends of your hip bones allowing the ball to glide easily in the socket. Smooth weight bearing surfaces allow for painless movement.

In a problem hip, the cartilage wears away and the bones rub together, becoming rough and pitted. The ball grinds in the socket when you walk, resulting in pain and stiffness.

Your damaged hip joint can be replaced with new, smoothly surfaced components. A ball will replace the worn head of your thigh bone, with a stem inserted into the bone for stability. A cup will replace the worn socket. Like a healthy hip, your prosthesis has a smooth gliding surface that will allow you to move with ease and without pain. Unlike your healthy hip, however, your prosthesis has a limited range of motion, and will need your special care after surgery.

Symptoms

Hip replacement is usually performed to treat severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or aseptic necrosis. Most patients who have artificial hips are over the age of 55, but the operation is occasionally performed on younger patents as well. Circumstances vary, but generally patients are considered for hip replacements if:

• Pain is severe enough to restrict work, recreation, and the ordinary daily activities.
• Pain is not relieved by anti-inflammatory medicine, the use of a cane, and other restricting devices.
• There is a significant stiffness of the hip.
• X-rays show advanced arthritis or other hip problems

Treatments

When dealing with hip pain you would first start off with non-surgical procedures to help the pain. These normally don’t fix the problem but most likely with provide pain relief for a short period of time. Some non-surgical options are:

• Rest (Ice, Compression, Elevation, Braces)
• Physical Therapy
• Walking Aids
• Pain relievers
• Cortisone Shot

After attempting the non-surgical approach and if you have not experienced results you may want to ask your doctor about hip replacement.

Why BioPro Hip Implants?

BioPro offers a variety of different implant solutions for hip replacement. The implants were designed by Dr Charles Townley, following his principles of “Design by Reason”. BioPro hip stems all incorporate a collared design, which helps preserve bone quality around the implant.

What to expect during and after surgery

Hip replacement is one of the most common forms of total joint replacement. To begin the surgical procedure, the patient will be given an anesthetic (usually a spinal unless contraindicated). The surgeon will then make an incision and prepare the hip bone for implantation of the prostheses. The surgeon will remove the rough surfaces of the bone at the joint and replace them with new smoothly surfaced implants.

Like the human hip, this artificial joint is composed of three components that fit together to form a ball and socket joint. The components of the prosthesis are the ball, stem, and cup. The ball will replace the worn upper end of the femur, while the cup will replace the worn socket in the pelvis. The stem will be inserted into the bone for stability. These components are implanted separately and then brought together. In some cases, after the incision is closed, a small tube (called a hemovac) is inserted to help drain fluids from the hip joint area for the first day or so following surgery.

Complications of Hip Replacement Surgery

Most complications that occur after hip replacement are successfully treatable. Possible complications after knee replacement include:

Infections: Any infection in your body can spread to your joint replacement. Infections may occur while you are in the hospital of after you go home. Minor infections can be treated with antibiotics, while major infections may require surgery and removal of the prosthesis.

Blood Clots: If there is a severe pain and / or swelling that develops in your calf or thigh, you may have developed a blood clot. Blood clots result from several factors, including decreased mobility that causes slow movement of blood through your leg’s veins. Your doctor may take preventative action to reduce the possibility of blood clots, such as blood thinning medications, elastic stockings, exercises that increase the blood flow in the leg muscles, or plastic boots that inflate with air to compress the muscles in your legs.

Loosening: Loosening of the prosthesis within the bone may occur after hip replacement. If the loosening is significant and there is a large amount of pain, a revision surgery to correct the loosening may be necessary.

Dislocation: Occasionally, after total hip replacement, the ball can be dislodged from the socket. In most cases, the hip can be relocated without surgery. A brace may be worn for a period of time if a dislocation occurs.

Wear: Wear occurs in all joint replacements. However, excessive wear can lead to loosening and pain and may require revision surgery.

Prosthetic Breakage: Breakage of a hip replacement is extremely rare, but it can occur. If this case does occur, a revision surgery will be needed.

Nerve Injury: Nerves in the vicinity of the total joint replacement can be damaged during the total replacement surgery. This type of injury is not common and may often improve and/or completely recover after some time.

Notify your surgeon or nurse if you experience any of the following symptoms:

1. Pain, soreness, swelling, or redness in the calf muscles of either leg.
2. Unexplained, increased pain in the operative area.
3. Redness, swelling, or puslike drainage from the area around the incision
4. Cough, high fever, or chills.
5. Chest pain, shortness of breath, or difficulty breathing.

What to expect after surgery

After surgery, you will be taken to the Recovery Room for a period of close observation. Your blood pressure, pulse, and temperature will be monitored and close attention will be paid to the circulation and sensation in your legs and feet. Post operatively, you may have temporary nausea and vomiting due to anesthesia or medications. (Anti-nausea medication may be given to you when you are in your room to minimize nausea and vomiting.) It is also important to tell your nurse if you experience any numbness, tingling, or extreme pain in your legs or feet. When your condition is stabilized, you will be transferred to your hospital room.

A tube (called a hemovac) that may have been placed in you during surgery will drain excess fluid to keep swelling down, while an intravenous (IV) line may be used to provide fluids for nourishment, medication to prevent blood clots, and antibiotics to prevent possible infection. You may also have a catheter placed to aid in urination. To relieve pain, you can be attached to a special device that will allow you to get pain medication when you feel it is necessary.

Despite the back discomfort that some patients experience after surgery (caused by the soreness of the hip area and prolonged lack of movement), you must remember a few precautions to prevent dislocations:

1) The head of your hospital bed should not be elevated more than 70 degrees during the first few days after surgery.

2) Use a high-rise toilet.

3) Use 2-3 pillows between your legs.

4) Do not cross your legs or bend them forward 90 degrees.

At first, you will be restricted to ice chips and clear liquids, but your diet will be allowed to progress as your condition permits. Meanwhile, the surgeon and physical therapist will work together to set movement guidelines for you. The physical therapist will continue to check the strength and flexibility in your leg and hip, and your ability to stand and sit. The physical therapist may also recommend some gentle exercises that will help strengthen and increase your new hip’s range of motion.

After total hip replacement surgery, it takes only a few months to regain strength and confidence in your new hip. With the help of your orthopedist and physical therapist, activities that you were not able to do before surgery can be enjoyable again.

Hospital Recovery and Rehabilitation After Hip Replacement

Exercises will begin as soon as possible to help strengthen your leg muscles and increase your ability to bend your knee. Your balance may seem unsteady at first, but will improve as you progress with walking.

During your recovery period in the hospital, your recovery team’s goals are to minimize any swelling or pain caused by the surgery, and to start your gentle physical therapy exercises. Your physical therapist will initially teach you exercises that will increase your circulation and will then continue to teach you exercises that will improve your strength and increase your endurance so you can recover more quickly. Your therapist will finally teach you how to properly get out of bed, stand, sit, and walk, so you will be able to do these activities safely on your own.

Understanding Hammertoes

An abnormal bending of the 2nd, 3rd, 4th, and/or even the 5th joint in between the phalanges is known as a hammertoe. The most common cause is due to a muscle and/or tendon imbalance due to abnormal mechanics of the foot along with congenital factors. There are two types of hammertoes:

• Flexible hammertoes: movement is still possible at the joint. This is a milder condition and there are several treatments for this condition
• Rigid hammertoes: the tendons become rigid and the toe can no longer be moved. This usually means surgery is needed.

Symptoms

Common symptoms of hammertoes are:

• Abnormal bending of the toe
• Pain or irritation
• Forming of corns and calluses (build up of skin).

Treatments

There are always non-operative alternatives for hammertoes such as:

• Shoe modifications
• Splinting of the toe
• Padding or trimming corns and calluses
• Exercises or therapy
• Medications

When non-operative solutions are no longer able to control the pain and disability to your satisfaction, surgery becomes a reasonable option. Surgical options include:

Joint Fusion (arthrodesis) – The cartilage surfaces of the joint are removed and a device such as a screw is utilized to prevent motion. The bones eventually grow together which prevents pain; however, a loss of function occurs as the joint will no longer bend.

Phalangeal head resection (arthroplasty) – a portion of the phalanx is removed, releasing tension on the tendons. This may be done in conjunction with or without some type of implant. Advantages include retaining motion, but may be accompanied by a flail toe and loss of stability.

Tendon Transfers – the tendons that are too tight may be cut or transferred to relieve the tension and allow the toe to straighten. While this allows motion to be retained, like the head resection it can lead to a flail toe or loss of stability.

Why the BioPro Digital Compression Screw?

The Digital Compression Screw is used to fuse the joint, permanently straightening it. Unlike some other options, it provides compressive forces across the bones, which speed the fusion process. The screw is also buried beneath the skin, allowing the patient to wash their feet with no exposed wires, eliminating the potential for pin track infections. The Digital Compression Screw is also easily removed. Some devices permanently remain within the bone and require very invasive surgeries if removal is necessary.

What to expect during and after hammertoe surgery

The goal of the surgeon is to restore normal alignment of the joint and eliminate pain by fusing the joint. A Digital Compression Screw is inserted into the tip of the toe and compresses the bones together, speeding the fusion process. The screw typically stays in for 6-8 weeks while the bones heal, after which it is removed.

Varying degrees of hammertoe deformities with severe contracture and/or displacement on the metatarsal heads may require your surgeon to perform additional procedures in conjunction with the hammertoe repair. These may include metatarsal osteotomies or tendon transfers to maintain toe purchase after fusion.

Most patients have a rapid recovery and have considerably less pain than they did before surgery. Weight-bearing is only allowed while wearing a stiff soled post-operative shoe until the screw is removed.

Understanding Flatfoot

Flatfoot is a condition where the arch on the inside border of the foot is flat rather than raised causing the foot and toe to turn out and the ankle to roll inward. Although there are several types of flatfoot, such as rigid and flexible flatfoot, they both have a common factor: partial or complete loss of the arch. The posterior tibial tendon serves as one of the major supporting structures of the arch. This tendon descends the leg, runs along the inside of the ankle, and down the side of the foot. When it overstretches or becomes inflamed, it often results in the flattening of the foot known as posterior tibial tendon dysfunction (PTTD). Health factors such as obesity, diabetes, and rheumatoid arthritis may increase the risk of developing flatfoot.

The term “flexible” means that the foot is flat when standing and returns to a normal arch in non- weight bearing positions.

The term “rigid” means that the arch stays flat or collapses even without weight pressure.

Symptoms

Common symptoms of flatfoot are:

• Ankle turned inward
• Weakness/fatigue felt in the foot or leg
• Pain felt in the shin
• Pain in the heel, arch, ankle, or along the outside of the foot

Treatments

Before considering surgery, there are always non-operative treatments such as:

• Shoe modifications
• Orthotic devices
• Medications
• Immobilization
• Physical therapy

Custom orthotics, arch supports prescribed by a foot and ankle specialist, are made individually for each patient and can be helpful in reliving symptoms. Each custom orthotic is specifically made from an impression of the patient’s foot. Long-term arch support with a reduction in symptoms is the main goal of custom orthotics.

When non-operative solutions are no longer able to control the pain and disability, surgery becomes a reasonable option. Surgical options include:

Arthroereisis – An implant is inserted within the sinus tarsi, which is the opening on the outside of the foot in between the ankle and heel bone. This restricts excessive joint rotation outward and creates an arch in the foot.

Arthrodesis (Fusion) – The cartilage surfaces of the joint are removed and a device such as a screw, plate, staple, etc. is utilized to prevent motion. The bones eventually fuse together which prevents pain; however, a loss of function occurs as the joint no longer functions. With this loss of function, your gait, or way of walking may change, which may affect other joints such as knees, hips, spine, etc.

Osteotomy – The bones are cut and reshaped to correct alignment.

Why the Subtalar Implant?

What the BioPro® Subtalar implant offers to the patient:

The BioPro® Horizon Subtalar implant acts as an internal orthotic, similar to wearing an orthotic within your shoe. The implant blocks excessive joint motion, maintaining the arch in your foot. The BioPro implant is designed with a smooth surface for your bones to rest against. This helps prevent any inflammation or bone erosion that is sometimes associated with this type of procedure.

The surgical procedure for the BioPro® Horizon Subtalar Implant usually lasts about 15 minutes. Before leaving, your surgeon is urged to also take an overhead X-ray to insure that the placement of the internal orthotic is correct.

Most patients have a quick recovery and are walking the same day of surgery or the following day. Patients may also require the use of a walking boot to help provide support to the operated area.

Other information:
Please note: the benefits of short surgery time and recovery are related to the arthroeresis procedure using the BiopPro® Horizon Subtalar Implant only. Often times, this is done in conjunction with other procedures. If you are having more than one surgery, you must follow your surgeon’s prescribed post operative protocol after surgery.

What to expect after flatfoot surgery

After surgery the surgical site should remain numb for approximately six to eight hours. It is important during your recovery to elevate your foot. The application of ice to the surgical site is another effective post-op tool that will aid in minimizing inflammation and pain. Within 10 days of your surgery you should return to your physician for a post-op visit. Between 4 to 6 weeks patients usually return to the majority of their daily activities. After 2 to 3 months, minimal soreness may still be present in some patients and may be reduced by applying ice.

Understanding Bunions

Bunions (hallux valgus) are a common foot problem involving the formation of a bump at the base of the big toe joint (first metatarsal joint). Bunions often lead to pain, swelling, and tenderness of the affected area. Sometimes, bunions can form on the outside base of the little toe. These are called a tailor’s bunion or bunionettes.

Bunions are found in people of all ages and genders. However, some people are more likely to get bunions than others, including:

• Women
• The elderly
• People with a family history of bunions

Bunions occur in approximately 30% of women and 13% of men. They are found in 23% of adults ages 18 to 65 and over 35% of adults over the age of 65. Bunions are more likely to develop with advancing age. However, bunions have been reported in children as young as 5 or 6 years of age. Bunions in young children can get worse throughout childhood and adolescence and are highly linked to a family history of the condition. Bunions can be very painful and can get worse if left untreated.

Symptoms

The symptoms caused by bunions vary from person to person, and can include:

• The appearance of a bump on the base of the big toe joint
• Pain in or around the big toe joint, often described as a dull ache with some shooting pains
• Reddening and/or inflammation of the bump from pressure and rubbing of the area
• Pain when moving the big toe joint Formation of blisters and/or calluses in and around the first and second toes
• Dull or sharp pain in the ball of the foot, especially in the center and spreading outward
• Pain with walking or when wearing restrictive shoes

Over time, symptoms can worsen and include:

• A shift of the big toe towards the second toe
• Sometimes, this can change the position of the other toes and may even cause the toes to lie on top of one another
• Arthritis of the big toe joint A stress fracture
• Difficulty walking and finding comfortable shoes

The symptoms associated with bunions can vary from person to person. In fact, the worst bunions do not always cause the most severe symptoms. Furthermore, the wrong shoes and too much activity can causes symptoms to worsen. Once symptoms are felt, they generally get worse and the bunion must be treated.

Treatments

Non-Surgical Treatments for Bunions

Non-surgical treatment is a good way to reduce the pain and other symptoms associated with bunions, but these therapies will not cure or eliminate bunions. The success of non-surgical treatments often depends on the severity of the symptoms and how long the bunion has been present. Using non-surgical treatments early is important for preventing the development of more severe complications. If bunions are treated early, they can be managed and more serious interventions, such as surgery, may not be needed.

Wearing comfortable and supportive shoes is the first step in helping to relieve pain and other symptoms associated with bunions. Good choices for shoes may include:

• A stretchable, breathable slip-on or tie type shoe
• A shoe with good arch support and a wide toe box
• A shoe that fits well and conforms to the shape of the foot
• A shoe with a rigid heel counter

Custom orthotics, which are arch supports prescribed by a foot and ankle specialist, are made individually for each patient and can be helpful in relieving symptoms. Each custom orthotic is specifically made from an impression of the patient’s foot. Many modifications can be made depending on how bad the bunion is. Long-term arch support with a reduction in symptoms is the main goal of custom orthotics.

Surgical Treatments for Bunions 

Surgical correction for bunions may be recommended by a foot and ankle specialist. There are many effective surgical options available and the type of procedure selected is based on the needs of the patient and the current condition of the bunion. Before undergoing any procedure, it is important to have realistic goals and expectations about the surgery and the rehabilitation process, and to talk about the procedure with a foot and ankle specialist.

General goals for surgery:

• Remove the bump on the big toe joint
• Straighten the joint as much as possible
• Provide greater range of motion

How does the BioPro Accu-Cut Guides Help?

Bunionectomies, the cutting of the first metatarsal, are traditionally done free hand. The Accu-Cut® Guide is available for a large variety of procedures and guide the blades to ensure the most precise cuts possible. This in turn ensures that the bone surfaces match up as closely as possible, helping speed bone healing time.

What to expect during and after bunion surgery?

Bunions can be categorized as simple, moderate or severe which will require different selective procedures, decided on by your surgeon. Surgery is typically not recommended only for improving the look of the foot. For a very minor bunion with bump pain, a foot and ankle specialist may recommend a simple shaving of the painful bump with or without soft tissue removal. However, this is not the way most bunions are corrected.

Bunion surgery commonly involves cutting the first metatarsal and shaving off the bony bump of the big toe joint. This is commonly referred to as a bunionectomy or an osteotomy. Once the metatarsal is cut, it is realigned into its appropriate position and is secured with screws or some other fixation device. The screws usually stay in the foot permanently, but may be removed once the bone fully heals.

Bunion surgery may be completed under local, spinal, or general anesthesia, depending on your surgeons preference.

Recovery and Rehabilitation for Bunion Surgery

What to expect after surgery:

• There will be some pain after surgery
• Wearing of a specialized postoperative shoe
• There may be periodic swelling on or near the site of the bunion for 6-12 months
• Physical therapy may be recommended
• Long-term use of non-surgical devices, such as orthotics, and therapy is often recommended to prevent bunions from returning

Recovery time depends on the type of surgery that is performed and may vary from patient to patient. For example, recovery after a traditional bunionectomy will typically take longer than recovery after a simple shaving procedure. In most cases, a surgical shoe or walking boot is recommended after surgery. This allows the patient to return to normal activities sooner while still protecting the foot. If a cast is required, crutches, a walker, or a wheelchair may be used to assist in non-weight bearing of the recovering foot.

A physician is able to track bone healing through physical evaluations and by using x-rays. As a general rule, the patient can be more active and return to wearing normal shoes once the bone has fully healed. Even once the bone has healed, the patient may experience mild to moderate swelling and may need ongoing physical therapy and non-surgical treatment.