Bunionectomy Orthopaedic Department

Bunionectomy
Orthopaedic Department
Patient Information Leaflet
Originator: Gail Parsons, Jenny Wynn
Date: July 2012
Version: 2
Date for Review: July 2015
DGOH Ref No: DGOH/PIL/00702
Introduction
Welcome to The Dudley Group NHS Foundation Trust. This leaflet
will provide you and your relatives with information about
bunionectomy.
What is a bunion?
A bunion is a painful swelling of the soft tissue, and bone
enlargement over the inside of the ball of the big toe. Often the big
toe will look as if it is bent in towards the other toes or even can lie
across them.
What are the alternatives to surgery?
Painkillers/anti-inflammatory medications
Bunion pads
Orthotics, such as insoles, bunion pads and toe spacers
Modifying your footwear
The benefits of the surgery
Surgery will only usually be recommended if your bunions cause
considerable pain and non-surgical treatment has failed.
Please remember that everybody recovers differently following
surgery so do not worry if you feel tired or weak for several days.
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Useful Websites
Patients Choice NHS
www.nhs.uk
Best treatments clinical evidence/BMJ site
www.clinicalevidence.bmj.com
Royal college of surgeons - patient's information
www.rcseng.ac.uk/patient_information
The success of your surgery will depend on the severity of your
bunions, the type of surgical procedure you have and your ability
and willingness to rest after the operation.
Bunion surgery may be up to 85% successful in people who have
it. However, after you have had surgery, there is no guarantee that
your foot will be perfectly straight or pain free. Surgery may reduce
the flexibility of your big toe joint and you may experience stiffness
in the area where the bunion was. Your toe may also be shorter
than it was before you had surgery.
The procedure
Bunion surgery involves realigning the joint into a better position.
The procedure is usually performed under a general anesthetic so
you are not awake during the operation. It is normally a day case
procedure, which means you will not have to stay overnight in
hospital. You will be informed during your assessment if you
require an overnight stay.
The procedure involves the surgeon making a cut on the inside of
the big toe joint and removing excess bone whilst also repositioning
ligaments and tendons. The joint may be fixed with screws or
wires, which may be dissolvable, or may be removed at a later date
or in some cases, remain in the foot.
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Surgical risks
After surgery, your risk of developing problems is increased if you
have other medical conditions that prevent or slow down the
healing process. For example, problems with wound healing and
infection are more likely if you have diabetes or problems with your
circulation. Smoking is also a risk factor.
These will depend on the type of surgery you have and can
include:
Infection
Deep Vein Thrombosis (DVT)
Stiffness in the joints of your toes
A delay or failure of the bone to heal, or the bone heals in the
wrong position
Pain under the ball of your foot
Damage to the nerves in your foot
Prolonged swelling
The bunion coming back
Complex regional pain syndrome - a condition that causes
long-term (chronic) burning pain in one of the limbs
Pre-operative assessment
Please inform us if you are diabetic, have a cough or cold or have
any kind of infection.
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You must not drive home or go home on public transport. Please
arrange for someone to collect you from the day case unit or ward
Your discharge Nurse will provide you with a letter for your GP, a
sick note (if required) and any medication that you have been
prescribed. You will be given instructions on caring for your wound
site or plaster cast. Your follow up appointment will be sent to you
by post.
Work
It is advisable that you do not return to work until your dressing has
been removed. If you require a medical certificate, please inform
the nursing staff as soon as possible. Manual workers may require
a little longer returning to work.
Wound Care
Please ensure that your wound remains clean and dry.
Contact numbers
If you have any concerns or questions or if there is anything that
you do not understand, please do not hesitate to ask the nursing
staff prior to discharge or contact:
Russells Hall Hospital
Ward B1 01384 456111 ext 4690/4691
Day Surgery Unit 01384 45611 ext 3578/4700
Pre-assessment Unit 01384 456111 ext 1656
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After this period, the foot will be assessed to check the bones have
healed correctly. At which point full weight bearing may be
gradually introduced. Expect some swelling of your foot and ankle.
While you are recovering, you will need to elevate your foot to
reduce the swelling.
You will not usually be able to wear normal shoes until three to four
months after surgery. It is recommended that you wear flat or
low-heeled, wide-fitting shoes. Shoes made from soft leather are
ideal because they will relieve any pressure on the foot.
Immediate advice prior to discharge
Your follow up appointment will be made for you in about 10-14
days for inspection of the wound and removal of stitches.
General advice
You must have a responsible adult to accompany you home
and look after you for 24 hours following a general
anaesthetic
Try to spend a restful evening and maintain a gentle level of
activity, you will probably feel quite drowsy
Do not operate machinery
You must have access to a phone on the day of your surgery
once you return home in case any problems occur
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You must inform us if you are taking any tablets as some of these
may need to be stopped for a short period of time prior to the
procedure.
Information for females - We will need to know the start date of
your last menstrual period this is due to the use of x-ray equipment.
If you think you may be pregnant, please let us know. You may be
asked to undergo some investigations such as:
Blood tests, if you take certain medications
An ECG may be performed depending on your age and
medical history
If you need to be treated as an inpatient you will also need to have
swabs taken for Meticillin Resistant Staphylococcus Aureus
(MRSA). The pre-assessment staff will give you more information
about this.
What to do if you become ill before your
procedure?
It is important that you inform the day case unit /ward or
pre-assessment unit if you are not well enough to attend for the
procedure.
For example any type of infection such as a cough or cold, or chest
infection. Any skin problems such as rashes, abrasions cuts or
infection.
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What you will need to bring into hospital
After the procedure
Please bring a dressing gown, slippers and any medication you are
currently taking. If you require an overnight stay, please bring night
wear and an overnight bag with toiletries etc.
Your blood pressure and pulse will be monitored. If you have any
pain, oral pain relief can be given. Please inform a member of the
nursing staff if you have any pain.
What you will not need
Once you have had something to eat and drink you will be allowed
to get up. You will be assessed by the physiotherapist as safe to
use crutches and issued with a surgical shoe to which has a plastic
sole and velcro fastening as you will not be able to wear a shoe for
some time.
Ladies do not wear any make-up or nail varnish to fingers or toes.
We advise you leave all jewellery at home. Wedding rings can be
worn.
You will not be able to eat or drink from midnight the day before
your surgery.
What will happen when I get to the day case
unit or ward
When you arrive you will be shown to your bed and locker where
you can store your personal belongings. A member of staff will
prepare you for your procedure by completing your theatre
checklist. These questions ensure that you understand and are
prepared for your planned procedure. During this checking you will
be informed of the approximate time of your procedure. You will be
asked to undress and put on a theatre gown
Prior to discharge you will be assessed for any numbness and / or
weakness in your foot. We will check that you have passed urine. If
you are comfortable and have recovered from the procedure you
will be allowed to go home so long as there is someone to assist
you for the first 24hours.
After care following surgery
After the operation the foot will be immobilized in a plaster cast or
dressing to keep the bones in the correct position until the bones
have healed. Crutches will usually be issued to help you get about.
The foot is immobilized for 6-12 weeks. You will be given a surgical
shoe that enables you to walk on your heel and protects the wound
area.
You will be escorted to theatre by a member of the theatre team.
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