silver`s and akin`s bunionectomy

 PODIATRIC SURGERY INFORMATION GUIDE BUNIONS: SILVER’S AND AKIN’S BUNIONECTOMY Before surgery Surgery After surgery ABOUT YOUR OPERATION: •
A ‘Silver’s bunionectomy’ is an operation in which only the prominent bony bump on the 1st metatarsal is removed. •
In some cases an ‘Akins’ osteotomy is combined with the ‘bunionectomy’ to make the big toe straighter. •
An ‘Akins’ osteotomy is where a wedge of bone is removed from the big toe bone (proximal phalanx). It is therefore common for this type of surgery to shorten the big toe slightly. •
The operation does not aim to correct the underlying first metatarsal bony position which is part of the cause of the bunion; hence there is a good chance that the bunion bump will return over time. •
This type of surgery is an option in cases where the metatarsal bone is not strong enough to withstand being broken (such as advanced osteoporosis), in cases where a long recovery after surgery may cause problems (such as with advanced age), or in cases when the bump and irritation of the big toe against the smaller second toe are the only problems. •
Throughout the operation you will have a tight band (called a tourniquet) around the ankle to keep the blood away from your foot. This is sometimes uncomfortable but is released immediately after the operation. •
The skin layers are stitched together with stitches that dissolve. Occasionally, if your skin is very sensitive, or you are prone to problem scarring you may need stitches that need to be removed at 2 weeks. www.totalfootcaresolutions.co.uk 1
RECOVERY AFTER YOUR OPERATION: The first 2-­‐3 days • You must rest with your foot elevated just above hip level. • You will be given advice on how to keep the foot as comfortable as possible and exercises to keep the blood circulating during your recovery. • You should restrict your walking to the bathroom only, and must use crutches in the way shown. You may be able to bear a little weight on the foot carefully using just the heel. • If you experience pain, it is usually worst for the first 2 days. You will be given pain killing tablets to help control this. After 2-­‐3 days this should begin to improve. • An X-­‐ray will be needed before you return for your 2 week review appointment. You will be advised where to go for this. Two weeks after surgery • Two weeks after the operation you must attend for removal of the dressing. • The skin should be healing well by this time and any non-­‐dissolvable stitches will be removed. Your X-­‐ray will be examined. • You should no longer need a bandage and will be able to wear a normal shoe again. But this shoe does need to be roomy (ideally a trainer) because your foot will be quite swollen. • At this stage you will no longer need crutches and can gradually increase your activities gently. You will still need to rest between your activities. • You will also be given a rigorous regime of exercises in order to regain strength and flexibility in the toe joint. Between 2 and 8 weeks after surgery • You can normally start bathing the foot once again 3 days following stitch removal. • During this time the foot gradually returns to normal and you may be able to vary your footwear a little, (60% of patients have returned to roomy shoes at 6 weeks, and 90% by 8 weeks). • There will still be noticeable swelling especially towards the end of the day, which is quite normal at this stage. • WORK: You may return to work after 6 weeks (depending on the type of work and footwear in which you are allowed to return). For certain jobs this could be an unrealistic expectation. • DRIVING: At 6 weeks you can generally return to driving, however you must feel able to perform an emergency stop. (It is worth checking with your insurance company about when you policy covers you to drive). • Although normal everyday activities will be possible, sporting activities are still restricted at this stage. Between 8 and 12 weeks after surgery • The foot should now be comfortable and returning to normal but there may still be some slight swelling. • SPORTS: You can return to sporting activities / gym work at 12 weeks. www.totalfootcaresolutions.co.uk 2
Six to twelve months after surgery • The residual swelling should now be very slight, although the healing process continues for a year. You should be getting full benefit from the surgery. • All healing is complete at 12 months. SERIOUS AND FREQUENTLY OCCURING RISKS Unfortunately all operations carry a small risk of complications. If you have any concerns about the examples of complications given here, please discuss them with your specialist before deciding to have surgery. • Delayed healing of the skin •
Non compliance of patients •
Bone break associated with non compliance •
Intolerance to the medication given for post operative pain •
Prolonged swelling post operatively •
Thick or sensitive scar formation •
Loosening or movement of the screws or wires used to fix the bones •
The toe may not be perfectly straight. •
The toe may become stiff which could affect the heel height of the shoes you wear •
Recurrence of the bunion •
Development of secondary pain or tenderness under the 2nd toe knuckle joint •
Infection of soft tissues and / or bone •
Blood clot in the leg – a deep vein thrombosis •
Chronic pain or so called ‘Complex Regional Pain Syndrome’ You should be aware that these complications are relatively uncommon. They mostly resolve without permanent disability or pain using medications, therapy and on occasions further surgery, but even allowing for these, sometimes you may not achieve the result that you want. If you are considering surgery, please be aware we do not advise patients to undertake air travel until at least 6 weeks post surgery. For these reasons we do NOT advise surgery purely for cosmetic reasons. We also advise against prophylactic surgery (which is preventative surgery to avoid problems that are not yet present). www.totalfootcaresolutions.co.uk 3
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