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What To Expect When You're Expecting...Bunion Surgery!!
Most bunion surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.
Academy Foot & Ankle Specialists' Hospital Affiliations
- Texas Health Harris Methodist Hospital Southlake
- Forest Park Medical Center Southlake
- Baylor Medical Center of Grapevine
- Calloway Creek Surgery Center
- Texas Health Presbyterian Hospital Flower Mound
- Victory Medical Center Hurst
Prior to the surgery, patients will need to make some preparatory arrangements. These include:
- Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to the surgeon.
- Arranging your schedule to make sure you don't need to take any long trips for at least two to three weeks following the surgery.
- Lining up another person to drive you home and stay with you for the first 24-48 hours after the surgery.
- Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.
- Further clearance may be needed by a specialist (i.e Cardiac Clearance) as well. Your surgeon will let you know what is needed at the time of your surgical consultation.
The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.
Day of Surgery: Day 1
The surgery is performed on this day. The hospital will let you know what time they would like you to be there and how long it will take. Prior arrangements for transportation home after the surgery must be made.
The patient leaves the facility walking with special surgical walking boot or splint (to be used at all times). It will be provided for the patient at the pre operative visit in the doctor’s office prior to surgery. A presciption for crutches or a walker will be given if needed. There is no cast on the foot, only a soft gauze dressing. The dressing must stay dry and should not be changed until the first post-op office visit.
The application of a ice machine or ice packs to the foot is important. If using ice machine the hospital will fill the machine the first time and you will add ice as needed. The pad will remain on your foot and you will turn on for 1 hour and off for 1 hour except for night time where you will fill the cooler halfway full, turn on low setting, and leave on for the night.
If using ice packs be careful to make sure the foot does not get wet. Apply a towel around the ice pack to absorb any condensation from the ice. New ice packs should be applied about four times each day, for the first 3 or 4 days.
The patient may ambulate for short distances within the home or to a car during this period, using the surgical walking boot.
It is equally important during this time to keep the foot elevated to the level of the waist.
Those patients that elevate their foot and apply the ice packs report minimal post-operative pain, experience the least amount of swelling and require the least amount of pain medication. Ice and elevation is VERY important. The reduction of foot swelling during this period will have a significant effect on the entire recovery process. The #1 complaint after foot surgery is swelling.
First Post-Operative Visit: Day 3 -7
The patient comes to the office. The sutures (stitches) are NOT removed at this visit. Only the bandages are changed and an unna boot is applied (soft cast) for edema control.
Pain Pump will be removed.
It is normal to see mild bruising and some dry blood on the foot.
The patient continues to wear the same walking boot, with limited ambulation. Some patients are recommended to be non-weight bearing the doctor will let you know.
It is extremely important to limit ambulation (standing, walking) during the first two weeks, as it will cause increased foot swelling and a delay in healing.
Second Post-Operative Visit: Day 14
The patient comes to the office, where the dressings are removed and based on the rate of healing the sutures maybe removed. Removal of the sutures is only minimally uncomfortable.
Post-operative x-rays may be taken.
An Unna boot (soft cast) will be applied. The patient may remove that dressing in 24-48 hours. They may then begin getting the foot wet as usual. Do NOT soak the foot in any hot tubs, bathtubs, swimming pools, lakes, rivers, etc.
The doctor may also recommend a special compression sock (to help with swelling), and/or a toe alignment splint.
If sutures are removed a prescription scar cream or scar cream recommendation will be given (to improve the scar appearance and reduce painful or raised scars).
You will continue the use of the ice machine or icing (to help with swelling and any discomfort).
A TENS unit (for inflammation and pain)may be dispensed or used by Physical Therapy.
Range of motion exercise as well as physical therapy is typically begun at this visit; (it is very important to regain joint motion/mobility and break up scar tissue).
Continue to limit your activities.
Third Post-Operative Visit: Week Four
Post-operative x-rays are taken.
You will be seen in the office to evaluate your healing and ambulation.
Depending on the type of procedure and current healing the doctor may allow you to transition into sneaker or hard/thick soled shoe (no barefoot or flip flops).
The comfort levels will vary. Do not push yourself. A larger than normal shoe may be needed due to moderate foot swelling which is normal at this time.
Fourth Post-Operative Visit: Week Eight
Post-operative x-rays are taken.
You may be able to return to regular shoes.
Custom molded orthotics maybe recommended at this time.
Most low-impact exercises are performed to about 80% of their usual level.
Fifth Post-Operative Visit: Week Twelve
Postoperative x-rays are taken.
You may return to your normal activity level.
One year Post-Operative Visit
Postoperative x-rays are taken.
NOTE: THE ABOVE GUIDELINES MAY VARY FROM PATIENT TO PATIENT. INDIVIDUAL PATIENTS WILL VARY IN THEIR EXPERIENCES. WAIT FOR THE DOCTOR TO APPROVE EACH OF THE CHANGES ON THIS LIST.
Bunions are among the most common type of foot ailment today's podiatrist treats, especially in women. Studies show that women are anywhere from two to nine times more likely to develop a bunion than men! While your high heels and peep toes are partially to blame for your pain, your foot type (passed down through your family) is the true culprit.
Here's the good news! The Foot and Ankle Surgeons at Academy Foot and Ankle Specialists are true experts when it comes to diagnosing and treating bunions. Podiatrists perform tens of thousands of bunion procedures every year, more than any other medical professional in the United States.
Fortunately, we are only a click away! The doctors at Academy are uniquely qualified among medical professionals to treat bunions, based on their education, training, and experience. If you suspect a bunion, contact one of our Foot and Ankle Specialists and beat bunion blues!
'Tis the season for icy weather. And with icy weather, comes icy roads and sidewalks. If you're not careful, it could be the season for an ankle fracture! These types of fractures are very common when the conditions outside get slippery!
A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken. Twisting or rotating the ankle, rolling the ankle, tripping or falling, or direct trauma, as in a car accident, can cause these fractures.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require surgery and that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.
According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.
There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.
Symptoms of a broken ankle include:
- Immediate and severe pain.
- Inability to put any weight on the injured foot.
- Tenderness to the touch.
- Deformity, particularly if there is a dislocation or a fracture.
The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.
Many people underestimate the importance of keeping their toes physically fit. Toes take a lot of abuse from the hours we spend on our feet each day. The American Orthopaedic Foot and Ankle Society recommends doing the following simple exercises to strengthen your toes and prevent foot discomfort.
These foot workouts work great to strengthen the feet and toes to prevent fatigue and cramping.
Toe raise, toe point, toe curl: Hold each position for five seconds and repeat 10 times. This especially recommended for people with hammertoes or toe cramps.
Toe squeeze: Place a small, cylindrical object, such as a wine cork, between your toes and hold a squeeze for five seconds. Do this 10 times. Recommended for people with hammertoes and toe cramps.
Big toe pulls: Place a thick rubber band around the big toes and pull them away from each other and toward the small toes. Hold for five seconds and repeat 10 times. Recommended for people with bunions or toe cramps.
Toe pulls: Put a thick rubber band around all of your toes and spread them. Hold this position for five seconds and repeat 10 times. This is especially good for people with bunions, hammertoes or toe cramps
Golf ball roll: Roll a golf ball under the ball of your foot for two minutes. This is a great massage for the bottom of the foot and is recommended for people with plantar fasciitis, arch strain, or foot cramps.
Towel curls: Place a small towel on the floor and curl it toward you, using only your toes. You can increase the resistance by putting a weight on the end of the towel. Relax and repeat this exercise five times. Recommended for people with hammertoes, toe cramps, and pain in the ball of the foot.
Marble pick-up: Place 20 marbles on the floor. Pick up one marble at a time and put it in a small bowl. Do this exercise until you have picked up all 20 marbles. Recommended for people with pain in the ball of the foot, hammertoes, and toe cramps.
Sand walking: Take off your shoes and walk in the sand at the beach. This not only massages your feet, but also strengthens your toes and is good for general foot conditioning.
The Common Denominator
Foot and Ankle Specialists see a vast variety of foot and ankle pathology. Dr. Sara Suttle and Dr. Paul Marciano are Foot and Ankle Surgeons in Southlake, TX. They treat everything from Bunions and Plantar Fasciitis, to Hammertoes and Achilles’ Tendinitis. But all of these conditions have something in common. Patients that suffer from each of these ailments, and many more, all have a Common Denominator: A tight Achilles’ tendon.
A tight Achilles’ tendon, or Equinus, is the root cause behind the majority of foot and ankle conditions. The ankle joint requires 10-15 degrees of flexion for normal ambulation. When a tight Achilles’ tendon limits this flexion, the foot has to flatten out to compensate for this lack of motion.
What is Equinus?
Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.
People with equinus develop ways to "compensate" for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by "toe walking," while a smaller number take steps by bending abnormally at the hip or knee.
Foot Problems Related to Equinus
Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:
• Plantar fasciitis (arch/heel pain)
• Calf cramping
• Tendonitis (inflammation in the Achilles tendon)
• Metatarsalgia (pain and/or callusing on the ball of the foot)
• Arthritis of the midfoot (middle area of the foot)
• Pressure sores on the ball of the foot or the arch
• Ankle pain
• Shin splints
Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus.
To diagnose equinus, the foot and ankle surgeon will evaluate the ankle's range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight and to assess whether bone is interfering with ankle motion. X-rays may also be ordered. In some cases, the foot and ankle surgeon may refer the patient for neurologic evaluation.
Although treatment for each of the above-mentioned conditions is different, treating the underlying problem, the equinus, is always necessary. This can be done conservatively, by stretching and Physical Therapy or surgically, by different lengthening techniques.
This article will touch on a few of the most common foot and ankle ailments and how a tight Achilles’ tendon perpetuates them.
Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present.
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying cause-equinus- that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching the Achilles’ tendon, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.
Other characteristics shared by most types of flatfoot include:
“Toe drift,” in which the toes and front part of the foot point outward
The heel tilts toward the outside and the ankle appears to turn in
A tight Achilles’ tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse
Bunions and hammertoes may develop as a result of a flatfoot.
A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. This foot type includes a tight Achilles’ tendon, or Equinus.
Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
The most common cause of hammertoe is a muscle/tendon imbalance. It is this imbalance, which leads to a bending of the toe. This imbalance is from a tight posterior group, including the Achilles’ tendon.
The treatments of these conditions vary greatly. Management ranges from conservative to surgical correction of the deformity. Only your Foot and Ankle Specialist can determine the cause of your condition and the appropriate treatment regimen. Contact Dr. Paul Marciano or Dr. Sara Suttle at Academy Foot and Ankle Specialists if you suffer from foot or ankle pain. After a complete evaluation, they will formulate a treatment plan best suited for your condition to get you back on your feet!
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