An osteotomy is a procedure which involves cutting and realigning bone. In bunion surgery it is the most common type of procedure used. The operation is carried out usually as a day-case procedure without the need to stay in hospital overnight. There are many types of osteotomy procedures. However, in simple terms an osteotomy involves the following;
Initially the foot is washed with antiseptic.
- A tight band called a tourniquet is applied to the ankle to keep the blood out of the foot during the procedure.
- An incision is made along the side of the big toe joint.
- The surgeon will cut away the bony bump on the joint.
- The surgeon will then cut and realign the two main bones which form the big toe joint. This will straighten and eliminate the bunion.
- It may also be necessary to release or lengthen the ligaments and tendons around the big toe joint to help maintain the new corrected position.
- The two small (sesamoid) bones that are abnormally displaced by the bunion are then realigned underneath the joint.
- Screws and pins or a plate (internal fixation) are then inserted into the bones to hold them in the corrected position and allow quicker healing and weight-bearing following surgery. These may need to be removed at a later stage as they sometimes work loose (but this is nothing to be concerned about).
- The wound will be then be stitched with absorbable sutures in the deep wound and stitches in the skin, which are removed at around 2-weeks.
- A large padded dressing and bandage is then applied for protection. Occasionally a cast is applied or a walker-boot is used to assist with walking.
- The procedure takes on average 30-60 minutes depending upon the type and extent of surgery needed to rectify the problem. Depending on whether you have had a local anesthetic, sedation or general anaesthetic, you will be allowed home between 1-3 hours after surgery.
Modified Lapidus Procedure
This operation involves fixing (fusing) the joint at the base of the 1st metatarsal (not the big toe joint). This is undertaken using plate and screw fixation with the latest titanium locking plates, which allows immediate post-operative weight-bearing. It is used for patients with very large bunions, especially when there is a high v-shaped angle between the 1st and 2nd metatarsal bones. It is also used when there is arthritis in that joint, instability, hypemobility, or joint laxity, which can be a factor for why some bunions recur after surgery. It is combined with removal of the bump on the side of the joint and also with an (“Akin”) osteotomy to realign the big toe into a natural position. See x-rays (which also shows wires in the 2nd toe for hammertoe repair). The scar for this is slightly longer as is the total recovery period. A walker-boot is required for the 1st 4-6 weeks following the surgery.