Bunion Surgery & Treatment in Singapore

Scientifically known as hallux valgus, this condition affects the joint at the base of the big toe. Although commonly referred to as a bunion, the bunion technically refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint. In fact, this condition is actually much more complicated than a mere bump on the side of the big toe. It is interesting to note that hallux valgus rarely ever occurs in societies that tend to go barefoot. This is because pointed shoes, like cowboy boots and high heels, can play a role in the development of this deformity. While it is difficult to eliminate bunions completely, there are a number of treatments that can help lessen the deformity, ranging from wearing broad shoes to having bunion surgery. Here’s all you need to know about bunions before you start therapy.

In this article, we will cover:

• Development of hallux valgus
• Issues this condition causes
• Bunion surgery and other available treatment methods

We will discuss the possible causes of bunions, some common problems that may arise from having bunions, and what you can do to eliminate bunions from your feet in this article. The ways to treat bunions can often be noninvasive, and sometimes, you might not even need bunion surgery to completely eliminate them.

Neat and Precised Incisions with Minimally Invasive Bunion Surgery

What is Bunion Surgery?

Bunion surgery in Singapore often comprises making incisions along the affected portion of the foot to remove or realign the damaged bones and tissues. The operation is performed to reduce inflammation and correct joint alignment. It is specifically aimed to rectify the bone alignment and provide early mobility.

Bilateral Minimally Invasive Bunion surgery X-ray

Do’s and Don’t After the Surgery

As previously stated, wearing pointed shoes may be a contributing factor in the development of bunions. As a result, it’s advised to avoid wearing uncomfortable shoes after bunion surgery. It is also recommended to rest your feet and avoid heavy activity while you’re recuperating. If a cast is necessary to avoid dislocation, your doctor will advise you to acquire one. Following bunion surgery, a special type of shoe should be worn to aid in the regeneration of the afflicted soft tissues.

To learn more about the operation, we will first give an overview of the condition itself.

The scientific name for the big toe or bunion is hallux valgus, in which valgus means that the condition is in a direction that is away from the body. Thus, hallux valgus means that the big toe is pointing away from the foot. In addition, the symptoms of hallux valgus worsen as the condition progresses and may impact mobility. When that happens, the doctor might recommend bunion surgery to correct the bone alignment and restore mobility.

One such symptom of having bunions is metatarsus primus varus. “Metatarsus primus” refers to the first metatarsal – the bone above the big toe – and “varus” means that the condition is in a direction that is away from the body. This means that the first metatarsal develops at too big an angle in the opposite direction of the big toe, which sticks out at the inner edge of the ball of the foot. Due to the pressure of the shoe at that angle, a bunion develops. The hump is first made up of inflamed, swollen tissue that is continually stuck between the shoe and the bone. The bump is first made up of inflamed, swollen tissue that is continually stuck between the shoe and the bone. As time passes, the constant pressure on the bone may lead it to thicken, resulting in an even larger lump.

The majority of foot problems are caused by improper pressure or rubbing. This is because our feet are made up of hard bone and soft tissue, and many symptoms are caused by the skin and soft tissue of the foot becoming trapped between the shoe and the hard bone.

A bump in the bone will aggravate the condition since the skin will produce a callus in response to the persistent pressure and rubbing. At the same time, the soft tissues underneath the skin thicken in response to the pressure. As a result of the pressure, the callus and soft tissues become uncomfortable and inflamed. This pressure must be relieved in order to alleviate pain, necessitating bunion surgery.

Some signs and symptoms of a bunion include:

• soreness, redness or swelling around the joint of the big toe.
• Ongoing pain or one that comes and goes
• Limited movement of their big toe.
• As the condition worsens, the second toe becomes displaced upward and may constantly rub on the shoe

The severe deformity caused can also become a troubling cosmetic issue, especially for women who struggle to find appropriate yet fashionable footwear. Although bunion surgery can help realign the bones around the problematic area, there is no guarantee that the pain will go away. As a result, further measures might be necessary.

Although bunions result from various factors, including genetic predisposition, choosing a pair of well-fitting shoes can help slow their progression. Follow these tips for a good fit:

1. Avoid shoes with narrow, pointed tips, especially if they fit tightly on your toes.
2. Even if you’re familiar with your shoe size, try on several pairs to ensure the best fit, as labelled sizes can vary between brands and styles.
3. Sit, stand, and walk in new shoes before purchasing to ensure no movement or position causes discomfort on your toes.
4. If possible, try on shoes at the end of the day to get a more accurate fit. Our feet will naturally swell throughout the day.

Doctors will start with a thorough physical examination and a review of the patient’s medical history. They will also examine the role of footwear in the development and management of bunions. X-rays can assist the doctor in determining the most appropriate treatment by measuring critical angles formed by the bones in the feet.

Depending on the severity of the bone deformity, your doctor may suggest various treatments for bunions. Here are some of the available treatment in Singapore:

Non-surgical

Adapting footwear to fit the foot is usually the first step in treating hallux valgus since the goal is to relieve the bump of the shoe’s exterior pressure. Subsequently, changing from pointed-toe shoes to shoes with a wider front may help prevent the disease from deteriorating in the early stages. In addition, wider shoes and bunion pads can reduce the pressure caused by rubbing on the shoe. Other devices like toe spacers may also be recommended for splinting the big toe and reversing the deformity.

Bunion Surgery

If the deformity has progressed to the point where special shoes and spacers are no longer effective, bunion surgery may be recommended. Furthermore, many people are unaware that there are many types of bunion surgeries in Singapore depending on the degree of the deformity. Here are some of the surgeries you might encounter:

Bunionectomy

For mild cases, surgery may only be needed to get rid of the bump that makes up the bunion. Known as a bunionectomy, this procedure is carried out by making a tiny incision on the side of the foot, over where the bunion is located. The bump then is taken out using a chisel or a special surgical saw, and the bone’s rough edges are smoothened. Small stitches are used to close the incision to complete this type of bunion surgery.

It is likely that the big toe will also have to be realigned, so an important decision has to be made on whether the metatarsal bone also has to be cut and realigned. This is determined by examining the angle between the first and second metatarsal. Since a normal angle would be around nine or ten degrees, the metatarsal will likely need to be cut and realigned if the angle is thirteen degrees or higher.

Distal Osteotomy

Another form of bunion surgery is a distal osteotomy. The far end of the bone is cut and moved laterally in this operation. This helps to reduce the angle between the bones of the first and second metatarsal. One or two tiny incisions in the foot are usually needed in this procedure. Once the position of the bones has been ideally adjusted, one or several metal pins can be used to hold the osteotomy in the desired place. When the bones heal, usually within three to six weeks after surgery, the metal pins are removed.

Proximal Osteotomy

In a proximal osteotomy, the first metatarsal is cut near the end of the bone. Two to three tiny incisions in the foot are commonly needed for this type of bunion surgery. The bone is realigned and held in position using metal pins until it has healed. Similarly to distal osteotomy, the angle between the first and second metatarsal bones is reduced as a result.

To realign the big toe, the tight structures on the lateral or outer side of the first MTP joint is released in this type of bunion surgery. This also involves the tight joint capsule and the tendon of the adductor hallucis muscle, which tends to pull the big toe in an inward direction. This ensures that the big toe is not pulled out of alignment. As a result, the toe is realigned and the joint capsule on the side of the big toe closest to the second toe is tightened, keeping the toe balanced and straight.

Once the big toe is in an ideal position where it is balanced and straight, small stitches are used to close the incisions. Finally, the foot will be wrapped in a large bandage.

Bunion surgery or not, rehabilitation is important after a bunion treatment. It is important to note that the pain along the affected area rarely goes away even after treatment. Therefore, rehabilitation is crucial to prevent the deformity from returning or worsening.

Non-surgical rehabilitation

Patients with painful bunions should receive four to six physical therapy treatments. To avoid squeezing the metatarsals, shoes with a wider front are recommended. Special pads can be used to cover the bunion, and foot orthotics may be prescribed to support the arch and keep the big toe in its proper alignment.

Patients may be able to walk normally after treatment if they use the proper footwear, but more intensive activity should be avoided for a few weeks. This will give the discomfort and inflammation time to go away.

Treatments can be applied to the affected area to help manage the pain and swelling. Moist heat, soft-tissue massage, and ultrasound are examples of such techniques. Iontophoresis, which uses a low electrical current to deliver anti-inflammatory medications to the sore area, may also be used during some therapy sessions. This procedure is very useful for people who dislike injections.

Post-Bunion Surgery Rehabilitation

It usually takes around eight weeks for the bones and soft tissues to heal after bunion surgery. A cast or a wooden-soled shoe may be used to provide protection for the bones during the healing process. Crutches will likely be needed.

In addition, a dressing or bandage will have to be worn for about a week after the surgery. Stitches are usually removed in 10 to 14 days. For dissolvable sutures, there will be no need to remove the stitches.

X-rays will likely be taken during follow-up visits to observe how the bones have healed, and to determine the effectiveness of the treatment.

_{*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.}