Tratamento Cirurgia joanete
What is a bunion?
A bunion or Hallux valgus is a deformity of the big toe joint where the big toe moves towards the little toe and the long bone (1st metatarsal) moves away from the little toe. This forms an abnormal angle in the joint causing stress and pain to the joint and soft-tissue around the joint, frequently with periods of joint inflammation. It is very often an inherited problem, but can also be the result of injury or conditions such as rheumatoid arthritis.
The causes of bunion deformity are complex and multifactorial. Footwear certainly plays a role as an exacerbating factor by making the deformity worse. However bunion pain is certainly in the family with 65-80% being hereditary, however, successive generations won't always produce the deformity.
Underlying medical conditions can also play a part, for example with generalized joint laxity (hypermobility) being common in the hallux valgus sufferer. Other rarer conditions such as Marfan's and Ehlers Danlos syndrome can produce remarkable joint laxity resulting in unstable and severe hallux valgus. This "splay foot" type is also seen in the more elderly patient where weakened muscles cause instability of the toes, as does rheumatoid arthritis. Other biomechanical factors such as overpronation or flatfoot, may also play a part, but remain unproven.
Conservative (nonsurgical) Treatment
Medical evidence has demonstrated that this deformity can only be reversed or corrected by surgery. However, some treatments are provided that can help give temporary relief to the symptoms caused by a malaligned big toe joint. For example, if the joint is very inflammed, an injection of cortisone (steroid) helps to temporarily reduce pain and inflammation in around 50% of cases. Changing your footwear to accommodate the wider forefoot, can also help to reduce pressure on the joint. Some clinicians believe in prescribing orthoses (insoles) for hallux valgus, although one large PhD study found that the orthoses made the problem worse in children.
Bunion surgery is one of the most common procedures carried out on the foot. The techniques we use are tried and tested and have a high success rate (~93%), and a much lower complication rate, such as reducing the incidence of vein clots and joint stiffness. They also reduce the need for time off work, with many patients being able to return after 2-weeks.
The procedure takes between 30 and 40 minutes depending on the severity of the condition.
The surgery can be carried out either under local anaestheic and sedation or full general anaestheic and be allowed to go home on the same day.
In simple terms an incision is made along the side of your foot (to make the scar less obvious). Because this is a bony deformity, the big toe joint is anatomically realigned by cutting and sliding the bones into the corrected position. They are then held in the new corrected position by using special bone screws, pins or plates. The foot is then stitched and a heavy protective bandage is applied for the first week . A post operative shoe will also be provided .
Your first checkup appointment will be around 7-10 days, where a smaller dressing will be applied. You must keep the wound dry for the first 10 days. The stitches will be removed between 10 and 21 days following surgery. Providing the wound is healing without complication, you may then commence normal bathing. Further information regarding walking and exercising will be provided.
The Procedures we use.
The bunion surgery procedures we use can be undertaken under local anaesthetic and sedation or full general anaesthetic (still be allowed home on the same day). We will normally perform a scarf (z-osteotomy) or in severe and unstable hallux valgus, fuse the base of the long 1st metatarsal bone (modified Lapidus procedure). Both these surgeries involve fixing the bones with special bone screws and or plates and remove the need for patients to have to wear a plaster cast following surgery.
Tailor's Bunion Deformity
This is very similar to the bunion deformity (hallux valgus) of the big toe joint but less common. In effect the 5th metatarsal (long bone to the little toe) protrudes, making the foot wider (splaying) and the little toe joint becomes inflamed when being rubbed in footwear. It can be managed by wearing sensible wider footwear to prevent the rubbing. Surgery is usually straightforward where the 5th metatarsal is cut and slid back into correct alignment to reduce the splaying, remove the lump and re-align the little toe joint.
The guidelines are very much the same as bunion surgery.