The most common bunion corrective procedure performed in America and in my office is the Austin bunionectomy. It is also called a Chevron bunionectomy. Most bunions are easily repositioned with this procedure. Like all the surgeries, the results vary from near perfect to having to perform it over. Why? I will answer that later.
The Austin is performed by cutting, sawing, breaking or whatever term makes you happy to change the position of the bone needed to correct a bunion. You can Google for pictures and videos. This article is to explain why I do it .It works. I have performed this procedure for over 30 years and never had an infection. That is luck.
THE OPERATION
The operation itself has a few components. One is the restructuring of bone. Once broken the bone must be fixed. There are some surgeons that don’t fix bunions but that I’m not one of those. When I started I used surgical screws to fix the bones but after a few years I used a stainless steel pin. I liked the pin because at the first dressing change my patient saw the pin sticking out of the skin; this made them less likely to walk on their foot. This gave better results.
I then switched to absorbable pins for a long time. The body, over time, resorbed the pins by biodegrading them. One or two patients had a reaction to the pins and caused swelling and longer recovery time. Now I went full circle and use surgical screws again.
The second component is repositioning of tendons and ligaments. This is done by cutting, lengthening or shortening and holding these structures with suture.
The third component is scar control. This is by using a subcuticular technique. This means the stitches are under the skin. This typically leaves minimal scarring.
POST-OP CARE
The last and most important is post-operative care to reduce the possible damage that a patient may inflict on my careful work. My post-operative instructions are the same for everyone. They received a surgical boot that they can walk with. They can only put weight on the heel. They are advised to elevate the foot above the level of their heart and put ice on top of their foot. They should open the boot when doing this. The boot needs to be used as a cast. That means they sleep with it on. They can’t get it wet, so they purchase a cast guard to take a shower. I see my patients three to six days later for x-rays and dressing change and they continue with the above protocol. We see each other every week to change the dressing and look at the wound. Changing the dressing keeps the great toe in the desired position while the internal structures heal in their new positions. Other than the bone which is held with screws, the tendons and ligaments are held by sutures. These can break or tear is forced to do so and would cause an unwanted result.
The final time frame for healing and functional results varies from four weeks to six months.
THE TRUTH
It is time to tell the truth regarding bunionectomy success. I hate to be the one to tell you this but we are all different. I’m talking about surgeons and patients. Surgeons have preferences in the way they perform the procedure and their post-operative course. They may rely on a different set of protocols and may have 100% success. I doubt that is true but they may say so. I have at times finished a surgery and wished I may have moved something more or less during the procedure. At times I could have gotten a better result and other times it came out better than expected. Every surgery is different even though the procedure is the same. This is because the patients are different.
For instance, the bones are sometimes strong like wood and other times they are soft as a sponge. The consistency of patients bones are everything in between. This makes putting in surgical hardware good or bad. In hard bone the hardware will usually stay put but in sponge it can move. I have seen bones on x-ray begin to disappear from lack of substance over four weeks. Soft tissue is the same way. In some patients it’s like leather and others it’s like tissue paper. Again, this makes the results hard to predict. These variations are not always related to age or gender. We are all biologically different.
Then comes the post-operative period, which I believe is more important than the intraoperative period. When patients leave the surgical center to go home their foot is numb. This numbness can last six to thirty-six hours. This is the time patients can destroy what I just created. They can walk directly on the great toe or miss a step and break everything inside. I go over this many times preoperatively with my patients. The use of ice and elevation limits swelling and pain. When the surgical area has limited swelling, it heals quicker and better. Some patients don’t adhere to instructions. Swelling will also cause skin to stretch and produce a wide scar.
The healing response to surgery is different for all of us. Some people heal fast and are able to flex there toe and walk in just four weeks and then others four months later the toe is still stiff. It’s all about genetics when it comes to our healing. Some people scar inside. We call it scar tissue. This will cause stiffness and less happy results. Icing and elevation battle the genetic scarring but even with that we sometimes lose.
Lastly, is the skin scar. I place the incision on the top of the foot and have dried many variants over the years including on the side, but the results for me are always better on top. The placement avoids the nerves and avoids the shoe rubbing against the scar. Even using the best cosmetic suture material I have had a few patients get unsightly scars. It is just the way a patient’s body responds to the trauma of surgery.
In conclusion, asking your next door neighbor about their bunion surgery experience doesn’t really give anymore facts to help with your surgical result. You could read reviews regarding the doctor and their office. If you feel confident with your surgeon, you usually have a better result. When everything goes as planned, your genetic makeup responds well to surgery and you do everything as prescribed during the post-operative period, you will have a 90% chance of being happy following your Austin bunionectomy.
