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Operative Summary

A surgical correction to straighten the toe is performed by cutting the bone with a small burr, shifting it, then fixing the bone with screws. This will be performed under an ankle anaesthetic block, numbing the entire foot. A general anaesthetic or sedation may also be used, according to your preference.

Day of Operation (week 1)

• Strict elevation
• Rigid post-operative sandal- mobilise full weight bearing (with 2 crutches only if needed)
• Home the same day
• Some bleeding may to be seen through bandage, (this is normal)
• Move toes, ankle, knee and hip
• Regular (3-4 times/day) pain relief (Codeine and Diclofenac) once discomfort begins (after ankle anaesthetic block wears off, approximately 6-12 hours after surgery)

Weeks 1 and 2 Post Operatively

• Day 3 – Start Rehabilitation Exercises if you feel comfortable to do so (see below)
• Strict elevation at the level of the chest, for 23 hours a day for 7 days (for pain relief, swelling and wound healing)
• Regular (3-4 times/day) pain relief (Codeine and Diclofenac) only if needed
• Full weight bearing in post operative sandal (can be removed at night if desired, but put back on when walking)
• Place 2 pillows under your mattress for elevation when sleeping
• Keep bandage on and keep dry. You may use a ‘cast / bandage protector for bathing’, available on-line Eg. LimbO device
• Ice for 10 minutes every hour, on top of bandage, even if you feel the foot is not getting cold
• Move toes, ankle, knee and hip. Straight leg raises

Week 3 Post Operatively (after 2 weeks completed)

• Clinic review by Mr Gordon – Bandage and steristrips removed, wound inspected, (no stitches need removing usually)
• Continue elevation at the level of the heart when not walking, especially at the end of the day or if swelling
• Continue Rehabilitation Exercises (see below, 5 times / day)

Week 3 – 6 Post Operatively

• You can have a bath or shower without protection once the bandage has been removed, unless advised otherwise by Mr Gordon
• Elevation should be continued whenever possible, at least just above waist level, preferably chest level
• You may go for a 10 minute walk but listen to the foot. If pain or more swelling, then ease off
• Increase your activities according to your pain or swelling
• If at the end of the day the swelling is minimal, remove the 2 pillows from under the mattress.
• Continue to ice when possible to reduce the swelling
• Continue in the post operative sandal unless advised differently by Mr Gordon

Week 6

• Outpatient visit – Pain, swelling and movement assessed
• Post operative sandal removed and normal shoe (eg lace up trainer) can be worn (will need to be a generous fit).
• Continue rehabilitation exercises
• You will still have some swelling for at least 3 months, this can continue in some cases for up to 1 year.

Month 3-6

• Outpatient visit as required – Pain, swelling and movement assessed.
• Shoe fitted reviewed
• Continue rehabilitation exercises

Returning to Work

• Sedentary jobs: Return after 2 weeks, if able to maintain foot elevated at level of waist, otherwise 4 weeks off
• Standing/walking jobs: Return after 6 weeks, but may be sooner depending on comfort and swelling
• Manual/labouring jobs: Return after 8 weeks, but may be sooner depending on comfort and swelling

Driving

You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe at 2 weeks post operatively. For right sided surgery, driving is probably safe at 6 weeks post operatively, once in a normal shoe. If you are unsure, please ask Mr Gordon.

Before (left) and After (right) Minimally Invasive Bunion Correction

Big Toe Joint Rehabilitation Exercises : Aim – To restore big toe joint movements

After 3 Days Post Operatively(5 times / day)

Remove post operative sandal, bandage kept on. Don’t worry if you feel the movements are restricted in the bandage, even a small amount of movement is good.

1. Toe lifts x 20: Sit with foot flat on floor, raise toe as far as possible to ceiling and return
2. Toe bends x 20: Sit with toes resting over the edge of a thick book, bend toes towards the floor
3. Toe pulls x 20: Pull toe up with hand to discomfort and hold for 3 seconds, relax
4. Toe pushes x 20: Point ankle and toes down (like a ballerina), push toe down with hand to discomfort and hold for 3 seconds, relax

After 1 Week Post Operatively(5 times / day)

5. Seated heel raises x 20: Sit with foot flat on floor, knees bent 90⁰keeping toes on floor, raise heel to the limit of pain and return

After 2and 3 Weeks Post Operatively(5 times / day)

Continue exercises 1-5.

After 4 weeks Post Operatively(5 times / day)

6. Standing both heel raises x 20: Stand close to a wall for balance, raise heelsto the limit of toe pain and hold for 3 seconds
7. Standing single heel raises x 20: Stand close to a wall for balance, stand on one leg, raise heel to the limit of toe pain and hold for 3 seconds. This requires good balance, don’t worry if you can’t do it.
8. Standing lungex 20: Place operated foot 1 step behind you, bend both knees, concentrating on bending the toeand hold for 3 seconds

After 6 weeks – 3 months Post Operatively

Continue exercises 6 – 8 until full mobility restored

References

• Postoperative Rehabilitation after Hallux Valgus Surgery: A literature review, Polastri, The Foot and Ankle Online Journal 4 (6): 4 2011
• Rehabilitation After Hallux Valgus Surgery: Bearing of the First Ray During the Stance Phase Importance of Physical Therapy to Restore Weight, Schuh et al, PHYS THER. 2009; 89:934-945

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