Dr Sean Ng is a Consultant Orthopaedic Surgeon with a special interest in Sports Surgery, Minimally Invasive Foot & Ankle Surgery. Besides being trained in general orthopaedic and trauma surgery, he has an active interest in foot and ankle surgery. He is also especially interested in percutaneous and minimally invasive surgery of the foot.
Bunions are a common condition that a lot of Singaporeans suffer from. The malaligned bone is not caused by wearing tight shoes, although that can worsen the condition. Bunions run in families, because foot type (shape and structure) is hereditary, and some types are just more prone to bunions than others.
Dr Sean answered questions from readers on:
- Conservative treatment options for bunions
- When is bunion surgery needed
- Bunion surgery in Singapore
- Cost of bunions surgery
Bunions get progressively worse with time. They do not reverse, and it really just depends when you want to get them corrected.
An example of a normal toes vs overlapping toes:
How is bunion surgery performed in Singapore, and what is it like to undergo bunion removal surgery?
Bunion surgery is done via either the traditional open method or a keyhole/ MIS method. It depends on the severity of the bunion, and what technique the surgeon is competent and proficient in.
My first option would always be to offer a keyhole correction for a patient if I feel the bunion is suitable for such correction. The advantages for keyhole surgery are plenty.
Bunion surgery is generally a very safe procedure. Risks will include surgical and anesthetic risks, and usually is between 1-2%.
Short term surgical risks include bleeding, infection, neurovascular damage and very rarely fracture; and anaesthetic risks include heart attacks and strokes/ brain damage. This is however very rare, and usually in the older folks with multiple medical problems.
Pain is very subjective. On a scale of 1-10, patient A’s pain score of 2 may be patient B’s score of 7. Nonetheless, there are ways to try reduce the discomfort and pain.
Pre-operatively, the surgical technique would be the most important. Why would someone opt for a wound that is 8-10cm long, compared to one which is 1-2cm long?
Example of a open scar:
Medisave can be used for a bunion correction, as it is a medical indication. It is not a cosmetic operation. It depends on how much work is needed, whether one foot or both feet are done.
It also depends on whether how many toes in total are done, or whether there are any other adjunct procedures.
Pre-operative investigations and fitness for surgery are of utmost importance. This is to ensure that the patient is suitable for surgery, and that both the surgeon and the anesthetist are comfortable with proceeding with the surgery.
Investigations would include blood tests, ECG, chest X-ray and any other investigations deemed necessary by the surgeon and/or anaesthetist.
I would usually advice the patient to start ambulation slowly. Patients are able to weight bear immediately the same day after surgery, but of course there will be some discomfort.
As the pain improves with each passing day, patients will be able to walk more and more surely/ confidently. Always take care of the wound(s), and keep the dressings dry. When taking showers, I usually give my patients a cast protector.
Bunions are not life and death surgery. It really is a matter of how much discomfort and pain it is causing you, and how much deformity there is.
The deformity can be that of just the big toe, or sometimes it may affect the other toes as the bunion gets progressively worse.
As mentioned above, I personally would think that keyhole/ MIS surgical correction would be the optimal way of correction.
The advantages are plenty, compared to a traditional “open” method. This would include less pain, less risks of infection and bleeding and damage.
If done properly, a patient would be able to weight bear the same day after surgery.
I give my post-op patients a special post-op surgical shoe, that allows the patient to fully weight bear and walk on, the same day of surgery. This is applicable to both open and keyhole technique correction. Skin stitches are usually removed at about 2 weeks post-op.
Internally, it takes about 3-4 months for the bones and soft tissues to heal.
Bunion correction usually gives good results and satisfaction rates. As one of the causes for bunions are usually about 90% genetic, we will always quote a risk of recurrence of about 5-10%.
This does not depend on what technique is done, whether it is open or keyhole. So again, the important point to note is: if the results are the same between an open or keyhole correction, why would one not choose a technique that has less pain, less risks of infection and bleeding, and is cosmetically much more pleasing.
90% of bunions are inherently genetic. 10% is due to footwear - tight, pointy shoes. High heels.
So after bunion surgery, we always quote patients a risk of recurrence of 5-10%. Of course surgical technique is important.
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