Bunion or "onion" surgery in Nice

The forefoot

Pathologies of the foot are by far dominated by damage to the forefoot.
The best known is the deformation of the big toe, also called "bunion" or "hallux valgus".
This condition is very common.
It affects women between 20 and 40 years old.

The big toe is deviated towards the outside, the foot is no longer functional because the big toe no longer plays its propulsion role. The consequences are multiple: problems with footwear, pain, difficulty wearing heels, metatarsalgia, toe claw, redness…

We find other pathologies less frequent but just as annoying such as Morton's syndrome, isolated toe claws, quitus varus, stress fractures, ingrown toenail…

As each situation is unique, only a consultation with a foot surgeon will allow you to make the right diagnosis and to propose an adapted therapeutic solution.

Discover the bunion surgery in video

Bunion surgery, what does this term mean?

We are talking about surgery for bunions here, but first let’s define this term.

Unlike the hand in which the thumb can move away from other fingers allowing the gripping of an object, the big toe of the foot must remain attached to the rest of the foot. However, these attachments are fragile, and when they no longer fulfill their mission, this can cause the 1st metatarsal to slide towards the inside of the foot. This sliding causes a deformity

("onion"). The pain in the foot that can be found frequently on the lump is called bursitis. It is linked to the suffering of the structure of the foot which normally maintains the 1st metatarsal on its axis. Bursitis evolves by cthe consistent short periods of pain which results in redness and pain in the lump.

A bunion is not a bone its a bone that becomes displaced. This bony protrusion can cause a conflict with narrow shoes, especially in women.

The deformity is aggravated by the retraction of the muscles and tendons that keep the vicious cycle going.

Why does this happen and what are the aggravating factors?

Even today, we do not know the exact causes of this deformation. On the other hand, we know of factors that promote the formation of bunions.

Factors that promote the onset of bunions:

• Wearing pointy, high-heeled or narrow shoes: the "shoe" factor is accepted by the scientific community as a contributing factor. In a narrow shoe, for example, the forefoot is compressed and the big toe becomes deformed.
• Being a woman
• The existence of a bunion in the family (heredity): it is common to see patients who have the same condition as the mother or the grandmother. This inheritance may be due to the genetic transmission of excessive joint flexibility (constitutional hyperlaxity)
• Certain foot shapes such as the flat foot or the anatomical orientation of the articular surfaces
• The Egyptian foot (1st toe longer than the 2nd) seems to favor the appearance of a bunion unlike the Greek foot or the square foot. In this form of foot, the excessive length of the first toe increases the likelihood.
• The existence of hyper-laxity: it can play a role in the genesis of a bunion. Only the hallux abductor tendon struggles with bunions. In case of hyperlaxity or deficiency of this structure,a bunion is more likely.
• Weight: according to some studies, it seems that a low BMI (Body Mass Index) increases the risk of developing a bunion.

How is it evolving?

As we have already mentioned, this progressive distortion is part of a vicious cycle and will tend to worsen over time. By the tension on the tendons, we can see an impact on the lateral toes with a toe claw deformity especially on the 2nd toe (2nd ray syndrome).

The initial pain or pain of bursitis may disappear, this indicates the rupture of the joint capsule which no longer hurts because it is ruptured. Therefore, we can witness a rapid worsening of the deformity.

It is important to note that in the case of a bunion the first ray can no longer perform its supporting role, this is called the insufficiency of the first ray. This insufficiency results in the appearance of corns on the first toe opposite the inter-phalangeal joint and will be supplemented by the lateral rays, which will have to compensate for the transfer of load and be at the origin of pain under the metatarsal heads. (metatarsalgia). The onset of pain or scratching in the lateral toes marks a turning point in the development of bunion. If such signs appear on your foot, it is essential to consult a foot surgeon quickly because the postoperative results are poorer if you operate on the little toes. The ideal results is to do the surgery before there are complications with the little toes.

In a very advanced bunion, there is a subluxation of the metatarsophalangeal joint which can progress to osteoarthritis.

In consultation, patients often ask the surgeon if a splint for bunions are effective… Yes, soft splints in the day or night are effective with managing the pain as a medical treatment to avoid surgery. When worn, they allow the first toe to be realigned, which relaxes the joint capsule and the internal elements of the joint which are the site of inflammation, therefore the pain decreases during the day. On the other hand, no splint can effectively correct the deformity in bunions over time. These different products can relieve pain at most.

When to see a bunion specialist, and when to have an operation?

A consultation with a bunion specialist should be considered as soon as the symptoms appear: pain, conflict or modification of the footwear, deformation of the claw toes or metatarsalgia.

Bunion treatment:

Medical treatment will be put in place, depending on your symptoms and the stage of the bunion:

• Adaptation of the footwear
• Insoles
• Orthoplasty (wedge between the toes)
• Night restraint splint
• Pedicure treatments with custom-made silicone orthoplasty

When medical treatment is insufficient, an intervention can be discussed. There are no set rules, except that of operating only when necessary, that is, in the presence of pain or functional impairment. Dr. Lopez does not perform any intervention for purely aesthetic purposes, bunion surgery is functional surgery.

Do not hesitate to contact the best bunion surgeon as soon as the deformities begin to have consequences on daily life or the footwear, and choose the period which is appropriate according to your family or professional requirements.

A specialist consultation will be necessary to follow up on minimally invasive bunion surgery

Each person is unique, so only a specialized consultation will be able to offer you the most suitable solution, whether it is minimally invasive bunion surgery, minimally invasive surgery or percutaneous surgery.

What is the purpose of the intervention?

• To correct the deformation by realigning the first ray
• To make the foot painless
• Have a shoe that can be fitted, ie compatible with all types of shoes including heelsReturn to sport without limitations Simply sanding down the bump (cheleictomy) is not enough because you cannot remove too much bone, it is the metatarsal head and therefore the articular part of the metatarsal. On the other hand, simple sanding or resection of the lump does not prevent the metatarsal from continuing its movement resulting in recurrence of the bunion.

How does minimally invasive bunion surgery work in practice?

Before surgery

After surgery

To know exactly the nature of the treatment to be performed for the bunion of the foot and for the operation, the surgeon will have to specify certain elements beforehand during the consultation. The choice of technique and the assessment of the procedures to be performed is left to the surgeon depending on the severity of the condition and the complexity of the intervention.

Percutaneous (micro-incisions) and minimally invasive surgery largely finds its place in the surgical treatment of bunion. The surgical procedures performed are the same as in conventional surgery except for the incisions made which are smaller. These modern surgical techniques reduce postoperative pain and allow faster rehabilitation in everyday life. Minimally invasive bunion surgery means it is done through a small incision measuring 2 cm. The procedure involves performing an "osteotomy", which is a small fracture in the neck of the metatarsal, allowing the metatarsal head to push back and slide into its original location. A small fracture is also made percutaneously in the first phalanx in order to improve the result. Each of these fractures is stabilized by a screw while awaiting bone consolidation (45 days). The procedure is usually performed under local anesthesic. The main goal of the surgery is to have a painless and shoe-able foot. The presence of corns (plantar hyperkeratosis) disappears within a few weeks with the removal of the hypo-support and the mechanical impingement. This disappearance testifies to the effectiveness of the intervention.

Hospitalization

The operation is usually performed on an outpatient basis (hospital stay of one day). However, for various reasons, it is possible to plan a few days of hospitalization depending on your social situation and your associated illnesses.

Anesthesia

You will need to perform the mandatory pre-anesthetic consultation with the anesthesiologist. During this consultation, the anesthesiologist will explain the possible modes of anesthesia to you according to your existing medical condition and the planned surgical procedure. If necessary, he will adapt your treatment before and after the procedure and may prescribe anticoagulants, analgesics, anti-inflammatory drugs or others.

Several types of anesthesic are possible: you may benefit from local or regional anesthesic meaning that only your leg will be desensitized: this is the most common. General anesthesia is also a solution if you prefer to sleep.

The intervention

• Before the operation for a bunion: you will be placed on a bed and then taken to the pre-anesthesia room. Local anesthesia will be performed before entering the operating room.
• Installation in the operating room: you will be installed in the supine position, on your back
• The tourniquet: Throughout the operation, a tourniquet is usually placed on the ankle to prevent bleeding
• The incision: the incision measures a few millimeters using the percutaneous technique (minimally invasive or micro-invasive surgery). The surgeon works with specific tools to make the incision through the skin and an intraoperative x-ray machine to cut the bone. The surgeon performs a section of the retracted structures then the osteotomies. The so-called "open" technique requires an incision of several centimeters, this technique is useful in severe deformities: the scar is made on the top of the toe or on the side.
• The surgical procedure: the objective of the surgical procedure is to realign the big toe and to relax the retracted parts. The correction is possible by moving the head of the metatarsal and possibly by making a fracture on the 1st phalanx to optimize the correction. This translation makes the bump disappear. Tenotomies (tendon lengthening) or joint releases (arthrolysis) are often performed.
• Operative time: the duration of the surgical procedure is relatively short, generally 45 minutes. The intervention may be longer in the event of associated procedures or operating difficulties.
• The material: in most cases, the osteotomies performed are fixed with 2 screws. This material can be kept or withdrawn after 6 months depending on your wishes and your functional state.
• At the end of the operation: the surgeon makes a dressing that must be kept on for 21 days.

It is important to note that the surgeon may face an unforeseen or unusual situation requiring different acts than those initially planned. In this case, the surgeon will explain the difficulties encountered and the actions taken as soon as you wake up or return to your room. If you have any questionq or if you are worried, do not hesitate to contact the secretary.

What are the consequences of percutaneous operation for a bunion?

Pain

Bunion surgery pain can last for an average of 48 hours. When leaving the operating room, the foot remains anesthetized for almost 12 hours, you will not have pain on the first day. The end of the effect of the anesthesia will be felt the same evening or the first night. From the evening of the operation and the next day, it is advisable to take the full prescribed painkillers so as not to allow the pain to set in. If you do not take the painkillers, you increase the risk of developing a complication known as algal neurodystrophy (pain and stiffness for several months). From the 3rd day, take the painkillers according to your pain.

Walking

As soon as you leave the operating room after a percutaneous operation for a bunion, walking is authorized provided you wear the shoe or shoes that will have been prescribed for you in consultation. You should strive to walk with your whole foot and not just your side edge or heel. The post-operative shoe(s) prescribed for you must be worn for 21 days. It allows you to move around by allowing you to take part in your usual daily acitivites after surgery. However, try to avoid long walks of more than 30 minutes. Crutches are not essential, however they can help you if needed.

Medicinal treatments

Depending on your history, your medical status and your mobility, the anesthesiologist may prescribe an anticoagulant therapy by injection (subcutaneously) or systemically (per os). This treatment helps prevent the onset of deep vain thrombosis (DVT), i.e. the formation of a clot in the veins.

It is strongly recommended to take the painkillers prescribed systematically during the 2 days following the surgery.

Driving

Driving is possible if you have had an operation on your left foot and you are driving an automatic car. In other cases, driving a vehicle is prohibited for 21 days (in the event of accidents, you will not be covered by your insurance).

Stoppage from work

The average length of time off work is 30 to 45 days.

Sports activities

You may resume swimming and cycling from the 1st month and the any other activities from the 2nd postoperative month.

Swelling

To limit the appearance of swelling or hematoma, keep the foot in an elevated position. During your recovery, keep the operated limb in an elevated position and regularly ice the foot using a cryotherapy splint, an ice pack or simply with a bag of frozen peas. The foot remains swollen for an average of 6 to 9 months. This swelling is not painful but it can be inconvenient when wearing tight footwear. You may use a normal shoe is after 30 days. To wear heels, you have to wait at least 2 months.

The dressing

There is no dressing until the next consultation appointment. The dressing you have on your foot was made in the operating room and it ensures that your toes are in the correct position. It is an integral part of your treatment and should not be repeated during the first 21 days after surgery. The first dressing will be repaired by us during your postoperative appointment, 21 days after the operation. You must protect it when you go to the toilet , have shower or bath and it must not get wet.

If by any chance this bandage comes undone, slips or gets stained, you will need to contact my secretary to come back to repair the bandage. You should not, except in an emergency, have it done by someone who is not trained to do this. In some cases, a silicone splint should be placed between the 1st and 2nd toe for 3 weeks.

Physiotherapy

In order to speed up functional recovery and the melting of the swelling, you will have around ten physiotherapy sessions (starting after the first postoperative consultation), this rehabilitative care is essential. The physiotherapy sessions are to start after the first postoperative consultation (beginning of the 4th week). We advise you to contact a physiotherapist as soon as you return home to organize the rehabilitation.

Wearing shoes with heels

It is possible and authorized after 2 months.

Post-operating appointments

A postoperative appointment is necessary at the end of the 3rd week to undo the dressing and control the scar. On the day of this consultation, you will have to come with a follow-up x-ray. I will give you the instructions for the rest of your recovery (shoes, passive mobilization of your toes, gradual recovery of your mobility). A second consultation is scheduled at 2 months to follow the postoperative progress. In the days preceeding, you will have to perform the X-ray control that has been recommended to you. New instructions will be given to you and rehabilitation will be advised if necessary.

The scar

From the 4th week, it is recommended to apply the repairing cicalfate cream every night at bedtime. Also remember to protect the scar from the sun's rays with a high-index cream, during the year following the operation. The scar will be almost invisible.

In case of questions

During the operation, the secretary will give you instructions and advice. For any additional questions or in the event of a problem, you can contact his secretary.

In conclusion

The bunion operation realigns the big toe to remove the bump and the conflict with the shoe. This realignment is possible thanks to the small bone fractures (osteotomy) and thanks to the release of the soft tissues. The operation is performed on an outpatient basis and full weight bearing is authorized immediately.

Things to know before undergoing micro-invasive bunion surgery

During the planning of the micro-invasive surgery of a bunion, the secretary will give you a prescription "Material" to provide you with the pair of therapeutic shoes, the COHEBAN band and the cryotherapy splint. On the day of the operation, it is imperative to come with the shoes and the band (or equivalent) because Dr Lopez will use this band in the operating room to make the dressing.

What are the complications of percutaneous bunion surgery?

The following list of complications is not exhaustive, but the most common complications of percutaneous bunion surgery are mentioned.

Any surgery exposes you to complications that are both common and specific to the type of intervention performed. This risk varies from one individual to another depending on their age, existing health conditions (hypertension, diabetes, poor skin condition, etc.) as well as depending on their lifestyle (tobacco, alcohol, practice of an activity, athletic).

Some complications can be prevented by simple measures such as:

• compliance with postoperative instructions
• stopping smoking

Common Complications:

• Hematoma is an infrequent complication, due to certain drug treatments (anticoagulants). Some drugs can be stopped and taken over by the anesthesiologist. The hematoma rarely requires surgical intervention, it most often is resolved with ice and rest.
• These healing problems are rare thanks to the combined use of the minimally invasive and percutaneous technique. Their occurrence is increased by tobacco and poor skin condition.
• Swelling is not a complication but a reaction of the body to surgery. In order to decrease its importance, it is useful to perform self-rehabilitation by moving your toes, to limit extreme activities for 15 days and to elevate your foot as much as possible when you are lying down.
• Thrombophlebitis is the formation of a clot in a vein, most often in the leg or foot. Its prevention is walking and possibly, depending on the anesthetic prescriptions, the administration of an anticoagulant treatment by the subcutaneous route or even systemically.
• Algodystrophy or "complex regional pain syndrome" is an overreaction of the body to the aggression of surgery. The symptoms are: redness, stiffness, swelling and pain. The evolution is always towards healing without long term consequences but the healing is long (up to 18 months). Certain simple measures minimize this risk: the pain must not be allowed to set in and the prescribed analgesics must be taken systematically during the 48 hours postoperatively.
• Infection can occur despite precautions (preoperative shower, surgical aseptic preparation). It should be considered in case of fever, scar breakdown, discharge or significant redness. It requires surgical advice.

Specific complications:

• hypercorrection or "hallux varus" is an excess of correction: the big toe deviates towards the inside of the foot. This complication requires surgical intervention.
• insufficient correction is the persistence of a deviation after the intervention.
• pseudarthrosis is the failure of fractures to heal. This complication is rare. It requires surgical intervention.
• The iatrogenic section of the flexor hallucis longus tendon: the minimally invasive and percutaneous technique increases the risk of sectioning this tendon. This causes a deficit in active flexion of the interphalangeal joint and requires surgical intervention.
• Bone necrosis is the death of bone due to damage to its vascularization.
• recurrence of the deformity is the reappearance of the deformity after surgery. Certain factors promote recurrence such as congenital forms or non-compliance with postoperative instructions.
• Appearance of toe claws: unfortunately operating a bunion will not prevent the deformation of the other toes. Each toe is independent and can undergo at its own pace and in time the effects of musculo-tendon retraction of its own tendons. • Osteoarthritis is the wear and tear of the cartilage of the metatarsophalangeal joint. When it is disabling, surgical treatment may be considered (blockage or arthrodesis).
• hypercorrection or "hallux varus" is an excess of correction: the big toe deviates towards the inside of the foot. This complication requires surgical intervention.
• insufficient correction is the persistence of a deviation after the intervention.
• pseudarthrosis is the failure of fractures to heal. This complication is rare. It requires surgical intervention.
• The iatrogenic section of the flexor hallucis longus tendon: the minimally invasive and percutaneous technique increases the risk of sectioning this tendon. This causes a deficit in active flexion of the interphalangeal joint and requires surgical intervention.
• Bone necrosis is the death of bone due to damage to its vascularization.
• recurrence of the deformity is the reappearance of the deformity after surgery. Certain factors promote recurrence such as congenital forms or non-compliance with postoperative instructions.
• Appearance of toe claws: unfortunately operating a bunion will not prevent the deformation of the other toes. Each toe is independent and can undergo at its own pace and in time the effects of musculo-tendon retraction of its own tendons.
• Osteoarthritis is the wear and tear of the cartilage of the metatarsophalangeal joint. When it is disabling, surgical treatment may be considered (blockage or arthrodesis).

Once the bunion has been operated on by Dr. Lopez, a foot surgeon in Nice, the other toes are likely to continue their deformation process, and may one day also require their own intervention. But this not always the case.

FAQ

What is a bunion?

A bunion is a deviation of the big toe towards the outside of the foot. It is also known as an "onion". This deformation is accompanied by a bone protrusion causing pain or conflict with the shoe. It mainly affects young women (but also men and young girls). Over time, it gets worse, sometimes forcing patients to adapt shoes or stop sporting activities. When the discomfort is significant, surgical treatment is necessary.

Which specialist treats bunions?

If you notice a defect in your foot, you should first see your doctor. He will then advise you on the choice of specialist, chiropodist or foot surgeon specializing in bunions. Whichever specialist you choose, medical and non-surgical treatment is always indicated as the first option. Either way you can consult Dr. Lopez, bunion surgeon, who will suggest an operation in Nice. For patients who live in Monaco and are looking for a surgeon specializing in bunion in Monaco, know that Dr. Lopez receives a consultation in Cap d'Ail (120 avenue du 3 Septembre 06320). For patients who live on the island of beauty, it is sometimes difficult to find a bunion specialist in Corsica. If you struggle to get an appointment, Dr Lopez can see you in Nice.

How to treat bunions?

It is not possible to cure, let alone reduce the progression of a bunion without resorting to surgery. A pharmacy can advise you on wearing corrective splints for bunions, which will mainly help relieve the pain you feel. None of these corrective splints prevent the progression of the deformity.

How to operate a hallux valgus?

The operation to operate on a bunion is performed on an outpatient basis under local anesthetic. The surgery is done using a minimally invasive and percutaneous technique through small incisions. The goal is to make one or two fractures in order to properly realign the bone. One or two screws stabilize the fractures until the bone solidifies.

How long does a bunion operation take?

On average, a bunion operation lasts between 30 to 60 minutes.

Bunion operation?

It is a technique of minimally invasive and percutaneous surgery of the foot. This surgery gives excellent results. Dr. Lopez practices a mixed technique combining a minimally invasive technique and a percutaneous technique. The incisions are small.

What pain do you feel during the operation for a hallux valgus?

The pain experienced depends on the surgical technique used during the operation. With a minimally invasive technique, the pain is non-existent or moderate and largely bearable. About 50% of patients do not feel pain. After the operation, the foot remains asleep for 12 to 24 hours. When stopping the effect of the anesthesia and during the first 2 postoperative days, it is important to take the prescribed medications consistently. From the 3rd day, the medication will be taken according to the pain felt.

What is the period of immobility after an operation for a hallux valgus?

No stillness is required. The surgical technique performed by Dr. Lopez makes it possible to walk immediately after the operation. Steps longer than 30 minutes should be avoided. The average duration of the work stoppage is 3 to 6 weeks depending on the professional activity.

Am I allowed to drive after an operation for a hallux valgus?

There is no surgical constraints to driving a car. If you are allowed to walk, you can press a pedal safely. You have the right to drive a motor vehicle if you have had surgery on your left foot and have an automatic car. In all other cases, the insurance does not cover you in the event of material damage and / or bodily injury, which is why it is advisable not to drive for 3 weeks.

Can we operate on both feet at the same time?

Yes it's possible. In contrast, Dr. Lopez does not recommend doing both feet at the same time. If there are complications on one foot, you may have a poor outcome on both feet. Studies show that bilateral bunion surgery lengthens recovery time. However, it is possible to operate on 2 feet 15 days or 3 weeks apart.

Is there a risk of bunion recurrence after surgery?

Yes there is always a risk of recurrence. At a minimum, this risk is equal to that of the general population who does not have bunions. The main criterion for the risk of recurrence is radiological: it is the refocusing of the sesamoid bones under the metatarsal head. It largely depends on the quality of the surgical correction. However, it should be noted that the more developed the bunion, the more difficult it is to refocus the sesamoid bones. Contrary to popular belief, a bunion operated on early will give better results than a severe and not very reducible bunion because the surgical correction will be better.

Can I put heels back on after bunion surgery?

Yes, you can put on your shoes without restrictions from the 2nd postoperative month.

How much does a bunion operation cost?

The price of an intervention varies depending on the clinical condition of the patient and the procedures to be performed. Social security covers the costs of the operation. The reimbursement of additional fees depends on your mutual contract. The average remaining charge after reimbursement by your mutual insurance company is €300.