Bunionectomy

WHAT YOU SHOULD KNOW:

• A bunion (BUN-yun) is a lump of overgrown bone or tissue at the base of your big toe. It grows from the joint that connects the big toe to the rest of your foot. As it grows, it sticks out from the side of your foot and may move your toe out of place. It may push your big toe in at an angle. It may push your big toe against your other toes or cause it to cross over them. A bunion can cause pain, swelling, and redness. It may cause your shoes to feel uncomfortable on your feet.
  
  
• A bunionectomy (bun-yun-EK-tuh-me) is surgery to remove a bunion from your big toe. Caregivers move bone, ligaments, and tendons during surgery to bring your big toe back to its correct position. Ligaments and tendons hold your muscles and joints together. You may also need a pin, screw, or rod placed in your toe joint. If you have a condition like arthritis, your toe joint may be damaged beyond repair. In this case, you may need to have the joint rebuilt or repaired.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You may bleed more than usual or get an infection. You could have trouble breathing or get blood clots. Your caregivers will watch you closely for these problems. After surgery, you may have stiffness in your toe joint. Your big toe may not line up exactly with your other toes. You may still need to wear special shoes or inserts in your shoes after surgery. If you do not have surgery, your bunion may grow larger and the pain may get worse. Call your caregiver if you are worried or have questions about your bunion, surgery, or care.

WHILE YOU ARE HERE:

Before Your Surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Anesthesia: Anesthesia is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep. Do not make important decisions for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. An adult may need to drive you home and stay with you after you have had anesthesia.
  
  
  • Intravenous (IV) Regional Anesthesia: This is medicine put into an IV in the foot with the bunion. A pressure cuff is first put on your lower leg. After the cuff is tightened, the medicine is put into the IV. The cuff keeps the medicine in your foot so you will not have pain during surgery.
    
    
  • Local or monitored anesthesia: This is a shot of numbing medicine put into the skin where you will have surgery. You may still feel pressure or pushing during surgery but you should not have pain. With local anesthesia, you will be fully awake during the procedure. With monitored anesthesia care, you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the procedure.
    
    
  • Saddle block or caudal anesthesia: This is medicine used to numb you below the waist. You may lie on your abdomen while your caregiver puts a shot of medicine in the lowest part of your spine. You may lie on your back with your legs up in stirrups (leg holders). When this type of anesthesia is used you will be awake during the surgery or procedure.
    
    
  • Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.
    
    
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.

During Surgery:

• A tourniquet may be put on your leg just below your knee. The tourniquet squeezes your leg during the surgery to help decrease bleeding. Your foot and leg are cleaned with a special soap. This soap may make your skin yellow, but is cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• An incision is made in your foot, and the extra bone and tissue are removed. Then the ligament that has tightened and pulled the toe inward may be cut. A ligament is a strong tissue that holds a joint together. Cutting this one ligament will help make the toe point straight ahead again. A pin, screw, or rod may be placed in your toe joint. In some cases, you may need to have your toe joint rebuilt or repaired with an artificial joint. The incision is then closed with stitches. The stitches may be taken out in 1 to 2 weeks.

After Surgery: You will be taken to a recovery room. You will be watched closely until you wake up. Feeling will return to the surgery area. You will then be taken to your room in the hospital, or you may be able to go home. You will have a bulky bandage on your foot. This bandage keeps the area clean and dry to prevent infection. Do not get out of bed until your caregiver says it is OK. If you are going home right after surgery, do not drive yourself. Have an adult drive you home. Have someone stay with you for the first day after surgery or until you can care for yourself.

Waiting Room: Your family can wait in the waiting room until you are done with surgery. Caregivers will find them in this room to let them know how your surgery went. If your family leaves, ask them to leave a phone number where they can be reached.

• Elevation: Keep your foot raised on a pillow when lying in bed. Keep your foot raised on a foot stool whenever you are sitting. This will decrease pain and swelling.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Put crushed ice in a plastic bag and cover it with a towel. Gently place this on your foot for 15 to 20 minutes every hour for as long as you need it. Do not sleep with the ice pack on your foot, because you may get frostbite.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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