Mild hallux valgus deformities (bunions) and osteoarthritis of the big toe can cause discomfort, mobility challenges, and issues with footwear. Distal osteotomy is a surgical procedure aimed at addressing these conditions by reducing pain and correcting the alignment of the big toe. Here is an overview of what to expect from this procedure and its recovery process.
What is Distal Osteotomy?
Distal osteotomy is a surgical procedure designed to realign and straighten the big toe by cutting and adjusting the bones around the joint. It is a relatively quick operation that involves:
An incision on the top or side of the foot.
The use of absorbable stitches where possible.
Internal fixation with plates, screws, or pins to hold the bones in their new alignment. These fixation devices rarely require removal.
The surgery typically takes about 45 minutes and is performed as a day procedure, meaning you can go home the same day.
Why Consider This Surgery?
The main aims of distal osteotomy are:
To reduce pain caused by bunions or osteoarthritis.
To improve the alignment of the big toe.
To enhance mobility and comfort in footwear.
Advantages:
Corrects the poor alignment that causes deformity and discomfort.
Risks and Considerations
As with any surgical procedure, there are specific risks to consider, including:
Joint stiffness (8%).
Overcorrection (4%).
Pain in the ball of the foot (6%).
Recurrence of the deformity (8%).
Footwear restrictions, with 14% unable to wear high heels post-surgery.
Big toe joint pain (6%).
Wound infection (4%).
Revision surgery required (2%).
Failure to achieve full correction.
Your surgeon will discuss these risks and their likelihood with you, as well as the measures taken to minimise complications.
Who is a Candidate for This Procedure?
This surgery is typically recommended for individuals with:
Hallux valgus deformities or pain from prominent joints.
Difficulty wearing sensible footwear due to the deformity.
Alternative Treatments:
Altering activity levels.
Using painkillers or anti-inflammatory medications.
Wearing bespoke or modified footwear.
Joint injection therapy.
Insoles or orthotic foot supports (note that these do not correct deformities).
What to Expect During Surgery
Distal osteotomy is usually performed under local anaesthetic, ensuring you remain awake but pain-free. If you prefer or if your surgeon recommends it, sedation or general anaesthesia can be used. Following the procedure, you will spend some time in the day surgery unit to rest before going home.
You must have a responsible adult to assist you for the first 24 hours post-surgery.
Recovery Timeline
First 2-4 Days:
Pain is typically most intense during this period, but prescribed painkillers will help manage it.
Rest is essential. Keep your foot elevated and minimise walking.
Use crutches as instructed to limit weight-bearing.
One Week After Surgery:
Attend a follow-up appointment for dressing changes and to check your progress.
Gradually increase activity within pain limits. Pain or swelling indicates overexertion.
Two Weeks After Surgery:
Sutures will be removed if necessary.
Bandages and crutches are no longer required, and you can get your foot wet.
You may begin wearing trainer-style shoes and performing gentle toe exercises to maintain mobility.
2-6 Weeks After Surgery:
The foot will begin to feel more normal, although swelling may persist, especially at the end of the day.
By six weeks, 88% of patients return to wearing regular shoes.
You may return to non-manual work; manual work may require additional recovery time.
Driving can resume if you can safely perform an emergency stop. Confirm this with your insurance provider.
8-12 Weeks After Surgery:
Swelling will continue to reduce, and the foot should feel more functional.
Sporting activities can be considered after three months, depending on your recovery progress.
Six Months After Surgery:
A final review will assess your long-term recovery.
Swelling should be minimal, and the full benefits of surgery will be evident.
Twelve Months After Surgery:
Complete healing is achieved, and improvements in alignment and comfort will stabilise.
Planning for Recovery
To ensure a smooth recovery:
Arrange for assistance with daily tasks during the initial weeks post-surgery.
Follow all post-operative care instructions provided by your surgical team.
Attend all follow-up appointments to monitor healing progress.
Distal osteotomy is an effective procedure for reducing pain and correcting mild bunion deformities or osteoarthritis of the big toe. With proper care and adherence to recovery protocols, most patients experience significant improvements in mobility and quality of life. If you are considering this procedure, consult your healthcare provider to determine if it is the right choice for you.