Right now, I'm a post-bunion surgery patient.
I've had a Scarf-Akin bunionectomy, bi-laterally, 11 weeks ago.
Since about 7 or 8 weeks after surgery, I was able to walk normally, do gym workouts with low-impact treadmill walking, swimming, and all of the normal daily functions I needed to accomplish in my life and work. Albeit, slowly, and with Celebrex.
I'm not a doctor. I'm not a podiatrist or an orthopedist. But I am , at this point, a very educated patient. I'm also very satisfied thus far with my surgical outcome.
With all of that being said, I want to reply to one reader's comments, in this post. This story shared by A. is VERY similar to my story.
Her situation mirrors the situation I had:
#1: IM Angle 18 degrees on one foot, 19 on the other.
#2: Hypermobile with flat flexible arches.
#3: Pronation.
"Well, I visited the doctor again and discussed with him the procedure in question and he said that with my severe IM angle (18 degrees) he believes any other procedure than the lapidus would fail. The main reason being that my feet are very hypermobile. I do not have structured flat feet but rather my arches are fairly high when I sit but when I stand they flatten out. This is referred to as excessive pronation. I have read a lot of articles online that support the idea that a high IM angle with hypermobility needs to be corrected with a lapidus procedure. Did you face the same issue, Lynn, and do you think that the Scarf-Akin procedure will hold up long-term? By the way, he did offer to give me Mederma for the scars. Oh and another thing--he stated that he doesn't advise having surgery done bilaterally because from his experience one foot always seems to heal better than the other. What were you told about this?"
These are GREAT questions. There's no such thing as a perfect foot. Everyone has different variations of feet; and there are a lot of different ways to correct bunions surgically. As patients, we have to rely on the OPINIONS of our podiatrist or orthopedic surgeon in selecting the "correct" bunion surgery procedure. It can be very difficult to have a discussion with a doctor, and really differentiate between what part of what they're telling you is opinion, vs. what part is fact. Many will express strong opinions, and because they are The Doctor, we the patient take this as fact. For instance your doctor says "It has been my experience that xyz....." Then we the patient may hear this as a golden fact.
I was told pretty much exactly what you were told by 2 out of 4 docs. Here were my questions in response, and the facts I gathered in my pre-surgery doctor visits:
Q: Will the Lapidus correct my pronation?
A: No, that's a different problem.
Q: Will the Lapidus correct my flat arches?
A: No, but it will help make your feet "more stable."
Q: Will the fusion of the Metatarsal-Cuneiform joint as performed with the Lapidus cause a limitation in my range of motion in my feet; can this restrict my activities, or *might* it cause other biomechanical dysfunction at a later date; eg, back pain, knee pain, heel pain, etc.
A: Maybe. We don't know. It's possible. Range of motion in the mid-foot can be diminished 30%. It's possible you don't need that range of motion anyway unless you're a ballerina.
Q: Will I still have to wear orthodics after a Lapidus OR Scarf bunionectomy?
A: Yes. You will have some shoe-gear restrictions for the rest of your life.
Q: Will you guarantee me that if I have the Lapidus, my bunions will not return?
A: No. No surgeon can promise zero recurrence with any bunion surgery.
Q: Can I have the Scarf-Akin done bilaterally (both feet at once)?
A: Yes.
Q: Can I have the Lapidus done bilaterally?
A: No absolutely not.
Q: Can a "failed" Scarf-Akin be re-done with another Scarf, OR with a Lapidus later in my life?
A: Yes.
Q: Can a "failed" Lapidus fusion be "un-fused?"
A: No.
Q: How likely is "failure," or "recurrence," in numbers, according to studies?
A: We don't know.
The only question I can answer here that concurrs with your doctor's answer: BILATERAL Lapidus bunionectomy is ill-advised, assumably because you'd have to have a cast on both of your feet for 6 to 8 weeks. That's just a huge ordeal to go through, both physically and mentally. One podiatrist said to me "Well I might consider it, if you bring me the signed letter written by the person who's going to carry you to the bathroom every day for 6 weeks."
The thing is, as happy as I currently am with my experience and surgical outcome, I am not qualified to answer your question about whether or not the Scarf-Akin surgery will last me the rest of my life! Before I had my surgery however, I did speak with 2 patients of my surgeon who had undergone the Scarf-Akin procedure, bilaterally. One had the surgery 5 years prior, another had the surgery 4 years prior. Both had experienced bunions for a long time (like 20 years) and both were still happy with their results.
On the flip side, in my personal life, I had met 2 patients who had the Lapidus procedure. One, within the last 5 years. The other, about 18 years prior. Both feet, separately. Both were experiencing secondary pain and complications which may or may not have been relative to the operation.
Perhaps my decision was swayed by the stories I heard from these people. Perhaps the fact is I'll be faced with bunions again in 15 years. My followup-podiatrist in Seattle doesn't seem to think that's the case. Maybe you can wait 10 years to have your surgery, and then ask me how I'm doing? I'll bet you MONEY that in 10 years there will be better statistics on the topic, because right now there seems to be an ongoing controversy regarding the best practice in bunion surgery. Read some articles on Podiatry Today. You'll be amazed at the conflicting opinions expressed.
My OPINION is this: Life is for Living. Once you know all of the facts, and after you hear everyone's opinion, you make the best decision for your health that is amenable to your Life, your work, your love, your family, your goals....and in America, your Finances. Your decision.
I have been reading your website and was truly amazed of how my situation is almost the same as yours. Just like you I also had a bilateral scarf bunionectomy last Jan. 14,2009 a day after your procedure was done. I still have swelling on my feet. Do you also still experience swelling at this time? If so, other than elevation, what else do you do to help relieve the swelling?
Hi Martina,
Well first, *disclaimer* I'm not a doctor and of course if you are having unusual swelling or pain, go see your doctor!
In terms of the swelling, I was told by my doctor that I would have a lot of swelling until approximately the 10th week. I would say that's turned out to be about right.
The NUMBER ONE thing I could tell made a difference for the swelling - AS WAS ADVISED BY MY SURGEON - was to wear my gym shoes at all times during all activities (unless resting or elevating). With that Silipos pad, some cushy socks, and my gym shoes; that combination created a good amount of compression that helped keep the swelling under control. For instance if I stood in the shower for 10 minutes barefoot, I could visibly see the increased swelling afterwards.
Other than shoes/compression; of course elevating my feet as much as possible was necessary, especially for the first 8 weeks. I found ice to be helpful at the end of the day.
Also, the doctor had me on Celebrex beginning right after surgery, with an Rx for 30 days with 1 refill allowed. At 30 days I decided I could be tough and go without the refill. Bad idea. This stuff rocks for reducing swelling.
At the 6th week I had a doc visit and was advised to resume taking SOME sort of NSAID to help keep the swelling down. Since I had a good tolerance of the Celebrex, I re-filled that Rx and took it again for about 20 days. Last week I was able to stop taking it. That's about 11 weeks after surgery. Not too shabby. I bet you're going to notice a big difference this week or next week since you're just a week behind me.
THANK you for writing, and please keep in touch! And ask your doctor if your swelling is abnormal!
Posted by: Martina Gates | March 29, 2009 at 07:12 PM