A. About the bunion condition and syndesmosis procedure

1. What can I do to prevent the deformity from getting worse?

a.	Wear as little as possible high heel and pointed shoes.
b.	Use foot orthoses with properly positioned longitudinal and transverse arch supports.
c.	Wear silicon toe spreader or like for walking.
d.	Night splints provide limited temporary relief.
e.	No specific foot exercises have been proven effective.

2. When should I start to consider surgical treatment?

Usually when pain becomes interfering with daily activities and recreational sports. To prevent arthritis of the big toe, surgery should also be considered when the deformity becomes bad enough at a relatively young age even though there may not be significant symptoms yet.



3. If I have a family history of hallux valgus (bunion) deformities, will I be likely to develop more severe deformity than average?

Heredity plays a strong role in many bunion patients. If deformity started early in life (<20 y/o) it tends to become more severe especially with wrong type of shoes.



4. Many people who had bunion surgery said it was painful and took them long time to get back to pre-surgery level of activities, is it true?

Yes, it can be the case mostly for people who have had the conventional osteotomy or "break & shift" surgeries. But syndesmosis soft tissue procedure does not need to break any bones and therefore the pain after surgery is minimal, and the recovery period is not as incapacitating either.



5. Are there any artificial materials being used and needed removal later?

The only artificial or foreign material used in this procedure is dissolvable sutures. There is no need to remove them. They are the same suture materials as used in other surgeries.



6. What are the possible complications that can occur after the syndesmosis procedure?

Complications are possible but few and mild in comparison to the conventional "break & shift" surgeries. The commonest complication is slight numbness of a small area on the top of the big toe. Wound infection rate is less than one percent. Recurrence is possible in about 15% of cases, but usually partial and mostly related to excessive walking in the first three months after surgery.



7. Do medical insurances cover bunion surgeries?

Yes, they should because bunion surgery is primarily for pain alleviation and function improvement of the foot. Cosmetic improvement happens to be a nice bonus. But it is more advisable to consult your insurance company.



8. What is the surgery charge?

It depends on different cases and please contacts our staff by phone: 2525-5035



9. Can syndesmosis procedure be repeated if necessary?

Yes, should the initial syndesmosis bridging fail, the same procedure can be repeated without any significant consequence since this procedure does not burn any bridges each time.

B. About the recovery procedure

1. What is the recovery like for the syndesmosis soft tissue procedure?

After the surgery:

2 days:	weight-bearing walking can be started.
10 days:	remove stitches
10 days to 3 months:	A protective custom-made foot splint is applied. Walking is usually not a problem at all but should be strictly restricted to avoid possible interference with the internal syndesmosis healing process. (Crutches are recommended for the first 1-2 weeks for safety and comfort.)
3-6 months:	remove foot splint, comfortable walking shoes with shoe inserts and gradually increase walking is highly recommended.

Foot Splints	Cast Shoe

2. How long does the surgery take for recovery: normal function, back to office/school…?

a.	Normal office/school:	3 weeks [Normal leave from doctor, but it is more advisable to have a longer leave from the company if possible] (prevent heavy walking, selected means of transportation to minimize walking)
b.	Driving:	3 months
c.	Athlete/Sports:	6 months
d.	Swimming:	2 weeks

3. Procedure before the surgery, the surgery will undergo in the hospital or clinic?

a.	Procedure:	1. Consultation to doctor
		2. X-Ray and Foot function (F-Scan ®)
		3. Issue admission letter
		4. Normally, patient needs to wait for 2 weeks for surgery (subject to the availability of doctor and hospital, special arrangement when necessary)
a.	Surgery will undergo in hospital.

4. How long do I need to stay in the hospital?

Normally, 3 days for both feet and 2 days for one foot.



5. Is the surgery painful? What kind of anesthesia will the surgery take, can it be local one?

a. Little painful only, patient can normally start to walk within one day.
b. General anesthesia will be taken. Local one is not available right now.



6. How can I do with the foot splint on my foot during the recovery period?

a. Need to wear the foot splint when there is a pressure insert on the foot e.g. walking and standing.
b. Foot elevation on sitting to prevent foot swelling
c. Can take off the foot splint when sleeping, sitting and taking bath.
d. Need to wear cast shoes in PVC, wooden or ceramic floor with foot splint to prevent slipping down.



7. Before the consultation, do I need to have the referral letter from my family doctor.
It is not necessary for our center but it depends on the terms of your insurance company, it is better to consult with your insurance company before.



8. Can I ever wear high heels again?
Although some patients have gone back to high heel shoes on their own and still had no problems after many years, we advise no high heels for the first six months after surgery and only in moderation thereafter.



9. Is physiotherapy needed?
Physiotherapy is rarely needed. There is a period of 3-6 months of the big toe joint feeling stiff but toe movement exercise done by patients themselves is usually sufficient.