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1ST MTP CHEILECTOMY

Arthritis is the loss of the cartilage, Teflon-like coating, on the ends of the bones.  As this smooth surface erodes, the joint becomes swollen, painful, and spurring occurs.  Arthritis is most frequent following some injury, but can also be seen due to wear and rear.  The early signs of arthritis include spurring of the joint.  The spurs are most common of the dorsal or top of the joint.  This can cause pain with shoes being too tight and causing pressure over the spur and can also cause pain with motion of the joint due to the spurs hitting together.  Initial treatment may involve medications, such as glucosamine and anti-inflammatories, shoe modification, such as a rigid shoe or carbon insert to limit motion and activity modification.  In more severe cases surgery is required.  During this surgery the spurs are shaved down and allow for better motion and the lump from the spur is removed.  This surgery is performed as an out patient.  The surgery is generally very successful at eliminating the pain.  You will have some swelling for six to nine months following surgery, this is normal.

As with any surgery there are risks, these include infection, bleeding, and numbness.  We try hard to make your surgical experience as pleasant as possible and find the following points helpful.

  1. We use a re-circulating cold water unit called a “Polar pack.”  Mark with Pacific Medical will contact you before the surgery date and have you pick this up.  Bring this with you to surgery as it will be applied during surgery.  The polar pack helps greatly with decreasing swelling and decreasing pain.  Turn the polar pack off every 2 hours for 15 minutes to prevent your foot from becoming too cold.
  2. Elevation will help with pain and swelling.  You need to elevate your foot above your left shoulder constantly for the first 72 hours and then frequently the first 10-14 days.
  3. You will be in a bunion shoe following surgery.  You need to wear this 24 hours as day for the first 10 days.
  4. You will have a moderate amount of bleeding the first night of surgery, this is normal.  We see you the following day for a dressing change.  You will have another appointment 10-14 days following surgery.  At this time we obtain an xray and remove your stitches.  You need to keep your foot dry until this appointment.  After the appointment you are allowed to get back into a regular shoe and start working on motion of your toe joint.  You will have another appointment six weeks from surgery to evaluate your progress.
  5. You will be non-weight bearing for the first couple days following surgery.  You will need to bring crutches or a rollabout with you to surgery.  A list of providers is supplied.
  6. In order to minimize pain after surgery, we generally use regional anesthesia, called a popliteal block, so you will have no pain for 6-18 hours following surgery.  During this time your foot and ankle will be numb and will not support you.  In addition, it is important that you begin your pain medication before this block wears off as you will have increased pain.  Generally we recommend you start your pain medication when you get home and then set your clock to awake throughout the night to take the medication to help stay on top of the pain.  Below are listed the common medications and their dosages:

If you have questions or concerns please feel free to contact your physcian's nurse at
323-2600.

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