Bunionectomy: Preparing the Home in Advance of Surgery

What is a Bunionectomy?

Patients may rely on the experience of a family member or friend who was up and walking on the day of surgery or, to the contrary, was laid up for weeks. The recovery process is individual and should be discussed with the surgeon in advance.

Bunionectomies are typically outpatient procedures. The extent of surgical intervention to repair a foot with a bunion varies, but most will correct tendons, ligaments, and joint capsules to correct the big toe position. The first metatarsal and often the proximal phalanx are cut and repositioned, which straightens the big toe. More severe bunions may also require a joint fixation. Surgeons stabilize the foot with screws, plates, wires, or specific bandaging techniques.

Patients and family may not be aware that the recovery process after a bunionectomy is long and tedious. There can be significant pain for the first 3 to 5 days post-surgery. Typically narcotics are prescribed to manage the initial post-op pain.  Pain pills, impaired mobility, and the use of assistive devices create a fall risk.

Points to Discuss with the Surgeon

Ask the surgeon what they will apply during surgery, such as a soft cast or a boot. It is important to know what weight-bearing status is allowed upon arriving home from surgery. The patient should be educated about the levels of weight bearing. Some patients are allowed to walk in a boot with heel touch immediately post-op. However, the reality is that often it is too painful to walk for 3 to 5 days. Imagine stepping on legos on a hardwood floor. In that case, crutches or a knee scooter are lifesavers. Other patients may be non-weight-bearing for weeks post-surgery. Assistive ambulatory devices, as recommended by the surgeon, should be ready at home when the patient returns from surgery. This may include crutches or a knee scooter. This is no time for trial and error.

Safety

The surgeon will want the site to be kept dry initially. Ask when showering is allowable and how to keep the site dry. It is important to contact their office promptly if the site accidentally gets wet. In the first few days, it may be necessary to cleanse the body with wipes or a washcloth instead of showering. Have a supply of hypoallergenic wipes at the bedside.

When the patient can shower, falls and slips are a concern. Grab bars in the shower, and a shower chair can help considerably.

A toilet seat riser with handles helps those who are non-weight-bearing. A bedside commode is an option if a knee scooter does not fit in a bathroom, provided that someone is able and willing to empty and clean it.

Remove any rugs that pose a tripping or slipping hazard.

If the patient's home has steps or stairs, practice maneuvering these obstacles in advance of surgery with the assistive device/s. Consider if there are alternative routes into the home or a sleeping space for post-surgery that doesn't require the obstacles.

Practice balance, turn, and pivots using the non-surgical extremity in advance of surgery.

Meals and Hydration

Bedside

Initially, have several water bottles at the bedside. Pain pills are generally taken with food. Place a box of crackers or bars at the bedside for pill time. Have a piece of paper and pen in reach to record the amount and timing of pain pills.

Meals

Most patients will be taking narcotics for pain for at least the first few days post-op. Constipation is a concern that one must address proactively. Keep prunes in reach for snacking. Colace and Miralax are also helpful to encourage bowel movements.

Set up an account for grocery delivery prior to surgery. Consider if assistance will be needed to bring in the groceries and put them away. If so, enlist a friend or family member's help.

Taking a bit of time to meal prep several individual meals in advance of surgery will pay off post-op.

Accept offers for meals from family and friends. Let them know any dietary restrictions and what size of the meal might be helpful.  A full-size lasagna may be helpful for a family but overwhelming to a couple or single person. Ask them to divide the meals into single-serve containers if that would be helpful.

Comfort

Consider customized ice packs such as ice pack slippers for the foot. A wedge pillow to elevate the extremity is easier to manage than a stack of pillows. Purchase padding for assistive devices such as crutches and knee walker. A shoe leveler is an item available at medical supply stores that attaches to the shoe of the non-impacted extremity allowing the hips to be level when wearing a boot. Set aside clothing that will fit over the swollen foot or cast, such as wide-legged pants. Laying out a few outfits (including socks and underwear) will save precious steps post-op.

Supplies

Put together some essentials in a small zipper bag. Keep it at the bedside or in the basket of the knee walker. Include over-the-counter pain relievers, eye drops, daily meds in a pill organizer, lotion, a small hair brush, reading glasses, acid reducer, lip balm, breath mints, dry shampoo, and cleansing wipes for face and body.

Pets

An excited pet may cause a fall initially while the patient is adjusting to assistive devices and taking pain medication.  Dogs, in particular, need to be let out, fed, watered, and exercised. Consider short-term boarding or a stay with friends/family.

FACT:  Patient education, proactive discussions with the surgeon, and a bit of planning can make the home a safer and more comfortable haven for recovery.

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References/Resources

Bunions: Bunion Surgery: NIH