I had bunion surgery about two weeks ago. I'm still wearing the funky bunionectomy boot. But when it comes off, I'm thinking about seeing a physical therapist. They helped me so much after my knee surgery last year. Do you think rehab after a bunionectomy is necessary? No one has mentioned it to me at the doctor's office.

Physical therapy has been shown effective following many types of orthopedic surgeries (e.g., joint replacements, ligament reconstruction, bone fractures). A recent study from Gait Analysis Laboratory at the Foot and Ankle Center in Vienna, Austria showed how function can improve with rehab after forefoot surgery like bunionectomies.

A bunion deformity is referred to in medical terms as hallux valgus. Surgery to restore a more normal alignment of the toe is called a bunionectomy. The surgeon removes a pie-shaped piece of bone from one side of the big toe and wedges it on the other side of the joint to straighten it out. But studies have shown that even when the X-ray shows a surgical success, the patient may not resume a normal gait (walking) pattern. There is a tendency to shift the weight while walking away from the first toe to avoid pain and stay off the surgical site.

What can be done to help patients recover fully after surgery for hallux valgus? Physical therapists have demonstrated through this study that a multimodal rehabilitation program can help restore more normal weight-bearing and walking patterns. Physical therapy began four weeks after surgery with leg elevation, lymphatic drainage, gait training, manual therapy, and strengthening exercises. Manual therapy included release techniques for the muscles of the foot and lower leg as well as manipulations of the big toe, forefoot, and ankle. Specific training exercises to restore normal walking patterns were also part of the rehab program. Everyone had four sessions (once a week for four weeks) and did a home program of daily exercises as well.

Post-rehab testing showed marked improvement in function and motion along with a decrease in the maximum force placed on the first toe. Total motion did not change significantly but dorsiflexion of the big toe improved by five degrees. Dorsiflexion describes the movement of the big toe needed to push off from the ground to move forward.

Analysis of the plantar pressure patterns (weight and load placed through the foot) from before to after surgery showed improvement. This suggests improved function of the big toe in pushing off while walking. This particular finding helps support the benefit of physical therapy intervention after bunionectomy surgery. Although there wasn't a control group in this study (i.e., patients who had the surgery but did not have rehab), other before and after studies using plantar pressure data have not shown this type of change.

So there is some evidence that physical therapy can benefit patients who have had a bunionectomy. A short program of manual therapy, supervised exercises, and a follow-up home program may be all that's needed to get patients back on track with normal movement patterns. That's an important step in preventing uneven weight-bearing patterns that can lead to arthritis.

Reference: 

Reinhard Schuh, CM, et al. Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase. In Physical Therapy. September 2009. Vol. 89. No. 9. Pp. 934-945.

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