Braking After Bunion Surgery

Newswise — Six weeks following bunion surgery, most patients' pain levels are so low that they are able to get back behind the wheel of a car again. A study published in the August 2008 issue of The Journal of Bone and Joint Surgery also found that emergency brake time response in patients who underwent a first metatarsal osteotomy (a common surgical treatment for bunions) is similar to that of healthy individuals just six weeks later.

"It is probably not advisable to drive before six weeks after bunion surgery on the right foot—our research shows that the reflexes and the power required to brake suddenly in an emergency is fully returned only at six weeks in the post-operative period," says Graeme Holt, MBChB, MRCS, an orthopaedic surgeon at Glasgow Royal Infirmary in the United Kingdom and co-author of the study. "However, it is extremely important for all patients to discuss when they can return to driving with their surgeon after having any type of surgery to their foot."

This study focused on patients who were treated for hallux valgus, a condition that occurs when the big toe begins to angle sideways, toward the second toe, causing a bump on the side of the foot just below the big toe. This bump is called a bunion, and can become swollen and painful.

"¢ More than half of women in the United States have bunions."¢ 90 percent of those who suffer bunion problems are also women. "¢ Tight shoes and shoes with heels that are too high are thought to increase the risk of bunions; genetics may also play a role.

In some cases, bunions make it very painful to walk. When this happens, surgical treatment may be required to realign the bone, ligaments, and tendons and bring the big toe back to its correct position. After this surgery, many patients main concern is about their ability to drive a car.

The researchers studied 28 patients who underwent a first metatarsal osteotomy for hallux valgus on the right foot, using a custom-made driving simulator to assess:"¢ total brake response time (the time for the entire braking process)"¢ reaction time (the time it takes for a person to perceive a danger and to decide on a motor response)"¢ actual brake time (the time it takes to lift the foot off of the accelerator pedal, move it to the brake pedal, and then depress the pedal)

Patients were assessed before surgery, and at two and six weeks after surgery. A control group of twenty-eight individuals matched for age, driving status, and sex was also included for comparison.

At two weeks after surgery:"¢ Only 25 percent of patients were able to complete the test, and the reaction time, brake time, and total brake response time were just slightly higher than they had been before surgery.

At the six-week review:"¢ Patients' reaction, brake, and total brake response times were better than they had been before the bunion was repaired.

This is the first study to specifically address this concern, which is not only a safety concern for the patient, but for the public as well. "Before we started this project, we contacted multiple government agencies and insurance companies to find out what advice patients are given about driving after foot surgery and were very surprised to learn that no guidance existed," Holt says. "We found this not only surprising, but also unsatisfactory; anecdotal experience told us that patients are generally allowed to drive after a period of six weeks after other lower limb surgery, but no research existed before our study to support this advice."

Patients who return to driving before six weeks risk reinjuring the foot if they have to brake in an emergency.

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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.