Bunions and braking time

Patients often ask how long they need to wait before returning to normal activity after an operation.

A study reported in the Journal of Bone and Joint Surgery (America) at the end of 2008 used a novel method to look at recovery time after a first metatarsal osteotomy for symptomatic hallux valgus.

Graeme Holt and his colleagues from Glasgow Royal Infirmary showed that a good test of the degree of healing after bunion surgery was to see whether the patient was able to perform an emergency stop while driving. Because of the danger of sending patients out on the roads, the study used a modified driving simulator.

Twenty-eight patients who had undergone unilateral first metatarsal osteotomy on the right foot were assessed before the operation and again at two- and six-week intervals afterwards. Also tested was a control group of 28 people matched for age, driving ability and sex.

The reaction time and braking time — and thus total brake response time — were measured for each person and found to be lower for the control group compared with the preoperative results for the patients.

Clearly the discomfort caused by the presence of the bunion already affected the patient’s ability to perform an emergency stop — a worrying thought for the rest of us.

Only eight patients were able to finish the test procedure at two weeks after the operation. However, all were able to complete the study after six weeks. Indeed their total brake response times had significantly improved when compared with their individual preoperative results.

This study suggests that six weeks is sufficient time for the emergency brake response time to return to preoperative levels and thus is a measure of when a return to normal activity can be recommended.