Also called hallux valgus, a bunion is a bony enlargement of the big toe joint, often accompanied by swelling and pain. In this foot deformity, the big toe points towards the little toe. Bunionectomy is the term used to describe the surgical removal of a bunion. It is often associated with an osteotomy, which is the cutting and repositioning of bone. More than 50 techniques of bunionectomy currently exist, named after the surgeons who created them.
Choosing Bunionectomy
While bunions can greatly deform a foot, cosmetic reasons alone should not motivate bunion surgery. Conservative measures are usually recommended, and only after these have failed, is surgery considered. Conservative treatment of bunions includes: rest and elevation of feet; wearing properly fitting shoes with wide toe-boxes; orthotics; protective pads for bunions; warm soaks; and anti-inflammatory medications.
Bunions are progressive and the head of the big toe may move more and more towards the little toe, and even deform the foot to the point of making it difficult for a person to find fitting shoes. Additionally, bunion pain may progress to the point of interfering with normal life activities. According to the American Orthopedic Foot and Ankle Society, most bunion cases do not require surgery unless there is disabling pain or an underlying deformity.
The purpose of bunion surgery is three-fold: to remove the bump, re-align the joint, and reduce pain as much as possible. The surgical technique chosen for a bunion case depends on many factors, including the patient’s age, activity level, health, the strength of the bones, and the severity of the bunion. Regarding severity, bunions can be mild, moderate, or severe.
Surgical Treatment Varies with Bunion Severity
Mild bunions are usually corrected by surgically shaving the bony excess on the outer side of the bones at the base of the big toe. All the muscles, tendons and ligaments that surround the toe joint are then re-aligned. While this would improve the appearance of the foot, the deformity that initially caused the bunion may not be corrected. Recovery from a mild bunion surgery can take 3 to 4 weeks, and a postoperative shoe is usually required.
Moderate bunion surgery is the same as for a mild bunion, with the addition of the cutting (osteotomy) of the head of the metatarsal, which is the bone below the toe joint. This is done to shift the metatarsal bone, and properly re-align it before fixing it with pins and screws. Recovery can take 4 to 6 weeks, and a short cast, plus crutches, may be needed.
Severe bunions require more complicated surgical treatment. In addition to cutting away bony excess on the outside of the base of the big toe, a wedge-like piece of bone is usually removed from the metatarsal bone. Then the bone is re-aligned and fixed with pins and screws. What’s more, with severe bunions, tendons and ligaments also need to be corrected. Sometimes the joint is beyond repair, and an artificial joint is needed. Recovery from severe bunion surgery can take 6 to 12 weeks. A short cast and crutches may be required during that time.
Recovering from Bunion Surgery
While total recovery time from surgery varies with the severity of a bunion, there are common traits. First, patients typically have to wear a big bandage and a post-operative shoe or cast, to immobilize the big toe and ensure surgical repair. Secondly, feet should be periodically elevated, to prevent swelling. Thirdly, the use of a cane, crutches, or a walker, is common during recovery.
Stitches are usually removed between one to three weeks after bunion surgery,. However, even at this point, a patient still has to be careful not to tamper with the dressings, and must wait for the surgeon’s “green light” to start bearing weight on a foot. Following bunion surgery, one can usually expect to only be able to wear athletic, soft-leather, or Oxford-style shoes for several months.
Potential Complications from a Bunionectomy
In many cases, there is some loss of the big toe joint motion after bunion surgery. Other potential complications include: delayed healing of the bone, irritation from the surgical pins and screws, joint stiffness, excessive scarring; prolonged swelling, and nerve damage. However, the most common complication from a bunionectomy is the re-appearance of the bunion.
No surgical procedure is risk-free. However, choosing a competent podiatric or orthopedic surgeon can lower the risk of complications. Successful bunion removal makes feet “happier,” as toes become less painful, shoes fit better, and walking becomes much more comfortable.
References
Current Diagnosis & Treatment in Orthopedics (4th Ed.); Harry B. Skinner, MD, PhD; The McGraw-Hill Companies, 2006
"What to Do About Bunions;" Dr. James P. Ioli, DPM; Harvard Women’s Health Watch, Feb 2004
Resources
Bunion Removal (Patient education)
Video Presentation of a Bunionectomy with Osteotomy
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