Most people with bunions find pain relief with simple treatments to reduce pressure on the big toe, such as wearing wider shoes or using pads in their shoes. However, if these measures do not relieve your symptoms, your doctor may recommend bunion surgery.
There are different types of surgeries to correct a bunion. Bringing the big toe back to its correct position may involve realigning bone, ligaments, tendons, and nerves.
Are You a Candidate for Surgery?
In general, if your bunion is not painful, you do not need surgery. Although bunions often get bigger over time, doctors do not recommend surgery to prevent bunions from worsening. Many people can slow the progression of a bunion with proper shoes and other preventive care, and the bunion never causes pain or other problems.
It is also important to note that bunion surgery should not be done for cosmetic reasons. After surgery, it is possible for ongoing pain to develop in the affected toe — even though there was no bunion pain prior to surgery.
Good candidates for bunion surgery commonly have:
· Significant foot pain that limits their everyday activities, including walking and wearing reasonable shoes. They may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain.
· Chronic big toe inflammation and swelling that does not improve with rest or medications
· Toe deformity—a drifting in of the big toe toward the smaller toes, creating the potential for the toes to cross over each other.
· Toe stiffness—the inability to bend and straighten the big toe
· Failure to obtain pain relief with changes in footwear
· Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. The effectiveness of NSAIDs in controlling toe pain varies greatly from person to person.
Deciding to Have Bunion Surgery
After bunion surgery, most patients have less foot pain and are better able to participate in everyday activities.
As you explore bunion surgery be aware that so-called "simple" or "minimal" surgical procedures are often inadequate "quick fixes" that can do more harm than good. Although many bunion procedures are done on a same-day basis with no hospital stay, a long recovery period is common. It often takes up to 6 months for full recovery, with follow-up visits to your doctor sometimes necessary for up to a year.
It is very important to have realistic expectations about bunion surgery. For example, bunion surgery may not allow you to wear a smaller shoe size or narrow, pointed shoes. In fact, you may need to restrict the types of shoes you wear for the rest of your life.
As you consider bunion surgery, do not hesitate to ask your doctor questions about the operation and your recovery. Some examples of helpful questions to ask include:
- What are the benefits and risks of this surgery?
- What are the possible complications and how likely are they to occur?
- How much pain will there be and how will it be managed?
· Be sure to write down your doctor's answers so you can remember them at a later time. It is important to understand both the potential benefits and limitations of bunion surgery.
In general, the common goals of most bunion surgeries include:
· Realigning the metatarsophalangeal (MTP) joint at the base of the big toe
· Relieving pain
· Correcting the deformity of the bones making up the toe and foot
Because bunions vary in shape and size, there are different surgical procedures performed to correct them. In most cases, bunion surgery includes correcting the alignment of the bone and repairing the soft tissues around the big toe.
Your doctor will talk with you about the type of surgery that will best correct your bunion.
Lapiplasty: An innovative approach to anatomic bunion correction
The new, patented LAPIPLASTY® system is designed to deliver unmatched control and reproducibility to bunion correction by positioning the deformity in anatomic alignment (all three dimensions), performing precision joint cuts with correction held in place, and easy-to-apply multiplanar fixation. In other words, this procedure truly fixes the deformity in proper anatomic alignment, and it is the only procedure that can make that claim.
This procedure was developed by Drs. Mindi and Paul Dayton, partners of the Foot and Ankle Center. We at the Foot and Ankle Center strive to provide the best treatment options for our patients.
For more information on the procedure, refer to the Lapiplasty website or set-up an appointment with our surgeons.
Balancing the soft tissue around the great toe
In some cases, the soft tissues around the big toe may be too tight on one side and too loose on the other. This creates an imbalance that causes the big toe to drift toward the other toes.
Surgery can shorten the loose tissues and lengthen the tight ones. This is rarely done without some type of alignment of the bone, called an osteotomy. In the majority of cases, soft tissue correction is just one portion of the entire bunion corrective procedure.
In an osteotomy, your doctor makes cuts in the bones to realign the joint. After cutting the bone, your doctor fixes this new break with pins, screws, or plates. The bones are now straighter, and the joint is balanced.
Osteotomies may be performed in different places along the bone to correct the deformity. In some cases, in addition to cutting the bone, a small wedge of bone is removed to provide enough correction to straighten the toe.
As discussed above, osteotomies are normally performed in combination with soft tissue procedures, as both are often necessary to maintain the big toe alignment.
In this procedure, your doctor removes the arthritic joint surfaces, then inserts screws, wires, or plates to hold the surfaces together until the bones heal. Arthrodesis is commonly used for patients who have severe bunions or severe arthritis, and for patients who have had previous unsuccessful bunion surgery.
The x-ray on the left shows severe arthritis of the MTP joint. After arthrodesis (shown on the right), the entire foot is realigned. An advantage of arthrodesis is that no additional procedures are necessary to correct the bunion.
In this procedure, your doctor removes the bump from your toe joint. Exostectomy alone is seldom used to treat bunions because it does not realign the joint. Even when combined with soft tissue procedures, exostectomy rarely corrects the cause of the bunion.
Exostectomy is most often performed as one part of an entire corrective surgery that includes osteotomy, as well as soft-tissue procedures. If a doctor performs exostectomy without osteotomy, however, the bunion deformity often returns.
The x-ray on the left shows a mild bunion bump before exostectomy. After the procedure (right), the bump has been shaved but the toe deformity remains and is actually worse; the big toe drifts closer to the other toes and the metatarsal bone sticks out further.
In this procedure, your doctor removes the damaged portion of the joint. This increases the space between the bones and creates a flexible "scar" joint. Resection arthroplasty is used mainly for patients who are elderly, have had previous unsuccessful bunion surgery, or have severe arthritis not amenable to an arthrodesis (see above). Because this procedure can change the push-off power of the big toe, it is not often recommended.
This x-ray shows a failed resection arthroplasty. Although the damaged bone of the MTP joint was removed, scar tissue did not fill the space between the bones. The bone edges are still in contact. The photograph shows that without the needed scar tissue, the big toe is shortened. This makes it more difficult to push off while walking.
Preparing for Surgery
Before your surgery, you may be asked to visit your family doctor for a complete physical examination. He or she will assess your health and identify any problems that could interfere with your surgery. If you have a heart or lung condition or a chronic illness you will need a preoperative medical clearance from your family doctor.
Tell your doctor about any medications you are taking. He or she will tell you which medications you can continue taking and which you should stop taking before surgery.
You may require several preoperative tests, including blood counts, a cardiogram, and a chest x-ray. You may also need to provide a urine sample.
To help plan your procedure, your doctor may order special foot x-rays. These x-rays should be taken in a standing, weight-bearing position to ensure your doctor can clearly see the deformity in the foot. These x-rays assist your doctor in making decisions about where along the bone to perform an osteotomy in order to provide enough corrective power to straighten the toe.
In planning your surgery, your doctor will consider several things, including how severe your bunion is, your age, your general health and activity level, and any other medical issues that may affect your recovery.
Almost all bunion surgery is done on an outpatient basis. You will most likely be asked to arrive at the hospital or surgical center 1 or 2 hours before your surgery.
After admission, you will be evaluated by a member of the anesthesia team. Most bunion surgery is performed with anesthesia that numbs the area for surgery but does not put you to sleep.
· Local anesthesia. An ankle block numbs just your foot.
· Regional anesthesia. A popliteal block works for a longer period of time compared to an ankle block and numbs more of the leg. The numbing medicine is injected behind the knee.
· Spinal anesthesia. This injection will numb your body below your waist.
· General anesthesia. This form of anesthesia will put you to sleep.
The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.
Depending upon your bunion and the procedures you need, your doctor will make an incision along the inside of your big toe joint or on top of the joint. In some cases, more than one incision is needed to correct the bunion deformity.
The surgical time varies depending on how much of your foot is malaligned. Surgery will take longer if your deformity is greater or if more than one osteotomy is required. Every bunion correction is a little bit different, and there is no reason to be concerned if your surgery takes more time.
Afterward, you will be moved to the recovery room. You will be ready to go home in an hour or two. Be sure to have someone with you to drive you home.
As with any surgical procedure, there are risks associated with bunion surgery. These occur infrequently and are usually treatable — although, in some cases, they may limit or extend your full recovery. Before your surgery, your doctor will discuss each of the risks with you and take specific measures to avoid complications.
The possible risks and complications of bunion surgery include:
· Thick and ugly scar
· Nerve injury
· Failure to relieve pain
· Failure of the bone to fully heal
· Stiffness of the big toe joint
· Painful hardware
· Recurrence of the bunion
· Blood clots
Recovery at Home
The success of your surgery will depend in large part on how well you follow your doctor's instructions at home during the first few weeks after surgery. You will see your doctor regularly for several months — occasionally up to a year — to make sure your foot heals properly.