Everything you need to know when considering bunion surgery. For people who have bunions and want to understand how to surgically correct bunions.
Medical Term: Hallux Abductovalgus
A bunion occurs when the big toe begins to deviate towards the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While this may be true in very few people, the bunion really represents a dislocation or subluxation of the big toe joint and it bulges against the skin. This bony prominence is what is commonly called a bunion. Sometimes the bunion area may become irritated, red and/or callused.
No! Bunions are not created equal. They come in different sizes and shapes.
A bunion is graded on how spread apart the bones of the foot are. To learn more about the bones of the foot, see Anatomy Of The Foot
Specifically, doctors look at an X-ray measurement called the intermetatarsal angle to help determine the severity of the bunion.
Heredity and shoe gear are probably the most likely reason for you to develop a bunion. Bunions occur gradually over time. Tight and/or pointy shoes that crowd the toes may result in a bunion. High heels are also suggested to cause bunions as well. See Causes of Bunions
It’s hard to say. Some bunions may progress rapidly while other bunions slowly get bigger over several years. It may begin during adolescence and slowly progress. Some people have painful bunions in their teens while others only develop pain in their 40’s, 50’s, or 60’s.
No. Size doesn’t always matter. Some bunions hurt and some do not. The size of the bunion doesn’t always correlate with pain. Bunions that are made painful by shoe gear tend to be larger. Some small bunions may be excruciatingly painful.
It could be! When the bunion pushes against the second toe, it is typically is a good indicator that you have a moderate to severe bunion. Over time, the big toe may force itself under second toe – causing the second toe to buckle (this is called a hammer toe). The second toe could become painful as well.
Not all bunions require surgery and they can be managed conservatively. The most common things to try are wider shoes, inserts (orthotics) and activity modifications. See Non-surgical Bunion Treatment
The decision to have bunion surgery is personal and different everyone. While there are many reasons to have bunion surgery, the most common reasons include:
Some people have surgery simply because they don’t like the way the bunion looks. While some doctors may correct your bunion if it doesn’t hurt, you should be aware that permanent pain may occur after your surgery.
Bunion surgery is most often performed as an out-patient – this means you go home that same day. It will likely be done at a hospital or out-patient (ambulatory) surgery center. The anesthetic choices with bunion surgery are local with sedation, spinal or general anesthesia – see Preparing for Surgery.
Because Bunions Come in Different Sizes And Shapes The Surgical Bunion Correction Should be Tailored Specifically To Your Bunion.
You wouldn’t expect that a small bunion would be treated exactly the same as a large one. Over the years, surgeons have developed dozens of methods to surgically correct bunions. But don’t worry because only a handful of methods are used today.
With most bunion surgeries today, the procedure involves a combination of soft-tissue balancing of ligaments and tendons as well as bone work to re-align the foot structure.
You may have heard people say they had their “bunion shaved.” In most cases, the surgery often involves much more than simply shaving the bunion. The shaving part of the procedure is called an “exostectomy” and often performed in conjunction with other methods.
The most significant portion of the bunion surgery is re-aligning the bones. This is performed through bone cuts or a fusion involving the first metatarsal. The severity of the bunion determines where the bone will be cut or fused.
Mild or moderate bunions can be corrected close to the big toe joint.
Moderate or large bunions often require that the bone work be performed further away from the big toe joint to swing the bone in the proper position.
As mentioned above, with mild cases, the bone is cut close to the big toe joint and shifted over into a correct position. The cut bone is held in placed with one or two surgical screws. With this procedure, just the top of the bone is moved over and the bottom of the bone remains in the same place. This technique is called the Austin bunionectomy and refers to type of bone cut that will be made by the Surgeon. For more information – see Austin Bunionectomy.
There is, however, a limit on how far one can move the bone over with this technique. Its is generally thought that the cut bone should only be moved over a distance equal to half the width of the bone. In somes the bone may be moved over further.
Larger bunions often require the surgeon to move the entire bone over (1st metatarsal). This is accomplished by a cut or fusion at the bottom of the bone. The former technique, is called the Lapidus bunionectomy. For more information – see Lapidus bunionectomy. Additionally, the repositioned bone is held in place with one or two surgical screws.
There is more than one way to surgically treat a bunion. While there are some general guidelines, some procedures work well for some Surgeons and poorly for others. Your Surgeon should consider the severity of your bunion, medical condition, lifestyle, and recuperation time when considering the surgical treatment.
If your surgery requires bone healing (and most do) then expect that it will take 6 weeks for the bone to mend. This is the normal (average) time frame for bone healing and cannot be made to happen any quicker.
There is often a period of rehabilitation that takes place, and it’s likely that you will not be back to your full activities and/or shoe gear for few weeks thereafter. Full recovery from bunion surgery may take up to 6 months. Expect to some take time away from work to recover, but the amount of time you will need off depends on your Surgeon (see Preparing for Surgery).
Some bunion surgeries allow for immediate walking in a bunion shoe, while other procedures may require you to be in cast with crutches. Larger bunions usually require a period of non-weightbearing.
Typically when the bone work is close to the big toe joint then it is likely that your Surgeon will allow you to walk after the surgery. This is usually the case for mild or moderate bunions.
When the bone work is further away from the big toe joint, then crutches and a cast of some sort may be needed. This is usually the case for moderate to large bunions. In some situations, you can bear partial weight – but this also depends on the recommendations of your Surgeon.
If you have a large bunion, it is very likely that you will have to use crutches for about 6 weeks.
It’s surgery – expect some pain afterwards. The procedure itself should be painless as you will have had anesthesia (see above). Before the Surgeon places the surgical dressing the operating room, he or she will often numb the foot with a long-acting anesthetic that should provide excellent pain relief to get you through the night. In addition, the post-operative pain will be managed with narcotics and/or anti-inflammatories. You will experience the most pain during the first three post-operative days – expect each day to be better than the last.
When it comes to bunion surgery, lasers are NOT typically used as they don’t offer any advantage to other techniques. Minimally invasive surgery for bunions was popular in the 80’s and 90’s. For most bunions, minimally invasive techniques don’t offer any significant advantages to standard techniques either.
In order to correct your bunion, metallic surgical hardware such as screws, staples, plates and wires are usually needed to stabilize the bones in their corrected position. Surgical stainless steel is most commonly used. You should be aware that Nickel is present in surgical stainless steel hardware and if you have an allergy you should notify your doctor prior to surgery. Titanium is also used, but not as commonly as stainless steel. Absorbable screws are also available, but are much less commonly used.
Most Surgeons will say that the hardware can be left in your foot permanently. Some people elect to have the hardware removed if it is close to the skin and irritating. Others simply prefer to have the hardware removed. You should discuss this with your Surgeon.
There are many factors that you should consider when choosing a surgeon. The two most important factors are probably experience and Board Certification. Your surgeon should give you realistic expectations. See Choosing a Surgeon
How does one measure success? It is estimated that 85% of people who have bunion surgery are satisfied with their outcome. Of the remaining 15%, most are improved but may still have some pain and limitations (shoe gear and/or activities). A smaller percentage of people may experience no benefit from bunion surgery or may be worse. The bunion may re-occur if the bunion wasn’t addressed correctly. see Risks