Bunion surgery is a procedure that permanently corrects deformities caused by hallux valgus, which is a bony mass that forms over the joint at the base of the big toe. It is typically recommended bunion pain persists even after more conservative measures, like wearing orthotics or taking analgesics.
The type of surgery performed may vary depending on the person's age and the type of deformity that has formed. In most cases, it consists of cutting the big toe bone and placing the toe in its correct alignment. The new position of the toe is usually fixed using an internal screw, but in some cases, the doctor may opt to also insert a prosthesis.
Bunion surgery is usually performed under local anesthesia, and patients are typically discharged a few hours after the procedure is performed.
When surgery is indicated
Bunion surgery is usually performed when other, more conservative measures have not been sufficient in relieving discomfort. Your doctor may recommend bunion surgery if you regularly experience:
- Very intense and constant pain
- Chronic swelling of the big toe
- Deformation of the other toes
- Difficulty walking
- Difficulty bending or straightening the big toe
This surgery should not be performed for solely cosmetic purposes when the patient does not present with other symptoms. Before offering bunion surgery, the doctor will likely evaluate the effect of other treatments, like physiotherapy and using orthotics.
Types of bunion surgery
There are several types of surgical approaches your doctor can consider when correcting a bunion. The type of bunion surgery performed will depend on factors like the shape and size of the bunion, if the bony lump is mild or severe, the patient's bone quality, and whether the patient has a history of joint disease.
Some types of bunion surgery available include:
1. Osteotomy
This type of bunion surgery involves cutting the bones in the big toe to realigning the joint. The bone is normally fixed into place using a plate or screw to ensure the bone remains straight and in position.
The cut can be done in several areas of the big toe, depending on the patient's condition, while some cases may also require removal of some bone tissue to help support alignment.
2 Arthrodesis
This procedure is also referred to as a joint fusion, and involves shaving off arthritic surfaces of the joint tissue, and then inserting screws or wires to hold the surfaces together until the bone is healed.
This type of procedure is typically advised for very severe cases of deformity, or in patients with severe arthritis in the big toe joint.
3. Exostectomy
This bunion surgery involves the total removal of the bony bump that has formed on the big toe. It is usually done in combination with other procedures, as it does not resolve misalignment of the toe, which can lead to a new bunion forming.
4. Minimally invasive surgery
This bunion surgery is done through small incisions on the big toe through which the bone is cut and realigned in the joint. It is associated with less scarring and a quicker recovery time, and is often recommended for mild to moderate cases of bunions.
In addition to removing the bony lump, the doctor may also need to repair the tendons and/or ligaments around the big toe to reduce imbalances that tight or loose tissue can cause.
What is recovery is like?
Recovery time from the surgery depends on the type of surgery perform, as well as the patient's bone quality and overall health status. In most cases, patients can return home as soon as they regain sensation in their legs and have successfully urinated on their own.
Wound care following surgery is important to reduce the risk for infection. The doctor will likely advise you to avoid getting the dressing wet. Your doctor will set a specific time for healing and stitch removal.
In the first few weeks after your surgery, patients will usually be prescribed a splint or orthotic to maintain toe alignment. Walking and weight bearing should also be avoided or significantly reduced. From the third week onward, depending on your doctor's instructions, you may be cleared to partially or fully weight-bear, with our without the use of a cane.
Recommendations after surgery
Some recommendations after surgery include:
- Keeping the foot elevated to promote lymphatic drainage and reduce inflammation;
- Applying ice to the area to help reduce swelling (being sure to avoid direct contact of the ice to the incisions)
- Using footwear as recommended, to relieve pressure on the operated area
- Using analgesics as prescribed to manage pain
- Participating in physiotherapy as advised to prevent stiffness and strengthen the foot and leg muscles
- Gradually returning to your daily activities at home, as approved by your doctor or physiotherapist
- Monitoring for signs of complications, like fever, swelling or severe pain at the surgical site
If you do notice signs of worsening or complications, you should advise your orthopedic surgeon.
Shoes to wear
When recovery from bunion surgery, you should wear the shoes advised by your doctor physiotherapist for at least 2 to 4 weeks. They may additionally prescribe orthotics and splints. Following this time, you should opt for comfortable running shoes that are not too tight.
Possible risks
Bunion surgery is considered to be a safe procedure, but it may present with risks like:
- Misalignment of the big toe
- Persistent pain
- Changes in sensitivity
- Infections
- Arthritis
- Joint stiffness
- Poor bone healing
It is also possible to develop an infection in the surgical area, which can present iwth redness, increased pain, swelling, heat in the area and a fever. You are advised to report these symptoms to your surgeon if they appear.