Bunion surgery

Bunionectomy is a type of orthopedic surgery performed to correct certain deformities of the foot using a variety of techniques. During the pocedure, a bunion is usually excised, and the big toe is restored to its original anatomical position. Sometimes the position of the other toes needs to be adjusted as well.

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What is a bunion?

A bunion (hallux valgus) is one of the most common deformities of the foot, a bony growth that forms on the joint at the base of the big toe.

Normally the big toe is parallel to the others. However, in the presence of a bunion, it often bends in the direction of the other toes causing the joint stick out and become sore and red.

Rarely, a smaller bunion can develop on the joint of the little toe. It is called bunionette or tailor bunion.

How does a bunion develop?

Bunions most often occur due to an abnormal foot structure. Some deformities, such as flatness of the forefoot, an excessively flexible ligament, and abnormal bone structure can all contribute to the development of bunions.

There are many things that can contribute to the development of bunions such as:

Congenital deformities of the foot
Genetic predisposition
Certain injuries

Experts disagree on whether tight, high-heeled or too-narrow shoes can cause bunions or whether footwear only enhances bunion development in people who are already predisposed tot he condition. Women are more prone to the condition than men, and it is more often seen in elderly people than in younger patients.

Bunions might also be associated with certain types of inflammatory arthritis, such as rheumatoid arthritis. Bunions are often accompanied by hammer toe.

Do bunions cause any symptoms?

The signs and symptoms of a bunion include:

the presence of a bony growth on the outside of the base of your big toe
swelling, soerness and redness around the base of the big toe
corns and calluses
persistent or intermittent pain
restricted movement of the big toe

A tailor’s bunion causes similar symptoms on the outside of the foot near the little toe. It may lead to the widening of the forefoot, resulting in pain and irritation when wearing narrow shoes.

How is bunion treated?

The aim of any type of bunion treatment is to restore the balance of the foot and to prevent or slow the progression of deformities. Once anatomical changes have taken place, they can only be reversed surgically. Conservative treatments can only be effective in the early stages.

The most important thing you can do to prevent the development of bunions or to stop them from worsening is to wear the right kind of shoes. They can ease your pain by putting less pressure on the inflamed area. If possible, wear low-heeled (no more than 2-3 cm or 1 inch) shoes with a deep toe box, made of flexible material. The sole should bend easily. Make sure that your toes don’t reach the tip of the shoe.

As a part of conservative therapy, it is recommended to do exercises aimed at strengthening the muscles of the arches of your feet. Pain and inflammation can be relievedby taking with over-the-counter anti-inflammatory medication.

Special medical equipment can also contribute to pain relief and better allignment of the joint. The use of toe splints at night and silicone protectors or separators during the day can temporarily correct the angle of the big toe and ease the pain.

Normal anatomical structure of the joint can only be restored surgically.

When is surgery recommended?

Bunionectomy is recommended when conservative therapy fails to provide relief, the patient’s quality of life is significantly impacted, the complaints worsen, or the deformity cannot be corrected in any other way.

What happens during bunion surgery?

During your first appointment your orthopedic specialist will provide you with detailed information regarding the preoperative tests you need to undergo, the surgery itself (techniques, potential risks and recovery), and aftercare.

The purpose of the surgery is to restore the original position of the big toe and the metatarsal bone. This can be achieved by various methods; The degree and angle of deformity as well as the patient’s age and physical condition play a significant role in the surgeon’s choice of technique, which will determine how much tissue is removed and whether or not bone repositioning will occur.

In some cases, temporary implants are used (screws, wires or metal plates) which can be removed after 6-12 weeks. This type of surgery can be performed under general or regional anesthesia, your doctor will give you detailed information about both before you sign the informed consent form.

Are there any risks associated with the operation?

Bunionectomy is a very safe procedure. However, as with any surgical intervention, there are some risks and possible complications to take into account before making a treatment decision. On rare occasions the surgical site may become infected and the resulting inflammation can spread to the surrounding tissue, potentially affecting tendons, muscles, blood vessels, nerves and bones. In most cases pharmaceutical treatment is sufficient to control the infection, but in severe cases further operation may become necessary.

What to expect after surgery?

Length of recovery and aftercare depend largely on the technique used to correct your joint. Your doctor will discuss the surgery with you in detail during the first appointment,, as well as what to expect after the operation in your particular case. There are some general guidelines, however:

On the day after surgery the dressing on your wound will be changed and you will likely be ready to leave the hospital. Stitches removal will take place 10 to 12 days later. If meatllic implants were used, your doctor will remove them 4 to 8 weeks after surgery.

You should try and keep your weight off your foot and rest in the first few days following your discharge from hospital. You may be required to learn some exercises to help strenthen your foot and to wear special surgical boots for a few weeks instead of your usual shoes. Expect your foot to remain swollen to some degree for several months after bunion removal. Wear shoes with ample room to minimize your pain. Women should try to avoid wearing high heels for at least six months after bunion removal.

What happens if a bunion is not treated?

Without treatment, foot deformities tend to deteriorate. In case of a bunion this usually means intermittent periods of inflammation and increased pain.

It is strongly recommended to seek treatment for deformities such as bunions as soon as possible. It is likely that conservative treatment such as changing your shoes or using padding or shoe inserts and taking medication for a short while will relieve your symptoms. However, if these approches do not seem to help or you have frequent recurrences, surgery might be necessary, otherwise the smaller joints of the forefoot can suffer as well, eventually affecting the position of the ankle, knee and hip joint leading to more pain.