Bunions are one of the most common foot problems that surgeons encounter on a regular basis. While its exact cause remains unclear, advances in surgical techniques have offered patients relief from pain and better quality of life. There are many types of surgeries for bunions; it’s a good idea to learn as much as possible about the current treatment options available for you.
What are Bunions?
A bunion is a painful bump or swelling at the metatarsophalangeal (MTP) joint also known as the “big toe joint”. The terms bunion and hallux valgus are often used interchangeably, but they are not the same.
Technically, a bunion refers to soft tissue and bony enlargement which sometimes includes an inflamed bursa (a fluid-filled pouch that cushions the joint). Hallux valgus on the other hand refers to the deviation of the big toe from the normal position. Although bunions can occur without hallux valgus, this article discusses only bunions associated with hallux valgus.
In people with this condition, the first metatarsal bone gradually deviates towards the midline of the foot. As a result, the big toe moves towards the other toes (almost overlapping the second toe), and the metatarsophalangeal joint bulges out.
Most footwear doesn’t accommodate the resulting bump and put additional pressure on an already malformed joint. The bursa often becomes inflamed and the entire joint becomes stiff, red, and painful. The pain, however, is not associated with the degree of deformity. Some patients do not experience pain even with big protrusions.
Bunion removal surgery can relieve severe symptoms that don’t get better with conservative treatment. There are over 100 types of surgeries to correct a bunion deformity. The type of surgery that you need depends on the severity of the deformity and how the bunion developed. It is important to note that complications can happen after surgery and there’s no guarantee that it will make the symptoms go away completely.
Newer minimally invasive surgery comes with the potential advantages of reduced surgical time and hospital stay, quicker healing times, and smaller scars. But compared with the most common approach, there was no significant difference in the success of the surgery.
In this procedure, the surgeon makes small cuts in the bones and align the bones to the default position. The position and shape of the cuts depend on the surgical strategy. For example, a chevron osteotomy uses a V-shaped wedge cut while a scarf osteotomy utilizes a Z-shaped wedge. In the United Kingdom, chevron or short scarf osteotomy is the typical approach for mild hallux valgus. It has a satisfaction rate of 80% but was associated with long recovery time and higher foot care cost.
Exostectomy, also known as a bunionectomy, involves the removal of the bony protrusion from the joint without performing an alignment. Recurrence is common in this procedure because the surgery does not correct the underlying cause.
In resection arthroplasty, the surgeon removes the damaged portion of the joint to create a space between the bones and allows the formation of a flexible “scar” joint. This procedure is usually performed for elderly patients, those who have had previous failed surgeries, or have severe arthritis.
Arthrodesis or fusion surgery is indicated for patients with severe deformity, arthritic patients, or those who have had unsuccessful surgeries. The surgeon will remove the arthritic surface of the joint, and then use screws or plates to close the space within your joint.
What To Expect After Surgery
You will wear a cast or a special type of shoe for a minimum period of six weeks to protect your foot while you heal. Recovery after a bunion surgery takes about 6 to 12 weeks depending on the type of procedure performed. Stitches are removed after 1 to 3 weeks.
Full recovery can take as long as 4 to 6 months. The healing may take longer if you are a smoker. Possible complications of bunion surgery include:
- Persistent pain
- Nerve damage
- Bunion recurrence
- Failure of the bone to fully heal
Improvement usually occurs one year after surgery. Rehabilitation may be recommended to strengthen your foot and improve your range of motion. The overall outlook of bunion deformity has improved over the years. Expectations can influence your satisfaction with the surgery outcome. Discuss your expectations with your surgeon.