Are You Considering
Bunion Surgery?

Bunion surgery, like any other surgery, is not something to jump into lightly. Conservative treatment must always be attempted first. What are the indications for surgery? What should you expect following bunion surgery? The more information you have, the more informed you will be in making the best choice for you, and have a successful outcome.




Bunion Surgery….What Is It?

A bunion is a deformity of the big toe. It forms when the metatarsal of the big toe beings to veer inward, causing what is termed hallux valgus. As the toe drifts inward toward the pinky toe, a bump, called a bunion is formed.


bunion x-ray


Bunion surgery is the surgical means of correcting this deformity and reducing the associated toe joint pain. A variety of surgical approaches can be used, depending on the severity of the bunion. Although rare, some surgical approaches involve simply shaving the bone of the metatarsal in order to minimize the bump that has formed.

More often, the first metatarsal is cut (called an osteotomy) in a v-shape in order to realign the big toe. This wedge cut can be made either at the base or the distal end of the metatarsal, depending upon the severity of the deformity. In such cases, an incision is made either along the side or on top of the big toe. In order to hold the bones in their new alignment, a pin or screw is used.


bunion surgery


When Is Bunion Surgery Indicated?

As surgery to repair a bunion is not always successful, careful consideration must be made prior to surgery. Although people may be tempted to undergo surgery for cosmetic reasons, the only reasons for having the surgery are continued pain and limited function after conservative treatment has failed. Conservative treatment for a bunion includes medication, physical therapy, and addressing shoe wear and foot biomechanics. If these treatments have been attempted but pain and limited walking tolerance continues, surgery may be a viable option.



What Should I Expect Following Surgery?

Surgery to correct a bunion is an outpatient procedure. Surgery itself takes about an hour or so and generally only requires a local anesthetic. Following surgery you will be required to wear a post operative shoe. The shoe is very stiff in order to minimize motion of the big toe. The length of time you will need to wear the shoe will depend on the specific surgical procedure done.


post op foot shoe


It is recommended that following surgery ice therapy and elevation be utilized to minimize post operative swelling. Limited walking will also be helpful in keeping the pain and swelling at a minimum. Pain medication may also be recommended to allow you to be more comfortable as you heal.

Once the use of the post operative shoe is completed, progression toward wearing of a regular shoe is allowed. This can occur anywhere from two to six weeks following surgery. Often during this phase, increased pain and swelling can occur as the toe is allowed greater mobility. Shoe selection and minimizing walking during this phase of healing can help keep pain and swelling at a minimum. If not addressed prior to surgery, the use of a custom shoe insert may be recommended to minimize great toe stress.



Physical Therapy

Following surgery, physical therapy is often prescribed. The goals of physical therapy include helping to reduce swelling, improve incision healing, and improve joint mobility.

An at home means of assisting in incision healing is to massage the healed incision with vitamin E. Take a vitamin E gel pill and pierce it with a pin. Squeeze the gel out and use it to massage over the incision.

Range of motion of the big toe is greatly important to restoring function with walking and stair negotiation. Generally, the strength of the toe flexors and the range of motion of toe extension have the greatest impact on function.

Return to full function can take between weeks and even months depending on the specific type of bunion surgery performed. If you have an occupation that involves being on your feet for extended periods, make sure you discuss how long you will be off of your feet with your surgeon. Returning to weight bearing activity before healing has occurred can lead to a less successful outcome.


Summary

• Bunion surgery should only be considered after conservative treatment has failed.

• Surgery involves realigning the first metatarsal, generally by cutting away part of the bone and fixating it with a screw.

• After surgery you will be required to wear a post-operative shoe for up to 6 weeks.

• Appropriate shoe selection will minimize foot stress and reduce the risk of the bunion returning.


Bunion surgery should not be taken lightly. In cases where surgery is necessary to both reduce the toe joint pain and fix the associated deformity, take steps in advance to help you get the best outcome possible.



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References

Foot Ankle Int. 2011 Sep;32(9):917-22.Mobility of the first ray: review article.Van Beek C, Greisberg J.

Duodecim. 2011;127(16):1709-18.Hallux valgus--several ways to treat.Klemola T.

Br Med Bull. 2011;97:149-67. Epub 2010 Aug 14.Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review.Maffulli N, Longo UG, Marinozzi A, Denaro V.


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