BUNION SURGERY

What is a bunion?

A bunion is a bump that forms at the base of the big toe due to the shifting of bones and tendon imbalances. It is a progressive deformity that can worsen over time and even lead to overlapping of the big toe and second toe. This can lead to stiffness, bony deformity, pain, and discomfort in shoegear.

WHEN SHOULD YOU HAVE BUNION SURGERY?

At the North Texas Foot and Ankle we use the following criteria as a guideline when determining if surgery is indicated:

• You have a bunion – determined by clinical exam and x-rays.
• You feel you have exhausted all conservative care. Conservative therapy may include the following:
  • Functional orthotics, prescribed and cast by your doctor and designed to relieve pressure within the big toe joint.
  • Shoe Therapy, including proper shoes for your foot type and activities and possible modifications to your shoes.
  • Accommodative padding.
  • Activity modifications.
  • Medications – short term therapy may help to reduce inflammation.
  • Icing.
  • Injection therapy – rarely used but may help in treating an inflamed bursa.
  • Pain inside the joint.

The surgical procedure

There are a number of different ways to perform bunion surgery. The best procedure for one person is not necessarily the best for another. Some procedures allow you to walk much sooner meaning you may not have to use crutches for as long, and some require longer non weightbearing. Depending on your foot type and symptoms, a specific procedure may be warranted over another.

Types of bunion surgery:

• Generally, bunion surgery can be classified into two major categories:
• Head procedures (around the great toe joint).
• Base procedures (near or at the joint behind the great toe joint).

For a head procedure, the bone is cut and the head of the metatarsal moved over to correct the bunion. Various types of bone cuts can be performed depending on the necessary correction. Head procedures are usually indicated for a mild to moderate bunion, or for patients who do not feel they can be non-weight bearing for any length of time.

Head Procedure Bunionectomy – bone is cut just behind the joint and moved over.

Base procedures are performed around the base of the 1st metatarsal. They include cutting a wedge out of the bone (base wedge), making a semi-circular cut and rotating the bone (crescentic osteotomy) and fusion of joint behind great toe joint (Lapidus bunionectomy). Base procedures are usually indicated for a moderate to severe bunion or if there is hypermobility noted.

Lapidus bunionectomy – procedure performed at the base of the 1st metatarsal.

Overall, there are many variables in selecting a bunion procedure and the key to success is finding an experienced surgeon who understands each variable and who has the skills to perform all types of procedures. Some surgeons may not have the skills to perform base type procedures and offer head procedures as your only choice.

There is substantial medical research showing which bunion procedures are most effective in specific situations. At North Texas Foot and Ankle, we perform an examination of your lower leg and foot, review your biomechanics and x-rays, and give you an understandable and complete explanation of what choices you have, including what type of procedure is in your best interest.

Who Should Perform Your Surgery?

The most important criteria to ensure a good outcome for your bunion surgery is to choose the right surgeon. The qualities that make for a good bunion surgeon are:

• Understanding of biomechanics: To choose the best procedure, a surgeon must also have the ability to evaluate your biomechanical structure including tightness of leg muscles, foot and leg alignment, motion of the bones around the bunion site, and midfoot and rearfoot alignment.
• Extensive experience: An experienced surgeon usually has a better ability to deal with intraoperative or post operative complications and reduce the chance of complications. Numerous studies have demonstrated that one of the best predictors of surgical outcome is the experience of the surgeon.
• Defines realistic expectations and potential problems: Be wary of a physician who seems to talk you into surgery or makes surgery sound “too good to be true”.
• Use of foot orthotics following surgery: Bunion surgery does not usually alleviate all of the forces that caused the bunion in the first place. This is because the biomechanical cause of the bunion is often due to function in another part of the foot. Surgery to correct the underlying biomechanical cause would, in many situations, be too extensive and involved to be a practical treatment option. In addition, it is simply not necessary in most cases. Once the bunion is corrected, foot orthoses will likely be used to improve foot biomechanical function and help prevent return of the bunion deformity. The orthotics can fit into many shoe types, including women’s dress shoes. Note that if you already have orthotics, you will likely need new ones after surgery to match the new shape of your foot.