Bunion Surgery

Most bunions can be treated without surgery. But when nonsurgical treatments are not enough, surgery can relieve your pain, correct any related foot deformity, and help you resume your normal activities. An orthopaedic surgeon can help you decide if surgery is the best option for you. Whether you've just begun exploring treatment for bunions or have already decided with your orthopaedic surgeon to have bunion surgery, this website will help you understand more about this valuable procedure.

What Is A Bunion?

A bunion is one problem that can develop due to hallux valgus, a foot deformity. The term "hallux valgus" is Latin and means a turning outward (valgus) of the big toe (hallux). The bone which joins the big toe, the first metatarsal, becomes prominent on the inner border of the foot. This bump is the bunion and is made up of bone and soft tissue.

What Causes Bunions?

By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions.

A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men.

Can Bunions Be Prevented?

Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend "preventive" surgery for bunions that do not hurt; with proper preventive care, they may never become a problem.

Bunion pain can be successfully managed in the vast majority of cases by switching to shoes that fit properly and don't compress the toes. Your orthopaedic surgeon can give you more information about proper shoe fit and the types of shoes that would be best for you.

Is Bunion Surgery For You?

If nonsurgical treatment fails, you may want to consider surgery. Many studies have found that 85 to 90 percent of patients who undergo bunion surgery are satisfied with the results. Reasons that you may benefit from bunion surgery commonly include:

• Severe foot pain that limits your everyday activities, including walking and wearing reasonable shoes. You may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain.
• Chronic big toe inflammation and swelling that doesn't improve with rest or medications.
• Toe deformity-a drifting in of your big toe toward the small toes.
• Toe stiffness-inability to bend and straighten your toe.
• Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs. Their effectiveness in controlling toe pain varies greatly from person to person.
• Failure to substantially improve with other treatments such as a change in shoes and anti-inflammatory medication.

There are a variety of treatment options for bunion correction, the most fitting of which depends on the severity and nature of your bunion. Not all bunions are treated the same and various techniques are used to achieve adequate correction. Frequently these techniques are used in combination. Some of the treatments used include:

• Soft Tissue Balancing – Repair of the Tendons and Ligaments around the Big Toe
• Arthrodesis – Removal of damaged surfaces and fusion of the bone ends
• Exostectomy – Removal of the bony bump on the big toe
• Osteotomy – Cutting and realigning the bone in proper orientation

Dr. Samimi is an orthopedic surgeon with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves. He will review the results of your evaluation with you and discuss whether surgery would be the best method to relieve your pain and deformity. Nonsurgical options, including switching to different shoes, also will be discussed. He will thoroughly explain the potential risks and complications of bunion surgery with you.

Realistic Expectations about Bunion Surgery

An important factor in deciding whether to have bunion surgery is understanding what the procedure can and can not do. The vast majority of patients who undergo bunion surgery experience a dramatic reduction of foot pain after surgery, along with a significant improvement in the alignment of their big toe.

Bunion surgery will not allow you to wear a smaller shoe size or narrow-pointed shoes. In fact, you will have some shoe restrictions for the rest of your life. Always follow the proper recommendations for shoe fit and remember that the main cause of the bunion deformity is a tight fitting shoe. If you return to that type of shoe wear, your bunion may reappear.

Your Surgery

Almost all bunion surgery is done on an outpatient basis, meaning you will go home the same day. You will most likely be asked to arrive at the hospital or surgical center one or two hours prior to surgery.

After admission, you will be evaluated by a member of the anesthesia team. Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. General or spinal anesthesia may also be used. The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.

The surgery takes about one hour. Afterwards, you will be moved to the recovery room. You will be ready to go home in one or two hours.

Possible Complications after Surgery

Fewer than 10 percent of patients experience complications from bunion surgery. Possible complications can include infection, recurrence of the bunion, nerve damage, and continued pain.

If complications occur, they are treatable but may affect the extent of your full recovery. Your orthopaedic surgeon will explain various options in treating these complications.

Dressing Care

You will be discharged from the hospital with bandages holding your toe in its corrected position. You also will wear a special postoperative surgical shoe or cast to protect your foot. Your sutures will be removed about two weeks after surgery, but your foot will require continued support from dressings or a brace for six to eight weeks. To ensure proper healing, it is very important not to disturb your dressings and to keep them dry. Interference with proper healing could cause a recurrence of the bunion. Be sure to place a plastic bag over your foot while showering.

Bearing Weight

Your orthopaedic surgeon may advise you to use a walker, cane, or crutches for the first few days after surgery. You can gradually put more weight on your foot as your wound heals. However, walk only short distances during the first few weeks following surgery. You will probably be able to drive again within about a week.

Swelling and Shoe Wear

Keep your foot elevated as much as possible for the first few days after surgery, and apply ice to relieve swelling and pain. You will have some swelling in your foot for about six months. After your dressings have been removed, wear only athletic shoes or soft leather oxford type shoes for the first several months until the surgery has completely healed. Do not wear fashion shoes, including high heels, until after six months.

Medication

Your orthopaedic surgeon may prescribe antibiotics to prevent infection for several days after your surgery. Pain medication to relieve surgical discomfort also will be prescribed for several days.

Avoiding Problems After Surgery

Though uncommon, complications can occur following bunion surgery. Contact your orthopaedic surgeon if:

• Your dressing loosens, comes off or gets wet.
• Your dressing is moistened with blood or drainage.
• You develop side effects from postoperative medications.
• Fever.
• Chills.
• Persistent warmth or redness around the dressing.
• Increased or persistent pain.
• Significant swelling in the calf above the treated foot.