A bunionectomy is a surgical procedure to remove a bunion. A bunion, also called a hallux valgus, is an enlargement of bone or soft tissues around the joint at the base of the big toe that results in the formation of a bump. The bone that joins the big toe with the first metatarsal bone thickens and enlarges, tightening the tendons, which in turn causes the base of the big toe to angle out resulting in a painful bony deformity.
Causes of Bunions
The most common cause of a bunion is prolonged wearing of ill-fitting footwear that compresses the toes into unnatural positions. This can include:
- High heeled shoes
- Narrow shoes
- Shoes that are too small or pointy shoes with a narrow toe box
Genetics and certain disease conditions such as arthritis or polio may increase the risk of developing a bunion. Bunions are much more prevalent in women than men, which may be associated with the use of heels and fashionable shoes by women.
Signs and Symptoms
The signs and symptoms associated with bunions include:
- Pain with ambulation when wearing shoes
- Swelling with red, calloused skin at the base of the big toe
- Decreased mobility in the big toe
- Inward turning of the big toe toward the second toe
- Bulging of a bony bump at the base of the big toe
- Formation of corns and calluses at the overlapping of the big toe and second toe
The diagnosis of a bunion by an orthopedic surgeon includes taking a medical history and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Your doctor may order X-rays to help determine the extent of damage and deformity of the toe joints.
Treatment of Bunions
Your surgeon initially will recommend conservative treatment measures with the goal of reducing or eliminating foot pain. Such measures include wearing properly fitted shoes with specially designed shoe inserts, padding, or taping of bunions.
Physical therapy and certain medications may be prescribed for relieving pain and inflammation.
If conservative measures fail to treat the bunion pain, then your surgeon may recommend a surgical procedure to remove the bunion.
There are many surgical options to treat a bunion but the common goal is to realign the joint, correct the deformity, and to relieve pain and discomfort. Your surgeon will discuss the different options available to you and a plan specific to your foot will be agreed upon before your surgery.
Minimally Invasive Bunion Surgery
This is an X-ray guided procedure, in which, typically, a chevron osteotomy will be performed. The first metatarsal will be cut as in the chevron osteotomy and the base of the big toe may also be cut to realign it. The divided bones will be kept in place with special screws buried inside the bone. This type of surgery is best suited for milder bunions.
Risks and Complications of Bunion Surgery
As with any surgery, complications can occur. Apart from general complications related to all surgeries, complications after bunion surgery can include:
- Recurrence of the bunion
- Nerve damage
- Unresolved pain
In rare cases, a second surgery may be necessary to correct the problems.
Patients should follow all instructions given by the orthopedic surgeon. Common post-operative instructions include:
- Keep your dressing dry.
- Avoid bearing weight on the foot by using crutches for a few weeks.
- Elevate the foot above the heart level to minimize swelling.
- Exercise and physical therapy are recommended for strengthening and restoring range of motion to the foot.
- Eating a healthy diet and quitting smoking will help with healing.