The big toe is made up of two joints and a bunion forms when the enlarged joint becomes inflamed due to misalignment of the bones surrounding the joints. The ‘bump’ associated with bunions forms on the joint at the base of your big toe as your bones move out of place.
In most cases, patients find relief without surgery. Though this will not remove the bunion, it can help keep it from worsening as well as reduce pain and inflammation.
However, sometimes these types of treatments are not enough to alleviate your symptoms and surgery may be required. Surgery is recommended as the last form of treatment as it realigns bones, ligaments, tendons, and nerves to treat your bunion. Though the procedure may be done on the same day without a hospital stay, the road to recovery is long, so your decision for surgery should not be taken lightly.
Are you a good candidate for surgery?
Good candidates for bunionectomy, or bunion correction surgery, are those who:
- Experience significant amounts of pain that limit day-to-day activities such as walking and standing for long periods of time
- Chronic inflammation and swelling that does not improve with medication or rest
- Deformity caused by the bunion pulling the big toe towards the other toes with possible crossover
The goal of a bunionectomy is to realign the joint at the base of the big toe, correct deformity, and eliminate the patient’s pain. As bunions vary in nature, various surgical procedures can be performed to correct them. In most bunion surgeries bone cutting is necessary as is the use of metal pins, screws, and plates to hold the bones in the right position. Below is a list of other forms of treatment.
- Osteotomy– In this procedure, small cuts along the bone are made to realign the joint. The bone is held in place with pins, screws, or even plants to make the bone straight and balanced.
- Arthrodesis– This surgery is offered to those who have severe arthritis, a severe bunion, or those who have previously had unsuccessful bunion correction surgeries before. In this surgery, arthritic joint surfaces are removed and held into place with wires, screws, and plates as the bone heals.
- Exostectomy– Done alone exostectomy does not realign the joint or correct the bunion, instead the doctor shaves down the bone to minimize the appearance of the bunion. It is often performed as part of a larger corrective surgery combined with osteotomy and other soft tissue procedures.
- Resection arthroplasty– This surgery removes the damaged portion of the joint, shortening the overall length of the toe bone. However, due to the smaller size of the toe, walking and other activities can become more difficult.
Before deciding the right treatment option for you, your doctor will perform a medical evaluation to identify if any interference will occur with your surgery. Other factors such as the severity of the bunion, age, medication, medical history, and activity level will be taken into account.
With all surgeries there are risks and bunion surgery is no exception. The risks include scars, incomplete correction, nerve injury, restricted movement at the joint, failure to heal fully, inability to relieve pain, reoccurrence of the bunion, development of arthritis, painful permanent hardware, and difficulty healing.
The recovery from bunionectomy can take anywhere from 6 months to a year as bones take a while to fully heal. During this time, it is recommended that the patient not put weight on the foot. Following your doctor’s instructions on whether and when you can put weight on your foot or begin to use it is crucial. Putting weight on or disturbing the foot too early without proper support will cause the bones to shift and correction will be lost.
Crutches, walkers, and scooters are commonly needed during recovery as are protective boots and footwear. Physical therapy may be required as well.
It is important to be realistic when it comes to the expectations of bunion treatment. Even with surgery, you may not be able to continue to wear smaller shoes or narrow ones that you may have worn before. There is also the possibility that the bunion may return. However, a bunion shouldn’t damper your mood during any season, as most can be treated without surgery. Don’t let your bunion hinder you anymore. Contact Kenrick J. Dennis, DPM and Ronald P. Soefer, DPM today!