How is a Bunion Fixed?

One of the most common surgical procedures that a podiatrist performs is bunion correction.  Bunions are a result of hallux abducto valgus, a deformity of the foot that leads to increased pressure at the first metatarsophalangeal joint.  Bunions can become extremely painful, and can limit a person’s activity level and restrict them to only certain types of shoes.  Conservative therapy can help to alleviate some of the symptoms of bunions, but even the best methods of strapping and bracing do not correct the problem.  Surgical correction of hallux abducto valgus and the bunion associated with the deformity is paramount to treatment.

A small incision is made along the medial side of the metatarsaophalangeal joint, where the bunion is.  This incision site is then deepened until the joint is reached, being careful to avoid the nerves and veins that run in the area.  Once the joint is reached, the joint capsule can be cut to access the bone.

The surgical approach to bunions most commonly involves an osteotomy, or cutting of the bones, at the head of the first metatarsal.  This is the part of the metatarsal that is closest to the joint.  By cutting the metatarsal, the operating surgeon is able to reposition the head of the metatarsal in a more functional position, thus eliminating the bunion.  The bone is then fixed with one or two screws, which keep the two pieces of the bone in place while it can heal.  Any remaining bone in the area that may be prominent or painful is also removed.

Some other approaches to bunions may involve simply removing the painful bump, repositioning the metatarsal head to gain more motion at the joint, or the use of joint implants.  Some bone cuts may be positioned further away from the joint, which allows for a greater correction of a more significant bunion.  A number of different surgical osteotomies have been used over the years.

A lateral release may be performed as well, which is when the tendons on the lateral side of the metatarsophalangeal joint are cut.  The tendons that course through the foot and function at the first metatarsophalangeal joint often become contracted in the presence of hallux abducto valgus.  These structures are cut in order to reposition the toe in a more straightened position. 

Following all of the corrective procedures in bunion surgery, the final step is to close everything up, layer by layer.  The joint capsule is often closed using a technique to tighten it, as the once prominent joint has now been removed.  This leaves an excess of tissue that should be addressed.  The skin is then closed with suture, and stitches may be left in for two or three weeks.  Some sutures are absorbable, and there is no need to take them out. 

After the surgery, the patient is usually placed in a bandage and a surgical shoe, which they are allowed to walk in.  Patients receiving bunion surgery are instructed to only walk a little bit, and to keep the foot elevated most of the time.  This is done so that the body has time to heal the surgical wounds that have been created.  They are typically seen in the podiatrist’s office following the surgery, or in some sort of follow-up clinic. 

Some amount of pain and swelling is to be expected following surgery, as the surgery itself can be rather traumatic.  This swelling should resolve after a week or so, and the pain should go away also.  Pain is usually addressed with oral pain medications.  Elevation of the foot and ice placed behind the knee or calf for fifteen minutes at a time will also help with pain and reducing swelling. 

Typically the skin will heal after two or three weeks, at which time the sutures, if necessary, can be removed.  Once the sutures are removed and the skin is healed, the patient may either continue in the surgical shoe, or return to a stiff-soled shoe or gym shoe.  Much of the post-operative treatment plan is surgeon-dependent.  The bones will typically heal in six to eight weeks.  In the post-operative period, it is common for the surgeon to obtain x-rays to evaluate the status of the bones.  This helps to determine the post-operative course.

Bunions are sometimes corrected in conjunction with other deformities of the foot, such as hammertoes or tailor’s bunions.  If there are other areas of pain in the foot besides the bunion, be sure to point them out to your doctor.

Talk to your podiatrist if you have painful bunions or any other painful foot condition.  Conservative therapy will generally be attempted first, but surgical intervention should be discussed with the operating doctor.  They will be able to fill you in on details regarding pre-operative preparation, the surgery, and the post-operative treatment protocol.  

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. 
Winter Haven, FL 33881 
863-299-4551 
www.FLFootandAnkle.com