Bunions are progressive bone deformities of the foot that often cause recurring or chronic inflammation, irritation, and pain that require surgical correction. Surgical removal of a bunion is called a bunionectomy. However, there are multiple types of bunionectomies, each designed to resolve different structural changes caused by the deformity.
Bunion surgeries fall into two major categories:
- Head procedures that treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Head procedures are often used for patients who cannot be immobilized for long periods of time. Mild to moderate bunion deformites are typically corrected using this technique.
- Base procedures concentrate on the bone near or behind the big toe joint. Different types of base procedures are conducted depending on the nature of the deformity. These range from cutting a wedge out of the bone and closing down the open wedge it so that it can be moved into its proper position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure. Severe bunions usually require this type of bunionectomy.
There are three important factors that impact the success of bunion surgery:
- Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient's foot as well as the intricacies of each surgical option is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
- Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won't recur or that a patient will be absolutely pain free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
- Bunion surgery is not a magic bullet. Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times usually 3-6 months and often have to spend time in physical therapy. Additionally, you may need a corrective orthotic device on an ongoing basis.
What To Expect
Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day. At the Atlanta Center for Foot and Ankle Surgery, bunionectomies are our most common performed procedure.
Prior to the surgery, patients will need to make some preparatory arrangements. These may include:
- Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history. Your surgeon will determine if this is required for your particular case.
- Arranging your schedule to make sure you don't need to take any long trips for at least two to three weeks following the surgery.
- Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
- Stopping the use of any anti-inflammatory medications, such as aspirin or ibuprofen, for seven days before the surgery.
The night before the surgery, you will not be able to eat or drink anything after 11:00pm. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.
Bunion surgery is usually performed with a local anesthetic combined with IV sedation medication to put you into "twilight sleep" so that you are fully relaxed. After the surgery, IV sedation may result in drowsiness which is why someone else must drive the patient home.
The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe or boot. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the skin is healed.
During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Always follow your surgeons instructions about bearing weight on your surgery foot. Most patients also are instructed on some basic exercises that need to be performed daily. Continue following your surgeons instructions for increasing activity until you are back to normal.
By 3 months following surgery most patients are completely healed from their bunionectomy and may resume normal activity including running and sports but always follow your surgeon's direction prior to resuming these activities.