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What is bunion correction surgery?

There are several types of bunion correction surgery, all of them aimed at relieving the pain caused by a deformed joint at the base of the big toe. The choice of procedure will be driven by exactly how much the bones of your foot and that key joint, called the metatarsophalangeal (MTP) joint, are misaligned. In all cases, though, the orthopedic surgeon will adjust the positioning of the MTP joint, as well as bones, ligaments, tendons and nerves in your toe and foot.

Why it's done

Not every bunion requires corrective surgery. In fact, if your bunion isn’t causing pain, surgery probably isn’t appropriate for you, since every operation carries risks, and since bunion surgery, in particular, typically requires at least six months for recovery. Even if you’re experiencing some pain, it’s important to try lifestyle changes first. In many cases, switching to shoes with broad toes, a wide instep and relatively low heels and using pads to cushion areas that are inflamed may be sufficient to control the problem, even if the bunion itself doesn’t go away.

Surgery may be in order if you find it difficult to walk or experience pain after making those lifestyle changes. Chronic inflammation and swelling of the big toe and a lack of improvement with rest or medication are also signs that surgery may be needed. The same is true if your big toe is becoming increasingly deformed and “drifting” toward its neighbors, crowding them or even lying on top of them.

Complications

Bunion correction is generally uncomplicated, but there are some risks. As with any surgery, infection is possible. Additional risks include nerve injury, failure of the bone to completely heal, failure to completely relieve pain, stiffness of the toe joint and recurrence of the bunion. It is important to follow recovery instructions to minimize the risk of complications, and to contact your healthcare team if you notice possible signs of infection, including fever, chills, warmth or redness around the surgical site, or swelling in the calf above the foot that was treated. You should also tell your doctor if you experience persistent pain, or if pain increases.

Types of bunion correction surgery

An orthopedic surgeon can use a combination of surgical procedures to correct a bunion, depending on its size and shape and the underlying deformities of the bones of the big toe and foot. In almost all cases, the goal will be to realign the MTP joint, remove swollen tissue, and repair the tendons and ligaments of the big toe in order to hold the joint in its new, proper position.

The surgeon may perform an osteotomy, making small cuts in the bones of the big toe to straighten them and realign the joint. Depending on how crooked the toe is, the surgeon may remove a small wedge of bone to provide a sufficient correction, then fix the breaks with pins, screws or plates.

Other procedures include lengthening tendons or ligaments that are too tight and shortening those that are too loose. If your MTP joint is arthritic, the surgeon may remove some or all of its surface in a procedure called arthrodesis, and use screws, wires or plates to allow the bones to fuse.

The surgeon is also likely to remove the bump from the toe joint in a procedure called exostectomy. This will get rid of the most noticeable symptom of the bunion, though it doesn’t correct the underlying cause of the problem.

What to expect

Almost all bunion surgery is done on an outpatient basis. Patients rarely need to be admitted to the hospital.

Generally, general anesthesia is not used for bunion correction surgery. Instead, you’re likely to receive ankle block anesthesia, which numbs the foot. Sometimes, a popliteal block is used instead; this is injected behind the knee and numbs the lower leg. Spinal anesthesia, which numbs the body below the waist, is another alternative.

Because the surgeon may need to correct several related deformities in the toe and ankle, there may be more than one incision during the procedure, and more than one osteotomy. The length of the surgery may vary accordingly.

Recovery

Giving your toe time to heal will help prevent recurrence of the bunion. Your doctor will bandage your foot in a specific way in order to hold the bones in their newly aligned position; to protect the repair, leave those dressings undisturbed and follow your doctor’s instructions about how to care for them. Keeping your foot elevated for a few days after surgery will help reduce swelling and pain. However, some swelling is unavoidable, and may last six months or a year.

It’s important not to put weight on your foot too soon after surgery or without the proper support, since that can cause the bones to shift out of alignment. Your doctor may apply a brace or a cast to your foot and instruct you to use crutches or a knee walker, which you can use like a modified scooter. You may not be able to drive for a period of time after surgery.

Your doctor may prescribe physical therapy or recommend specific exercises to strengthen your foot after the procedure and restore range of motion. It may be helpful to work with a physical therapist for a time.

Once your bones fully heal, you can return to wearing conventional shoes. However, your doctor may advise against choosing tight-fitting or high-heeled shoes, since those increase the risk that your bunion will recur.

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