Before Surgery (left photo) and After Surgery (right photo)
Bunions are often painful deformities of the foot that require surgery to correct and alleviate pain.
There are many different types of bunion surgery.
In general, bunion surgery calls for an incision in the top or side of the big toe joint and removal or realignment of soft tissue and bone to relieve pain and restore normal alignment to the joint.
The surgeon may insert tiny wires, stitches, or screws to stabilize a severely deformed joint.
MILD TO MODERATE BUNION DEFORMITY
The procedure performed for mild to moderate bunions is called a Metatarsal Head Osteotomy and is performed close to the big toe joint. It is a weight-bearing procedure which means the patient can walk safely directly after surgery, and a cast is not needed. Some type of protective foot wear is used for several weeks, then there is a gradual increase in walking and progress to more normal shoes. This is the procedure used most of the time.
Metatarsal Head Osteotomy (Notice the placement of screws in this case)
Another example of a Metatarsal Head Osteotomy Procedure is seen above. The left foot is post-operative and the right foot is waiting to be fixed. Often we stage the procedures for both feet several weeks to several months apart. Both feet can be done on the same day in some limited cases, generally in younger patients who are in good physical condition.
MORE ADVANCED BUNION DEFORMITY
If you have a very severe bunion deformity with a very high angle bewtween the first and second metatarsal (intermetatarsal angle), a procedure known as a Metatarsal Base Osteotomy, or a fusion of a joint in the middle arch known as a Lapidus, is performed. These kinds of procedures are more difficult for the patient to recover from because they require casting and non-weight bearing (or partial weight-bearing) using some kind of assistive walking device like crutches, walker or knee scooter, for several weeks. In general it takes a little longer for long term recovery from these procedures. Luckily, in most cases we can safely perform the more friendly Head Osteotomy.
In either case, most of the time these procedures are performed in the out-patient, same day surgery center under a sedation anesthesia.
Metatarsal Base Osteotomy Procedure
An example of the Lapidus Fusion procedure. Note the hardware plate and screws. (Also note the screw in the big toe. This is to fix an Akin Osteotomy which helps straighten the big toe)
JOINT REPLACEMENT SURGEY
If there is serious degenerative arthritis of the metatarsophalangeal joint (aka big toe joint), it may be advisable to replace the joint with an artificial resurfacing.
Image of big toe joint arthritis