What is bunion surgery?
Bunion surgery is performed to reduce the pain and correct the deformity at the base of the big toe and in the ball of the foot.
A bunion (hallux valgus) is a bone deformity that results when the big toe moves out of place, causing enlargement of the metatarsophalangeal joint at its base. The enlarged joint pushes the toe downward against the shoe wall, building considerable friction and pressure. If this happens at the base of the little toe, it’s called a “bunionette” or “tailor’s bunion.”
Painful bunions often form when the joint is stressed over a prolonged period. Most bunions form in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait or result from arthritis. Different forms of arthritis often affect the big toe joint.
Dr. Andrew Marso, DPM, is an experienced podiatrist and skilled surgeon that provides surgical and conservative treatment of foot and ankle problems including bunions.
Before surgery is considered, Dr. Marso approaches bunion treatment with a two-step patient care plan. First, he seeks to relieve bunion pain symptoms and callus formation caused by friction. Then, he works to stop further growth.
Prescribed treatment may include:
- A protective felt padding to shield inflamed skin from the shoe wall
- Removal of nearby corns and calluses
- Fitted footwear
- Orthotic inserts
- Nighttime splints
In some cases, a surgery called a bunionectomy may be necessary to remove the bunion completely. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is performed in order return proper function to foot and big toe.
Other related modalities that may be used to help diagnose and plan appropriate treatment, include X-rays of both feet.
The specific operative procedure performed depends on the severity of the bunion deformity, your age, general health, activity level, and the condition of the bones and soft tissue. Other factors may influence the type of procedure you receive include:
- Mild bunion – For this type of surgery, Dr. Marso makes a small incision, may remove the bony bump and realign the muscles, tendons, and ligaments surrounding the joint.
- Moderate bunion – For a moderate bunion, our surgeon may cut the bone (chevron osteotomy) and shift it into proper alignment. Whether or not the bone is cut depends on the location and serverity of the deformity. In addition, the surrounding soft tissues and ligamentous structures may need to be repositioned.
- Severe bunion – For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments. Hammer toe correction might also need to be performed.
- Arthritic big toe joint – If the joint is damaged beyond repair, as is often seen in arthritis (hallux rigidus), it may need to be fused. This allows the bones to heal together and eliminate movement and pain. Occasionally, joint replacement implants may be used in the reconstruction of the big toe joint.
Why might I need bunion surgery?
You may need to undergo bunion surgery for severe foot pain that happens when walking or wearing flat, comfortable shoes. Surgery may also be needed when chronic big toe inflammation and swelling isn’t relieved with rest, conservative treatment or medications.
Other reasons for surgery include big toe drifting and causing deformity of the second toe or the inability to bend and straighten the big toe.
There may be other reasons why Dr. Marso would recommend bunion surgery.
What are the potential risks of bunion surgery?
As with any surgical procedure, complications can happen. Some possible complications may include:
- Joint stiffness
- Delayed healing
Other complications may include recurrence of the bunion, numbness, nerve issues, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.
There may be other risk factor depending on your medical condition. Be sure to discuss any concerns with Dr. Marso before the procedure.
How do I prepare for bunion surgery?
- Dr. Marso will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a documenting your medical history, Dr. Marso may ask your primary care physician to complete physical exam to make sure that you are in good enough health to undergo the procedure. You may also be required to get blood tests or other diagnostic tests.
- Tell Dr. Marso or his staff if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
- Tell Dr. Marso or his staff about all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify Dr. Marso and his staff if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. It may be necessary for you to stop or adjust these medicines around the time of a procedure.
- If you are pregnant or suspect that you might be, you should notify Dr. Marso or his staff.
- You may be asked to fast for 8 hours before the procedure, generally after midnight.
- You may receive a sedative before the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
What happens during bunion surgery?
Bunion surgery is almost always done on an outpatient basis and rarely requires a hospital. Procedures may vary depending on your condition and severity of your bunion deformity.
Most bunion surgery is performed under an ankle block with local anesthesia, in which your foot is numb, but you are awake. Occasionally, general or spinal anesthesia is necessary.
Generally, bunion surgery follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- You will meet nursing and anethesia staff who will start an intravenous (IV) line may be started in your arm or hand.
- If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medicine.
- The skin over the bunion and your foot will be cleansed with an antiseptic solution.
- Dr. Marso will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based upon the severity of the bunion.
- Dr. Marso will close the opening with stitches and apply a sterile bandage or dressing.
What happens after bunion surgery?
After you leave the operating room, you will be taken to the recovery room for observation. The length you’re there will vary depending on the type of anesthesia you received. The circulation and sensation of your foot will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be discharged to your home.
Dr. Marso and his staff will provide you specific instructions for how to care for your foot during the first few weeks after surgery. You may be discharged from the surgery center wearing a special surgical shoe or cast to protect your foot.
Once at home, it’s important to rest and keep the foot elevated on 1 or 2 pillows to help reduce pain and swelling. Dr. Marso may also recommend that you apply ice and limit walking. Depending on your strength and mobility, you may be advised to use a walker or crutches.
Most importantly, keep the surgical dressing clean and dry. You should cover the dressing with a plastic bag and tape it with plastic tape when bathing or showering. The safest alternative is to take a sponge bath. Unless instructed differently by Dr. Marso, keep the original surgical dressing intact until your first post-op visit with Dr. Marso. Generally the stitches will be removed after two weeks.
Take a pain medication as recommended by Dr. Marso. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines. Dr. Marso may also prescribe antibiotics to help prevent infection.
Notify Dr. Marso and his office to report any of the following:
- Fever of 100.4°F (38°C) or higher, or as directed by Dr. Marso and his staff
- Redness, swelling, bleeding, or other drainage from the incision site
- Increased pain around the incision site
- Swelling in lower leg of the affected foot
Our surgeon will advise you as to your postoperative activity restrictions. Your foot may need continuous support from dressings or a protective boot for 6 to 8 weeks. For your safety and others, you will need to stop driving for a week or more after surgery.
Physical therapy or non-weight bearing exercises may be recommended to help the foot regain strength and range of motion following surgery. High heels should be avoided for at least 6 months.
Dr. Marso may give you additional or alternate instructions after the procedure, depending on your unique situation.