Bunion Surgery

Conservative Treatment for Bunions

Your GP may have already initially recommended conservative treatment measures with the goal of reducing or eliminating your foot pain.

Such measures can include:

Medications for relieving pain and inflammation
Wearing surgical shoes with a wide and high toe box, avoiding tight, pointed or high-heeled shoes.
Use of orthotics to realign the bones of your foot and ease pain.
Padding of bunions
Ice applications several times a day

Conservative treatment measures can help relieve the discomfort of a bunion, however these measures will not prevent the bunion from becoming worse.

What are the types of surgery for bunions?

Surgery is the only means of correcting a bunion. Surgery is also recommended when conservative measures fail to treat the symptoms of bunion.

There are many surgical options to treat a bunion. The common goal is to realign the bones in the foot, correct the deformity, and relieve pain and discomfort. The surgery is performed as a day procedure, under the effect of a light general anaesthetic and a regional nerve block. When you wake up, you will not be in pain and will be able to walk on your foot straight away.

Osteotomy is a common type of bunion surgery that involves the surgical cutting and realignment of the bones around your big toe. Your surgeon selects the appropriate surgical procedure based on the type of bunion and its severity.

There are 3 main types of osteotomies used by foot and ankle surgeons; namely akin osteotomy, chevron osteotomy, and scarf osteotomy.

Akin Osteotomy

Akin osteotomy corrects the sideways deviation of the big toe. In this procedure, your surgeon makes a small cut in the proximal phalanx (base of the big toe) and removes a wedge of bone to straighten the big toe. The bony fragments are then stabilized using a screw or staples. This procedure is often used in conjunction with the other procedures below.

Chevron Osteotomy

A chevron osteotomy is usually recommended for mild to moderate bunion deformities. During this procedure, your surgeon will make an incision over your big toe. The joint capsule is opened and the bunion is removed using a surgical saw.

A V-shaped cut is made on your big toe and the metatarsal bones are shifted to bring your toe into its normal anatomical position. The bunion is then shaved and the soft tissues are realigned to correct the position. Akin osteotomy may be performed if necessary. The mobility of your big toe is examined, and the capsule and wound are re-approximated with sutures. Screws or pins are used to hold the bones in their new position until healing.

This procedure can also be performed minimally invasively with keyhole style incisions.

Arthrodesis: Involves fusing the two bones that form the big toe joint. This procedure is used for severe bunions and when arthritis has set in. The movement of your big toe is reduced following this procedure but pain and deformity are very well controlled.

Scarf Osteotomy

Scarf osteotomy is usually recommended for moderate to severe bunion deformities.

Your surgeon will make an incision along your big toe and open the joint capsule to expose the bump. The bump on your big toe is then removed using a bone saw. Your first metatarsal bone is then cut in a Z shape and realigned to correct the deformity. Your surgeon will fix the cut bone with pins or screws. The joint capsule and surgical wounds are then re-approximated using dissolvable sutures keeping your toe in a straight position. This is a very powerful corrective procedure with excellent long term results.

What are Risks and Complications of Bunion Surgery?

As with any surgery, bunion surgery involves certain risks and complications. They include:

Infection
Recurrence of the bunion
Nerve damage
Unresolved pain and swelling
Joint stiffness or restricted movement
Delayed healing or healing in the wrong position

In rare cases, a second surgery may be necessary to correct the problems.

Post-Operative Care for Bunion Surgery

Patients should follow all instructions given by the surgeon following the surgery. These include:

Keep your dressings dry and leave them in place until your next outpatient appointment.
Minimize walking where possible.
Elevate the foot to minimize swelling as much as possible for the first 6 weeks.
You will have to wear specially designed post-operative shoes to protect the wounds and assist in walking
You may not be able to wear regular shoes for 6 weeks