bunion surgeryImages (Click to view larger image)
hallux valgus correction, bunionectomy
Bunion surgery is a surgical procedure performed on the great toe joint. The purpose is to correct a deformity of the great toe or to remove a painful bump, called a bunion, at its base.
Who is a candidate for the procedure?
This procedure can be done for anyone who has a painful bunion that has not responded to other treatments. These other treatments include:
- altering the shape of the shoe to take pressure off the area
- prescription foot orthotics, which are special shoe inserts
How is the procedure performed?
The procedure can be performed in the office, in an outpatient surgical centre, or in the hospital. It can be done under general anaesthesia, regional anaesthesia or local anaesthesia, with or without sedation.
The procedure involves making an incision into the skin and carefully working down to the level of the great toe joint and bone. The bony prominence is removed using a bone saw. The soft tissue structures around the joint are then modified. The bones in the great toe and the bone just behind it, called the first metatarsal, are then cut with a bone saw and corrections are made to them. These corrections may be kept in place with stainless steel wires, screws, or plates.
After the surgery, the person usually wears a special shoe, cast, or splint to keep the area stable. Swelling is controlled by elevating the foot to the level of the heart, and using ice behind the knee or around the ankle. Rest is extremely important. If needed, anti-inflammatory medications can be prescribed. A bunion repair is usually not too painful. Most people can control their pain with the medications prescribed by the surgeon.
What are the potential complications after the procedure?
As with any surgery, complications can occur. The most common complication is postoperative swelling and pain. Increased swelling usually causes increased pain. This can create a vicious cycle in which the pain leads to an inflammatory response, creating more swelling, and more pain. Controlling the swelling after the procedure is the key to avoiding this complication.
Another possible complication is shifting of the corrected bony parts. This is more likely if the bones have been cut and repositioned. The stainless steel fixation devices can come loose, and bones can become misaligned. When this happens, the surgeon usually needs to go back in and reposition the bony parts.
Infection is rare, but it can be a serious complication. Infections can make the condition worse after the procedure. An infection in the bone can result in amputation of the toes or part of the foot. The person can help prevent this complication by carefully keeping the dressing clean and dry and intact.
A very rare but important complication is sympathetically mediated pain syndrome. Very rarely, someone undergoing a surgical procedure will develop this pain syndrome. It is produced by the nerves that run with the blood vessels, called sympathetic nerves. The resulting pain will be out of proportion to the procedure, even if the surgery went perfectly. This pain syndrome can be very difficult to treat and can last for a lifetime.
The results are usually good, and recovery takes about 6 to 12 weeks. The person usually has improved function, and can find shoes that do not cause pain. To prevent recurrences of the bunion, people should learn about choosing proper footwear. They may also need to use arch supports or orthotics, which are special shoe inserts.
Author: Bill O'Halloran, DPM
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 16/10/2004
Potential conflict of interest information for reviewers available on request