Surgical bunion treatment may be needed if simple treatments are not adequate to relieve your symptoms. Simple treatment steps should always be attempted before considering surgery.1 This is true for many reasons, most important of which is that simple treatments often work, and invasive treatments don't always work. For these reasons, simple steps should be attempted prior to the consideration of more invasive options. If the time comes that nonsurgical treatments are no longer effective, then surgery may be considered. Surgical treatment should accomplish two goals:
Restore the normal alignment and mechanics of the foot
Removing painful prominences and prevent their recurrence
Rarely, a bunion can simply be shaved off. This often seems like the logical treatment, just remove the bump that forms at the base of the big toe. Unfortunately, this treatment is seldom effective to manage the problem of a bunion deformity.1 When the bump is simply shaved off, the bunion will simply return over time.
Bunion surgery usually involves breaking the toe bone (metatarsal) to correct the alignment problem that caused the bunion to form, this part of the procedure is called an osteotomy.1 The surgery also involves tightening the ligaments on the outside of the toe, and loosening of the ligaments on the inside, so the tension on the ligaments holds the toe pointing in the proper direction. Some surgeons opt to use pins, plates, or screws to hold the broken bone while it is healing. Others opt to allow the bone to heal without metal holding the position.
After surgery, the foot must be protected to allow the broken bone to heal, and the inflammation to subside. The use of immobilization and/or crutches will depend on the particular procedure that needs to be performed.2 There are variations of how and where to break the bone depending both on surgeon preference and the severity of the deformity.
Complications of Surgery
Possible complications of surgery include:1
Recurrence of the bunion months or years down the road: This is especially true if there is an inadequate correction of the initial deformity. As mentioned before, when the bunion is simply shaved off, they often return. For this reason, more extensive surgery is typically needed. An experienced foot surgeon should be able to determine the appropriate extent of surgery.
Overcorrection of the deformity: Sometimes the surgery corrects the problem but subsequently leads to a new problem with the shape of the toe. One problem is called a hallux varus, a condition that causes the big toe to point inward.
Nerve injury: Nerves run along the sides of the toe and provide sensation to the tip of the toes. The surgical incision is located close to where the incision for bunion surgery is made and can be stretched or damaged at the time of surgery leading to numbness of the toes.
Infection: Infection is more common than many people think. Foot surgery is prone to problems because healing on the foot can be complicated by footwear, weight-bearing, and infection.
Nonunion and malunion: Nonunion occurs when the bones do not heal after an osteotomy and realignment. To prevent this complication, most surgeons limit activity after surgery, but other factors can lead to the development of a nonunion or malunion after surgery.
Patients should also understand that the width of the forefoot does not change dramatically when a bunion correction is performed. The average correction of forefoot width is just a small fraction of an inch. Therefore, if bunion surgery is being performed because patients want to wear slimmer shoes, the outcome is often less favorable.
Rehab After Bunion Surgery
After bunion surgery, patients wear a special post-operative shoe to prevent pressure on the healing bone.2 Most people will use crutches, at least until the initial pain has subsided. Bunion surgery can be quite uncomfortable and may require about three months or more to completely heal.