Bunions are a deformity of the bone at the base of the big toe, the metatarsophalangeal joint. It looks like a large bump on the side of the foot. The condition, which mainly affects women, can cause a great deal of discomfort. The patient may experience pain and need to wear wide-fitting shoes to ease friction on the bone.
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Factors to be considered for surgery
Some patients may opt for surgery to correct the deformity but this is an option only in the most extreme cases. The patient may be experiencing extreme pain when he or she walks.
Once non-surgical options have been explored, the surgeon would take other factors into consideration before choosing surgery. The patient’s general health needs to be assessed as surgery is successful in only about 85% of cases.
Complications can arise when a patient has a condition such as:
- Diabetes - a disease that affects the body’s ability to control blood sugar levels and causes blood clotting difficulties for wounds
- Rheumatoid arthritis, a disease causing swelling of the joints
- Gout, a condition causing crystals around the joints
- Predisposition to strokes, a condition cutting off blood supply to the brain
- Spastic neurological diseases which affect the muscles in the body.
Bunion surgery can make the patient’s toe less flexible, so their complete lifestyle and whether they still expect to wear particular types of footwear such as high heels need to be taken into account. The surgeon will also consider the age of the patient, the impact on other joints, the position of the pain, response to prior care, the person’s job, and how active they are.
The different types of bunion surgery include:
Osteotomy
This is the most common type of bunion surgery and involves removing the lump at the side of the foot and then cutting and realigning the deformed joint. This type of surgery may also involve operating on neighboring toes to remove bone. In addition, the surgeon might have to use distal soft tissue realignment to make sure the patient can stand properly and to refine the appearance of the foot.
Arthodesis
This surgery involves operating on the tendons and ligaments in the big toe to alter the position of the misaligned bone. This will help to keep the bone in place. Two bones will also be fused in the metatarsophalangeal joint. This operation will result in limited movement because of this fusion. It is unlikely that the patient will be able to comfortably wear high heels after this surgery.
Excision or Resection (Keller’s) Arthroplasty
This is a procedure used on elderly people with challenging bunions. In this case, the bunion and the toe joint are removed and an artificial joint is created from the resulting scar tissue. Wires also need to be used to keep the joint in place at first. These are then later removed.
Lapidus Procedure
This involves the fusion of the first tarsal-metatarsal (TMT) joint in the middle of the foot, decreasing the space between the first and second metatarsal. This procedure works well for large bunions.
Phalangeal Osteotomy
This includes removing a small section of bone from the base of the proximal phalanx in the toe.
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Further Reading