A bunionectomy is a surgical procedure to remove or correct a bunion. A bunion is an enlargement of the bony prominence or soft tissue around the joint at the inner portion of the the big toe, resulting in the formation of a painful bump. The metatarsal foot bone that joins the big toe begins to drift inwards, in turn causing the base of the big toe to angle outward, resulting in a painful deformity.
Causes of Bunions
Bunions may have a hereditary component; however, a bunion may progress due to the wearing of ill-fitting footwear that compresses the toes into unnatural positions. This can include:
- High heeled shoes
- Narrow shoes
- Shoes that are too small or pointy shoes with a narrow toe box
Genetics and certain disease conditions such as rheumatoid arthritis may increase the risk of developing a bunion, too. Bunions are much more prevalent in women than men.
Signs and Symptoms
The signs and symptoms associated with bunions include:
- Pain when wearing shoes at the inner portion of the big toe
- Swelling with red, calloused skin at the inside portion of the base of the big toe
- Inward turning of the big toe toward the second toe
- Bulging of a bony bump at the base of the big toe
- Formation of corns and calluses at the overlapping of the big toe and second toe
Diagnosis
The diagnosis of a bunion by an orthopaedic surgeon includes taking a medical history and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Dr. Richardson will order X-rays to help determine the extent of damage and deformity of the toe joints.
Treatment of Bunions
Your surgeon initially will recommend conservative treatment measures with the goal of reducing or eliminating foot pain. Such measures include wearing properly fitted shoes with specially designed shoe inserts, padding, or taping of bunions.
Physical therapy and certain medications may be prescribed for relieving pain and inflammation. If conservative measures fail to treat the bunion pain, then your surgeon may recommend a surgical procedure to remove the bunion.
There are many surgical options to treat a bunion but the common goal is to realign the joint, correct the deformity, and to relieve pain and discomfort. Your surgeon will discuss the different options available to you and a plan specific to your foot will be agreed upon before your surgery.
Osteotomy
It is a common type of bunion surgery that involves surgical cutting and realignment of the toe joint. Dr. Richardson will work with you to select the appropriate surgical procedure based on your particular needs. There are 3 main types of osteotomies, namely chevron osteotomy, scarf osteotomy, and Akion osteotomy
Akin Osteotomy
Akin osteotomy is usually performed under general anesthesia where your toe will be numbed, and you will not feel any pain during the procedure. Your surgeon will make an incision along your big toe. The joint capsule is then opened and a surgical saw is used to remove a wedge of bone from your big toe. Your toe is then brought back to its normal anatomical position and held together with an implant such as a screw, staple, or even suture depending on what is needed for stable fixation. The mobility of your big toe is examined, and the capsule and wound are re-approximated with sutures.
Chevron Osteotomy
A chevron osteotomy is usually recommended for mild to moderate bunion deformities. During this procedure, an incision over your big toe is made. The joint capsule is opened, and the bunion is removed using a surgical saw. A V-shaped cut is made on the metatarsal bone of your big toe, and the bones are moved to bring your toe into its normal anatomical position. Screws or pins are used to hold the bones in their new position until healing occurs. The mobility of your big toe is examined, and the capsule and wound are re-approximated with sutures.
Scarf Osteotomy
Scarf osteotomy is usually recommended for moderate to severe bunion deformities and is performed under general anesthesia, where you will be asleep during the entire procedure. Your surgeon will make an incision along your big toe and open up 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. The cut bone is then fixed with pins or screws. The joint capsule and surgical wounds are then re-approximated using sutures keeping your toe in a straight position.
Repair of the Tendons and Ligaments
The soft tissues around the big toe may be tighter on one side and looser on the other creating an imbalance. This can result in drifting of the big toe towards the second toe. Sometimes this requires shortening the oose tissue to tighten it and lengthen the tight tissues to loosen them. This procedure is often combined with an osteotomy.
Arthrodesis
Involves surgical fusion of the damaged bones, followed by insertion of screws, wires, or plates to support the joint while healing. This procedure is used for severe, or very large angulated bunions or bunions associated with arthritis. The big toe will have limited movement after the procedure but once the fusion heals the bunion pain is improved and recurrence of a bunion has the lowest risk. This type of surgery is rare for bunions.
Minimally Invasive Bunion Surgery
This is an X-ray guided procedure, in which, typically, an osteotomy will be performed via a percutaneous approach. The first metatarsal will be cut as in the chevron osteotomy and the base of the big toe may also be cut to realign it. The divided bones will be kept in place with special screws buried inside the bone.
Risks and Complications of Bunion Surgery
As with any surgery, complications can occur. Apart from general complications related to all surgeries, complications after bunion surgery can include:
- Infection
- Recurrence of the bunion
- Nerve damage
- Unresolved pain
In rare cases, a second surgery may be necessary to correct the problems.
Postoperative Care
Patients should follow all instructions given by Dr. Richadson.
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