Bunionectomy

Overview

A bunion is not just a bump. It is a slow, worsening change in the shape of the big-toe joint, where the long foot bone behind your big toe drifts inward while the toe itself drifts outward. The visible bump is the exposed inner side of that bone's end. Bunionectomy corrects the deformity by realigning the bone and toe, which also removes the bump. How the bone is cut and reset depends on how far off the bone has drifted. Milder bunions need a smaller cut near the end of the bone; more severe bunions need a larger correction further back along the bone, or a fusion at the base of the toe to fix the problem at its root. Your surgeon will explain which one fits your foot.

How the Procedure Works

Through an incision on the inner side of the big-toe joint, the prominent bone is exposed. The exact correction depends on how far off the bone has drifted. For a milder bunion, a small cut is made near the end of the bone and the end is shifted back into line, then held with a screw. For a more severe bunion, the cut is further back along the bone and the correction is larger. Tight tissue on the outer side of the toe is released so the toe can straighten, and the tissue on the inner side is tightened to keep it there. Screws or plates hold everything in place while the bone heals. How soon you can put weight on your foot depends on which correction was done.

When to Consider Bunionectomy

1. Painful bunion limiting shoe wear

   Pain over the bump or inside the big-toe joint that limits your shoe choices and daily activities.

2. Progressive deformity

   A worsening angle causing secondary problems, such as your second toe crossing over, or pain in the ball of the foot.

3. Failed conservative management

   Wider shoes, toe spacers, and activity changes have not provided enough relief.

Physicians Who Perform Bunionectomy

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Risks

Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a deformity that worsens over time, with the angle getting worse and bringing on problems like the second toe crossing over or pain in the ball of the foot. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.

The risks we discuss with you include the bunion coming back, overcorrection (the toe crossing too far the other way), stiffness of the big-toe joint, and the bone cut failing to heal. Pain can also shift to the ball of the foot under the other toes, and infection and numbness from irritation of a small nerve along the inner foot are possible. Surgery is offered when your bunion is painful and footwear changes and padding have not given you enough relief.

Further Reading

External patient-education references and related OSI pages for additional background:

• Bunion Surgery — AAOS OrthoInfo