A bunion scientifically called Hallux Valgus i.e., a Latin word meaning foot deformity; is a bony bump that often forms around the joint or base of the big toe or at the base of the little toe. Bunion formed on the joint of the big toe is called Bunionette or Tailor’s bunion. The underlining cause of a bunion is too much pressure or stress on the big toe joint for a prolonged time which can be due to wearing too-tight shoes or confined pointed shoes.
Although it can be inherited or can be formed as a result of arthritis and is mostly observed in women generally because they tend to wear such types of shoes (tight, confined & pointed shoes). Bunions can be painful and can cause issues such as finding a good pair of footwear, deformity of the foot, etc.
However, shoes can not be the real reason behind bunion formation but it is believed by many doctors or researchers that shoes may worsen the situation. Most people with bunions find simple methods which include reducing the pressure on the big toe joint to be helpful in relieving pain.
Before surgery, your doctor might suggest you wear shoes that are comfortable, helps to keep the shape of the foot intact, and do not cause pressure or stress. There are special shoe inserts called Splints/Orthotics which help to reform the shape of the foot.
If the bunion is caused by arthritis then medicines might help with the swelling & pain. But if the bunion gets worse and simple treatment can’t help then your doctor may recommend you to undergo Bunion removal surgery. Bunion removal surgery is done to reduce the painful swelling, help to reform the shape of the foot as much as possible and it is not considered as cosmetic (as it doesn’t help to improve the appearance of the foot).
Depending on the severity of the bunion, patient’s age, general health, activity level, and the condition of the patient’s bone & connective tissues the type of surgical procedure is selected. Factors that may influence the choice of surgical procedure to be done:
- Mild Bunion: In this case, the surgery to be performed includes removal of enlarged bone portion and muscle realigning of muscles, tendons & ligaments surrounding the big toe joint.
- Moderate Bunion: In a moderate bunion case surgeon may cut the enlarged bone, shift the bone to its natural position also surrounding the tendons & ligaments. Severity & location of the bone deformity decided of the bone need to be cut or not.
- Severe Bunion: In such cases, the surgical procedure might include removal of the enlarged portion of the bone, cutting & realignment of the bone, and correcting positions of tendons & ligaments of the big toe joint.
- Arthritic Bunion/ or big toe joint: In some cases, the joint seems to be damaged beyond any repair/treatment as might be seen in arthritis, and in some cases, the joint may need to be fused to be treated.
This helps with the healing of bone and to reduce/eliminate bone movement & pain. Joint Implant replacement may be suggested to use in the big toe joint reconstruction.
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Are You a Candidate for Surgery?
As mentioned above if the bunion is mild then it can be treated with mild methods and surgery is not necessary. Though it is also true that if left untreated for a long time the bunion can become worse but its progression can slow down by wearing comfortable shoes that provide proper fitting but do not exert pressure on toe joints.
One more important thing to keep in mind is that bunion surgery should not be done just for cosmetic reasons or to improve the appearance of the foot. Patients or candidates for bunion surgery commonly have the following factors:
- Chronic inflammation and swelling around big toe joint that is hard to improve/ treat with medications & rest.
- Toe Deformity- it is bending of the big toe towards the smaller toes causing other foot toes to cross each other.
- Extreme foot pain/ or pain in the big toe joint causing an interruption in day-to-day activities such as walking, wearing footwear.
- Inability straightens or bends the toe i.e., Toe stiffness.
- Unable to obtain pain relief from NSAIDs such as ibuprofen, the effectiveness of which can varies from one patient to another.
Deciding to Have Bunion Surgery?
After undergoing Bunion Surgery most people have experienced less pain, were able to participate in daily activities which they would not be able to do otherwise.
But before you decide to have bunion surgery it’s important to note that when you explore this surgery you may find a so-called mild treatment or simple or minimal surgical procedures that proclaim to heal your foot are often the inadequate, non-cautious procedure of no good and might result in doing more harm.
Bunion Surgery is a crucial procedure it can be performed on the same day basis and your doctor will not make you stay in the hospital but it does require a long recovery period. Varying from person to person its recovery period can last from several months to a year with follow-up visits to your doctor.
One more thing to consider is bunion surgery will not help you to wear pointed, tight, and confined footwears but you might need to restrict wearing ones and select only those footwears which are comfortable & do not exert too much pressure. Make sure to ask the following questions to your doctor before you take this surgery into consideration:
- Be sure to ask what are the benefits as well as risks of getting this surgery?
- The possible complication that might occur after surgery and how likely they can occur?
- Is the surgery too painful to be done and if yes then how the pain can be managed?
These questions will help you to get a clear mind and decide if you are ready to have Bunion Surgery or not. If not, and you still have doubts then feel free to ask your doctor.
Risks of Bunion Surgery?
Like any other surgical procedure, complications can happen in Bunion Surgery also. some of the possible complications/risks of bunion surgery are following:
- Toe Stiffness.
- Numbness in the foot.
- Swelling.
- Delayed healing or it might take a long time to heal properly.
- Infection.
Other complications that don’t occur with many people are:
- Recurrence of the bunion.
- Nerve damage while operating and never-ending pain.
- Sometimes the surgical procedures may result in overcorrection of the toe i.e., the big toe might bend away from the smaller toes or in opposite direction.
Depending upon one’s medical condition and other factors there may or may not be other risks thus, please make sure to discuss them with your corresponding surgeon.
Preparing for Bunion Removal Surgery
If you have decided to undergo bunion removal surgery then before you get it removed you will need to undergo a few medical tests first to check your overall health. Your doctors will ask you to undergo the following test:
- X-ray of your lungs.
- To check your heart functionality ECG (Electro Cardiogram) will be done.
- A sample of our urine & blood will be taken to check for any underlying/ or internal illnesses.
If you are taking any medication or drug course especially any blood-thinning drugs or aspirin then, your doctor may ask you to stop taking them for a few days before & after surgery to avoid any possible complications.
After your tests are done and all reports are okay then your doctor will determine your diet i.e., how long will you need to fast, what you can or cannot eat/drink before & after surgery. In order to avoid any possible complications, you must follow the directions given by your doctor carefully.
Surgical Procedures of Bunion Surgery
The common goals of various bunion removal surgical procedure include the following:
- The first goal is to realign the big toe joint or base joint i.e., Metatarsophalangeal joint.
- To relieve the pain and swelling.
- To correct bone deformity by making up the big toe and foot.
As bunions can vary in their shape & size in different people thus different procedures are performed for their correction. Most of those procedures include alignment correction of the enlarged bone and repairmen of soft tissues surrounding that joint.
Your doctor will better describe to you the type of surgery you need to undergo according to your type of bunion.
Repairing the Tendons and Ligaments Around the Big Toe
If in any case, the soft tissues around the big toe are imbalanced i.e., soft on one side and tight on the other side then this can also result in the big toe drifting towards smaller toes thus causing Bunion.
By repairing tendons & ligaments means shortening soft/loose tissues and lengthening the tight ones. In rare cases, only this can be done without performing an osteotomy (bone alignment).
However, in most cases, soft tissue correction is just a part of the entire bunion surgical procedure.
Osteotomy
This procedure includes the realignment of the deformed bone by making small cuts in that bone. Once the cuts are made then those breaks in the bone are fixed by using either pins, screws, or tiny plates. After the procedure is done bone becomes straighter than before and the joint is balanced.
To correct the bone deformity a number of Osteotomies may be performed in different places along the bone while in some cases after making cuts on the bone small wedge of bone are removed to correct & straighten then toe. Osteotomies in most of the cases are performed along with soft tissue repairment surgery.
Arthrodesis
This procedure includes removal of arthritic joints surfaces and then correcting the joint by inserting pins, screws, wires or tiny plates it helps to hold the bones together to heal & straighten them. This procedure is suitable for people suffering from severe bunion/ or arthritis and for those patients who have a history of unsuccessful bunion surgery.
Exostectomy
This procedure includes removal of the bump from the big toe joint and this procedure does not help with joint realignment thus it is not used much to treat a bunion. Even if it’s combined with other surgeries such as realignment of soft tissues, Exostectomy rarely helps with the correction of the bunion or the cause behind the bunion.
Since Exostectomy doesn’t help with joint alignment it is performed as a part of whole bunion removal surgery such as osteotomy or soft tissue repairment surgery etc. If Exostectomy performed alone i.e., without osteotomy or realignment of soft tissues then there is a high chance that bunion deformity may come back.
Resection Arthroplasty
This procedure includes complete removal of the damaged portion of the bone or joint. This procedure results in creating a or increasing space between the bones called a flexible scar joint. This surgery is mainly used for elderly/ or old age patients, or patients with bad bunion removal surgery history, or patients suffering from severe arthritis not amenable to an arthrodesis.
Because this surgery or treatment procedure help to change the push-off or bend the big toe back in its correction position it is most suggested by doctors.
Recovery at Home
As already mentioned above Bunion removal surgery can be done successfully in one day and doesn’t require for the patient to be admitted to the hospital which means the success of surgery and healing more than half depends on how well you follow the doctor’s instructions at your home in the week after getting the surgery done.
Also, you will be required to see your doctor on regular visits for several months or a year depending on the extent & type of your surgery.
1. Dressing Care
After the surgery is done and you are good to go home your toe will be covered with bandages to help hold your toe in its right position, because for successful healing it is important that your toe must stay firm in its right position.
You will need to take care of dressing your toe at home on your own and to avoid any complications you must follow your doctor’s instructions carefully. Plus, do not try to do anything i.e., cause any disturbance in the toe or try to change anything without consulting your doctor first.
Any interference caused in the process of successful healing of your toe can lead to the reoccurrence of the bunion. Always make sure that your dressing/ bandages around the wound and wound both are dry, do cover your foot with a plastic bag or sheet if you head to shower.
Two weeks after the surgery is done your doctor will remove your suture but for complete & successful healing of your toe, you will need to continue doing dressings of your foot for up to 6-12 weeks.
2. Medications
After surgery, your doctor will prescribe you various medications including the most important one i.e., pain-relieving medication as it helps with surgical discomfort. The most effective medicine for pain relief are opioids.
Opioids medications are narcotic in nature & can be addictive and thus it is important to take them only as per your doctor’s order and do not overdose. When these medications start to reduce pain stop consuming them and if they, does not help then talk to your doctor about it, they might prescribe you another medicine for pain reduction.
Your doctor might prescribe you some antibiotics also along with pain-relieving medicines, they are prescribed to prevent any sort of bacterial infection in your wound after surgery.
3. Swelling
After surgery, you might experience some swelling on your foot so you will have to keep your foot in an alleviated position as much as possible in the very first week after the surgery, and to reduce swelling & pain apply ice on your foot as prescribed by your doctor.
One important to remember is that never apply ice directly in your skin and swelling may persist on your foot for a long time maybe months so, do not panic it is very common & happens with many patients.
4. Bearing Weight
Depending on the type of surgery you had your doctor will give you instructions on whether or not you can put weight on your foot or not. If you put weight on your foot when it has not been healed properly or without any support then it can lead to complications such as bones can shift in other direction and your bunion correction will be gone to waste.
Most of the bunion surgeries are a bit critical and require a time span of not putting any weight on your foot to ensure proper & complete bone healing while few of the surgeries may allow the person to walk on their feet right after the surgery but they must wear special surgical shoes made to protect bunion correction.
There are various alternatives that can be used to help with walking after bunion correction surgery such as crutches or knee walkers their function is to avoid putting on any weight on the foot. Knee walker is said to be a better alternative to crutches it bears four wheels and works as a type of scooter, it includes a pad on which you have to place knee of your affected foot and in order to move, you will have to push yourself using your other foot.
In few cases, your doctor may apply dressings, or a brace or cast to maintain your foot in the correct position.
Your daily activities along with weight-bearing might be restricted as well which includes driving, too much walking, etc. (especially if the surgery is performed on your right foot).
Note: no matter what type of bunion you had or what type of surgery you went through it is always important to listen & follow every instruction given by your doctor carefully to avoid any further complication.
Until your doctor recommends do no try to walk without any support and put any weight on your affected foot.
5. Physical Therapy and Exercise
Along with medications and walking alternatives, there are some specific exercises that you can perform to regain your foot’s strength and range of motion after surgery.
There are few exercises that can be done using a therapist band/ or surgical band it helps to restore ankle-length or you can use marbles also helps in toe motion.
Always remember to start these exercises slowly, steadily, do not over-do, and follow instructions given by your doctor/physical therapist carefully.
6. Shoe Wear
After completion of surgery bunion correction may take several months to completely heal and after its completely healed your doctor will give you some advice on your shoe. Type of shoes that are better to wear for bunion correction includes athletic shoes or oxford shoes with soft leather as they provide complete comfort and do not exert too much pressure on your toes.
You must avoid wearing any fashionable shoes such as heels, pointed tip footwear, etc. to help prevent the bunion from coming back. In severe bunion surgery cases, you have to give up on wearing any high-heeled shoes forever.
Avoiding Complications
Although it is quite uncommon there is always a chance that complications might occur following bunion surgery or at home during the recovery period. Thus, contact your doctor immediately if anything happens such as:
- If your dressing gets wet, or become loose.
- If your dressing gets moist with blood or if there is drainage of blood.
- In case you develop/ or feel any side effects from postoperative medicines.
It is important to be careful and avoid any complication if may arise, so do not delay in calling your doctor if anything from the following warning signs of infection happens:
- If you experience persistent fever.
- Shaking chills.
- If you experience persistent warmth or redness on your foot around the dressing.
- If you feel an increase in pain or if the pain is persistent, especially a sunburn type of pain.
- Any significant swelling in the calf area of the affected foot, especially if there is a “charley horse” pain behind the knee or if you experience breath shortening.
Conclusion
Bunion a bump that is formed around the big or sometimes small toe joint in the foot and it can be formed due to various reasons including wearing tight, pointing shoes, or any joint disease like arthritis, etc. Bunions can be treated with some simple methods at home but in severe cases, it is recommended to undergo Bunion Removal Surgery.
Surgeries are performed depending on the severity/ type of your bunions. Bunion Surgery is the most effective way to treat bunion and most people have experienced a reduction in pain & swelling as well as improved alignment of the big toe joint.
After the surgery is done the length of recovery period may vary from patient to patient and it mainly depends on the surgical procedure. To avoid any complication or reoccurrence of bunion you will have to strictly all the instructions, advice given by your doctor.
