Bunion Surgical Procedure

Types of Bunions  

• Hallux Valgus: This is the most prevalent kind of bunion in which the big toe bends in the direction of the other toes, resulting in a bump on the side of the foot.  

• Tailor’s Bunion (Bunionette): This type of bunion occurs at the base of the little toe, causing a bump similar to the one associated with hallux valgus but on the opposite side.  

• Adolescent / Juvenile Bunion: These are types of bunions that affect people younger than 18. The joint may be less pronounced compared to adult bunions.  

• Arthritic Bunion: This type is associated with arthritis, where joint inflammation and damage lead to the formation of a bunion. 

• Congenital Bunion: Present at birth, this type results from inherited structural abnormalities in the foot.  

Causes  

The exact cause of bunions remains unknown however the condition is believed to be the result of a combination of genetic, structural, and lifestyle factors.  

The most common causes of extra pressure on your big toe joint include:  

• Inherited foot structure 

• Abnormal foot mechanics 

• Wearing tight or ill-fitting shoes 

• High heels and pointy-toed shoes 

• Conditions such as arthritis 

• Foot injuries or stress 

• Congenital deformities present at birth  

Symptoms  

Signs and symptoms of a bunion include:  

• A bulging bump on the outside of the base of the big toe. 

• Swelling, redness, or soreness around the big toe joint. 

• Corns or calluses — these often develop where the first and second toes overlap. 

• Numbness in or around the big toe. 

• Persistent or intermittent pain. 

• Restricted movement of the big toe if arthritis affects the toe. 

• Discoloration or redness.  

Diagnosis  

A bunion can easily be identified by examining the foot, however, a thorough diagnosis would need to be carried out. This typically involves several steps, including:  

• Medical history: Consultation in which a podiatrist or an orthopedic surgeon gathers information on the history of the condition, the severity and frequency of patient. Information typical footwear, physical activities, and any previous foot injuries or conditions will be discussed to understand contributing factors.  

• Physical examination: This includes visual inspection of the foot, examination of palpation, range of motion and gait analysis. 

• Imaging tests: X-ray images are taken to provide a clear picture of the alignment of the bones in the foot, the extent of the deformity, and any associated arthritic changes in the joint. In some cases, additional imaging tests like ultrasound or MRI might be used to assess soft tissue involvement or other underlying. 

• Lab Tests: If an inflammatory condition like arthritis is suspected, blood tests might be ordered to check for markers of inflammation or autoimmune disease.  

• Differential Diagnosis: Other tests might be carried out to rule out other conditions that can cause similar symptoms, such as gout, rheumatoid arthritis, or other foot deformities.  

Treatment options  

Treatment for bunion usually begins with conservative methods (non-surgical) to relieve the pain and pressure of a bunion. This may include orthotic devices, nonsteroidal anti-inflammatory drugs, corticosteroids and physical therapy.   

Should conservative treatment not relieve symptoms, surgical treatment may be recommended. It is important to point out that surgery is not recommended for cosmetic reasons; only when a bunion causes frequent pain or interferes with daily activities.  

• Bunionectomy: This surgical procedure is carried out to remove a bunion, realigning the bones of the foot, and correcting the deformity that causes the toe to deviate towards the smaller toes. The procedure may include cutting and repositioning the bones (osteotomy), realigning tendons, ligaments, and nerves, and sometimes fusing the joint to ensure proper alignment.   

• Osteotomy: This surgical procedure involves cutting and realigning the bones of the foot to correct the deformity caused by a bunion. This procedure typically targets the first metatarsal bone, either at its head (distal osteotomy) or base (proximal osteotomy), depending on the severity and location of the bunion. The surgeon repositions the bone fragments to restore proper alignment and secures them with screws or pins to ensure stability during healing.  

• Arthrodesis: This surgical procedure involves removal of the damaged joint surfaces followed by aligning the bones and holding them together with screws, plates, or other fixation devices to promote bone fusion to eliminate joint movement, and to provide a stable, pain-free joint that can support normal foot function. Arthrodesis is typically recommended for patients with advanced bunion deformities, severe arthritis, or when previous bunion surgeries have failed.  

• Ex-ostectomy: This procedure involves removing the bony bump without realigning the bones of the foot. This procedure primarily addresses the prominent bone and soft tissue overgrowth that causes pain and discomfort, particularly when wearing shoes. This procedure is often combined with other surgical techniques, such as osteotomy or soft tissue realignment, to prevent recurrence and ensure long-term effectiveness. This procedure is usually recommended for patients with mild to moderate bunions who do not require extensive bone correction.