Bunions are a common deformity. They are mostly seen in women and the condition often runs in the family. The big toe deviates toward the second toe and is often rotated. Sometimes the second toe crosses over. This causes a prominence on the inside of the foot at the base of the big toe, which is often painful. Shoe wear, for example high heels with a very narrow toe box, can exacerbate the symptoms. There may be evidence of osteoarthritis within the joint, resulting in progressive stiffness, swelling and pain.
If your bunion is pain free, it is likely suitable for treatment with non-surgical measures, especially if the deformity is only mild.
Surgery may be warranted if your bunion is becoming increasingly painful and shoe wear is a problem. Surgery is aimed at correcting the deformity and removal of the painful bump on the inside of your foot. Bunion surgery is not cosmetic surgery, it is a pain relieving procedure.
This procedure is used to correct a bunion, a deformity of the joint at the base of the big toe. During this procedure, portions of bone are removed and the bones of the foot and toe are aligned properly, eliminating the bump on the inner side of the foot.
- Non-operative Measures:
- Topical pain creams e.g. NSAIDS
- Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
- Footwear modification: shoes or boots with a wide toe box and supportive, cushioned sole. Sometimes a stiffer-soled shoe with rocker bottom modification may help if there is arthritis
- Avoid shoes with straps which press directly on the bunion causing pain
- Adhesive padded skin applications for comfort
- Modification of leather shoe to create more space over the bunion
- Bunion strap
- Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling,
swimming. Avoid axial loading exercises e.g. running
- Weight loss management
If pain is becoming a problem and the deformity causes difficulty with supportive shoe wear, surgery may be considered. Symptoms may be exacerbated with activity and particularly if wearing high heeled shoes.
Weight-bearing X-rays of the foot +/- the ankle are required before your consultation.
Depending on the extent of disease, surgical options may include:
- Open bunion correction with bone realignment surgery. This involves an incision over the medial or inside of the foot centred over the bony prominence. Bone cuts will allow realignment of the foot and this is stabilised with screws. The screws are not required to be removed.
- Minimally-invasive techniques with small incisions to realign the bone. There are several small keyhole incisions. The bone cuts are made with the use of an X-ray machine in the operating theatre. This allows the bone to be realigned and secured with screws. The screws are not required to be removed.
- Sometimes fusion (joining two bones together) is required, either at the base of the 1st metatarsal (Lapidus procedure) or of the 1st MTPJ (base of the big toe joint) requiring stabilisation of the bones with screws and plates. Again hardware is not usually removed.
During the first 6 weeks after surgery, you are allowed to weight bear in a specific post operative shoe with special bandaging applied to the foot. A Lapidus procedure requires non-weight-bearing. The 6-12 week period will allow gentle exercises to the foot, and progression to a normal shoe. Swelling is expected to decrease over this period.
The foot shape may slightly adjust over the 12 month period after your surgery.
Please find more information in the post operative protocol section for your specific surgical procedure.
- Surgery Risks
All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:
- Infection: superficial wounds or deep infections
- Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
- Nerve damage: tingling, numbness or burning
- Ongoing pain
- Stiffness of the ankle joint
- General or anaesthetic risks including to the heart and lung
- Drug reactions/allergy
- Scarring or tethering of the skin
- Rerupture or recurrence of deformity
- Calf weakness
- Revision surgery
- Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
- Post Op Guides
- Ankle Arthrodesis
- Ankle Arthroscopy
- Ankle Fracture
- Calcaneal Fracture
- Flatfoot Reconstruction
- Hallux Rigidus – Arthrodesis
- Hallux Rigidus – Arthroplasty
- Hallux Valgus Surgery
- Lapidus Procedure
- Lateral Ligament Instability
- Midfoot Arthrodesis
- Midfoot Fractures Surgery
- Subtalar Joint Arthrodesis
- Tibiotalocalcaneal Fusion
- Total Ankle Arthroplasty