(Hallux Valgus Repair, Bunionectomy)
What is a bunion?
A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe (in which case it is called a "bunionette" or "tailor's bunion"). Bunions often occur when the joint is stressed over a prolonged period. Ninety percent of bunions occur in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis, which often affects the big toe joint.
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling.
If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot.
Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Please see these procedures for additional information.
Different types of bunion surgery
The type of surgical procedure performed depends upon the severity of the bunion, the individual’s age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used.
Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint.
Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned.
Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments.
Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is commonly seen in arthritis, it may need to be reconstructed or replaced with an artificial joint. Joint replacement implants may be used in the reconstruction of the big toe joint.
Reasons for the procedure
Reasons to undergo bunion surgery may include severe foot pain that occurs even when walking or wearing flat, comfortable shoes. Surgery may also be indicated when chronic big toe inflammation and swelling does not subside with rest or medications.
Other reasons for surgery include toe deformity, a drifting in of the big toe toward the small toe, and an inability to bend and straighten the big toe.
There may be other reasons for your doctor to recommend bunion surgery.
Risks of the procedure
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to:
Other complications may include recurrence of the bunion, nerve damage, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Before the procedure
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you are pregnant or suspect that you are pregnant, you should notify your doctor.
You may be asked to fast for eight hours before the procedure, generally after midnight.
You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
Based on your medical condition, your doctor may request other specific preparation.