Corrective Bunion Surgery

David F. Hesse, DPM, FACFAS
Podiatric Medicine & Surgery
Hesse Foot & Ankle Clinic
Menomonie

One of the most common structural deformities of the foot is the common bunion, medically referred to as hallux abducto valgus.

A bunion is most commonly identified by the presence of a large painful bump on the inner side of the foot at the base of the great toe. This bump is actually the normal head of the first metatarsal bone that appears larger in appearance due to migration of the great toe towards the smaller toes. This causes painful dislocation of the great toe joint. Although most medical textbooks suggest poorly fitting shoes and various activities as potential causes, it is widely believed that bunions are hereditary, often developing in people born with a foot that flattens (pronates) during normal gait.

Multiple factors contribute to the development of bunion pain: pressure of the bump against the shoe, chronic stretching of the joint capsule from the dislocation, tendinitis, grinding of the imbalanced joint resulting in arthritis, pinching of the local nerves, bursitis, and the development of calluses due to unevenly distributed pressure.

Conservative bunion treatment options can include anti-inflammatory medication for arthritis or bursitis pain, the use of shoes with a wide toe area, and the avoidance of any aggravating physical activities. In early stages of bunion development, prescribed custom orthotic therapy has often been recommended. For later stages of bunions, and those not responding to conservative treatment, corrective surgery is recommended.

Corrective surgery for bunions (bunionectomy) is a reconstructive procedure that involves creating a precise surgical fracture of the first metatarsal bone. The surgeon repositions and fixates the first metatarsal back in alignment with the smaller metatarsals. This allows the great toe itself to straighten and relocate back into its joint space. This generally requires fixation of the metatarsal with metal pins, screws, or plates. (Fig 2) This hardware is unnoticeable and can remain in the foot indefinitely in most cases.

Bunionectomies generally can be done as an outpatient under mild sedation with local anesthetic at most hospitals and surgery centers. The procedure typically takes 40 to 60 minutes. Postoperatively, these procedures are treated as an adult fracture. This will usually require one to two weeks on crutches followed by an additional 4 to 6 weeks with the use of an ambulating fracture boot. The surgeon will monitor your progress with a series of x-rays during this two-month postoperative period.

The goals of bunion surgery are to reduce pain, realign the toe, and to restore normal weight-bearing function of the foot. The success of this reconstructive procedure has been excellent in recent years and is best when caught in early stages. Ultimately, this allows the patient to resume an active work and recreational lifestyle without foot pain.

FIG 1 :
A bunion is identified by a large bump on the inner side of the foot
at the base of the great (big) toe.

FIG 2 :
Corrective surgery has brought the great toe back into alignment,
reducing pain and allowing patient to return to normal activities.

For more information or to schedule an appointment with Dr. David Hesse, Hesse Foot & Ankle Clinic, Menomonie, call 715.231.8000 or visit www.hessefootandankle.com.