Bunion surgery is almost always contemplated at some stage by almost all those who have them - most reject the idea outright and others can't wait to have it done. Most would benefit from a surgical consultation, if only to get an opinion. The aim of surgery is to correct what was the cause of the bunion and prevent it happening again.
Conservative management before bunion surgery:
Several studies have shown that 85-90% of those who have bunion surgery are satisfied with the results. But, before bunion surgery is considered, non-surgical approaches or conservative care of the bunion should be tried.
Indications for bunion surgery:
Bunion surgery is indicated if:
If there is severe foot pain that limits your activities, especially work and being able to walk when wearing reasonable shoes.
Chronic inflammation of the big toe is present and doesn't respond to conservative care.
A significant deformity of the toe (this drifting of the big toe towards the small toes is usually called hallux valgus or hallux abducto valgus).
The big toe joint is stiff and does not bend so that it interferes with walking.
There is no pain relief with the use of nonsteroidal anti-inflammatory drugs.
There is a failure to respond to other conservative treatments such as changes in padding, exercises, footwear, etc.
Beware of unrealistic claims that bunion surgery can give you a "perfect" foot. The goal of surgery is to relieve as much pain, and correct as much deformity as is realistically possible. Unrealistic claims and expectations are are common cause of dissatisfaction with bunion surgery.
Types of bunion surgery:
It has been suggested that when it comes to bunion surgery that there are more different surgical techniques for this than there is for any other surgical condition. They range from the "simple" or "minimal" surgical procedures to the major forefoot reconstructions. The choice of procedure will depend on so many things, all of which will be evaluated and taken into consideration by the surgeon.
Some of the procedures include:
a simple bunionectomy just, literally, cuts off the lump of bone (it does not realign the big toe)
tendons and ligaments around the big toe can be out of balance, so this may be surgically corrected (this is often used in conjunction with other procedures)
an osteotomy is when a wedge of bone is taken out of the big toe and or metatarsal to 'straighten' the big toe (screws, plates or wires are used to hold the bones in place while they heal)
the damaged joint surfaces can be removed and the joint fused together (usually reserved for when there is severe arthritis present; or other types of procedures have failed). In less severe cases, a plastic joint spacer may be used to replace the damaged joint.
Expectations of bunion surgery:
Unrealistic expectations can be a common cause of dissatisfaction with bunion surgery. It is important that expectations are realistic. Bunion surgery will help relieve pain and result in an improvement in the alignment of the toe in the vast majority of cases. Bunion surgery will not allow you to wear a narrower shoe or smaller shoes. Tight fitting shoes are a major contributor to bunions in the first place, so returning to this type of footwear is a risk for the bunion reoccurring. It is important that you discuss your expectations with the surgeon.
Bunion surgery complications:
There are risks associated with any surgery and these should be discussed by the surgeon. Less than 10 percent of patients experience complications from bunion surgery. These can include infection, a recurrence of the bunion, damage to the nerves, and continued long term pain. Most of these are treatable.