When is it time for bunion surgery?
Updated: Feb 27, 2019
In my practice, I see patients with bunions frequently and bunions are one of the most common problems that I treat. I would like to go over what a bunion is and the best and most up-to-date way to correct them in this article. Bunions occur in the foot when the big toe joint is malpositioned leading to a prominent bump on the inside of the forefoot. This malpositioning can lead to pain within the big toe joint from uneven pressure on the joint surfaces as well as pain from rubbing of the bump on shoes. Bunions are mostly an inherited condition so most people are born with them, but bunions are also often times made worse by wearing improper shoegear or nonsupportive shoes and they often progressively worsen over time. Often people will have a bunion and be able to tolerate it without having pain or other symptoms. In these cases I generally tell patients that it’s ok to leave the bunion as is without correcting it surgically. In cases when a bunion deformity is causing pain there is a very effective surgical treatment. If the bunion has become progressively more malaligned with time without causing breakdown of the joint surface the indicated surgical treatment is called a Lapidus fusion which involves fusing the first metatarsal-cuneiform joint (The joint proximal to the big toe joint) to allow repositioning of the big toe joint and thus correcting the bunion deformity and eliminating the pain symptoms. The procedure involves placing a plate across the joint and screws to facilitate fusion of the joint. This is an outpatient surgery so the patient comes to the OR and leaves on the same day. During recovery, there is a period of protected weight bearing using a surgical boot until the fusion site is sufficiently fused then the patient can progress to weight bearing in shoes within a few weeks. When the bunion has been present for a long time often it can cause arthritis within the big toe joint. In this case motion within the big toe joint has usually diminished and the cartilage, which normally cushions the joint, has degenerated often times causing painful arthritis within the joint. When arthritis is present, another type of bunion procedure is indicated which consists of a fusion of the big toe joint usually accomplished with a plate across the joint and screws to hold the fusion site together until the joint is sufficiently fused. After a fusion of the big toe joint the alignment of the bunion is corrected and the bone on bone rubbing within the joint is eliminated thus resolving the pain symptoms. This procedure also requires a period of weight bearing within a surgical boot then transitioning into shoes. Patients are usually able to return to normal activities including exercise activities in a few months following surgery. These procedures are the most effective and up-to-date surgical procedures for correction of bunions. There have been many other bunion procedures utilized in the past which have fallen out of favor due to limited capability to sufficiently correct the bunion deformity, continued pain in the bunion after surgery, and also frequent recurrence of the bunion deformity over time. On a personal note, I actually had a Lapidus procedure performed a few years ago on my own foot due to longstanding pain within the joint secondary to a prior injury and arthritis. Before the procedure I wasn’t able to run or even walk long distances without having severe pain. I am now pain free and participating in all types exercise activities without any problems. If you have a bunion and you’re having pain or frustration from not being able to wear certain shoes please come in for an assessment and we can find out what the best treatment would be for you.
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