Bunion surgery

Bunions are one of the most common orthopedic deformities of the foot. A bunion develops when the bones and joints of the great toe of the foot deviate. As a consequence, the great toe moves toward the rest of toes, and a painful bump, a bone spur develops in the inner side of the foot, which could be affected by irritation, wounds, or ulcers.

Which causes lead to the disease?

Bunion deformity in children (juvenile hallux valgus).

It is often bilateral, and the leading symptom is not pain. In this case, even the most thorough examinations cannot identify what caused the sudden condition deterioration, but intrinsic (internal) factors (genetic predisposition, an increased angle between the metatarsal bones and the toes, loose joints) are dominant when it comes to the causes of the forefoot deformity, which develops gradually over the years. Girls are more often affected by this disease.

Bunion deformity in adults (hallux valgus).

In this case, additional intrinsic causes (a lower transversal arch, neurological comorbidities) are involved too, but biological aging, various degenerative changes, wearing high heels and/or shoes with narrow nose, and a predisposition to this may also play a role in the development of the disease. The disease course may be accelerated by previous injuries, fractures, inflammations, rheumatological diseases, congenital disorders, and previous surgeries. The disease more frequently affects women, than men.

What causes this orthopedic pathology and what does it mean?

• Angulation misalignment develops in the first ray (great toe and the first metatarsal bone), the toe rotates laterally, the metatarsal bone moves toward the midline, and it becomes heavier due to the painful bone spur.
• All of the above are caused by the disbalance of the bones, tendons, and the musculature.
• The joint capsule becomes inflamed and gets thicker because of the tightness, and the bone spurs.
• Joint wear may also develop in neglected cases.
• The joint’s range of motion is reduced by the shortening of the soft tissues.
• Movement and loading become painful, and the bunion oftentimes does not fit into the shoe.

What are the main symptoms of a bunion?

• Pain, which is characterized by the following:
  • The bunion itself is the most painful, but the whole forefoot may ache.
  • It increases on load, or during a longer walk.
  • It decreases or ceases at rest.
• Reduced ability to walk and walking distance.
• Difficulties in wearing shoes.
• All of the above lead to limping.

What are the treatment options?

Basically, there are two treatment options available:

Non-surgical (conservative) treatment

Aims:

• Reducing pain
• Stopping the joint deformity to grow
• Increasing muscle strength
• Reducing limping

Methods:

• Pharmacological treatment:
  • Anti inflammatory drugs
  • Painkillers
• Other treatments: foot exercises, foot reflexology, walking on rugs, sole massage, insoles for flat feet, or wearing orthopedic footwear, using a bunion corrector for night.

Surgical treatment

The physician may recommend surgery if the conservative treatment methods are no longer effective, and the diagnosis is confirmed by clinical examinations and X-ray scans. It is important to select the time of the intervention, which depends mostly on the patient’s pain tolerance, the condition of the stabilizing musculature, and the level of progression (aggravation).

The type and number of surgeries described in the literature is countless, your physician may recommend an optimal solution based on the current condition of the affected bones and soft tissues, and the patient’s needs. The aims of all techniques:

• The intervention starts with an incision made above the bunion, through which the surgical opening of the joint (arthrotomy) is performed. The incision may be extended to variable lengths in both directions, depending on the severity, and the surgical technique.
• Bone shaving or soft tissue release is rarely performed on their own, usually in case of a mild deformity.
• It is possible to perform a bone cutting procedure below the metatarsal bone’s head (subcapital osteotomy), a bone cutting procedure on the base of the metatarsal bone (base osteotomy) in more severe cases, and in certain cases, a combined osteotomy with shift correction (restoration). All of the above may be accompanied by soft tissue release from the same incision, or from additional incisions for the purpose of restoring the shortened soft tissues’ pulling forces and directions. The achieved corrected (restored) bone position could be secured with screws or other metal implants, if necessary, in which case, the use of an X-ray image intensifier may become necessary (certainly by taking the radiation protection precautions).

The surgical process:

• The sick joint and its area are explored from an incision made above the bunion.
• One of the surgeries described above, or their combination is performed.
• Rarely, a suction drain made of silicone is inserted into the surgical site due to the associated postoperative bleeding.
• The wound is closed after thorough surgical hemostasis.
• In line with the extent of bone removal, axis correction, ligament release and restoration, a cover dressing with an elastic bandage, or a redressive dressing is applied (this maintains the position, and it is corrective).

What happens if the justified surgical treatment is not performed?

• The pain is expected to increase further.
• The axis deviation and movement disability may aggravate.
• The quality of life keeps deteriorating.
• The effectiveness of a surgery performed later may decrease.