Bunion Surgery is the only way to correct a bunion. Bunions usually get worse over time, so a bunion that is left untreated is likely to get bigger and become more painful.
If your bunion is causing a significant amount of pain and is affecting your quality of life, your GP may refer you to be assessed for bunion surgery.
The aim of bunion surgery is to relieve pain and improve the alignment of your big toe. Surgery is not usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.
The operation will either be carried out under local anaesthetic (where the affected area is numbed but you are awake during the procedure) or general anaesthetic (where you will be completely unconscious).
Bunion surgery is usually performed as a day case procedure, which means you will not have to stay overnight in hospital.
Types of surgery: Numerous surgical procedures are used to treat bunions. The type of surgery that is recommended for you will depend on the severity of the deformity and how far the bones in your foot have moved as a result of the condition. Pre-existing wear and tear in the joint will also be taken into consideration.
Your surgeon may use pins, wires or screws to hold the bones in place while they heal. Depending on the type of surgery you have, these may be left in your foot or removed later on.
Some of the surgical procedures for bunions are outlined below.
An osteotomy is the most common type of bunion surgery. It involves cutting and removing part of the bone in your toe. During the procedure, your surgeon will remove the bony lump and realign the bones inside your big toe. They will also move your toe joint back in line, which may involve removing other pieces of bone. Distal soft tissue realignment
Distal soft tissue realignment can be used to correct a mild bunion deformity. This type of surgery aims to correct the deformity using soft tissue procedures, such as tendon release and capsular tightening, to help improve the stability and appearance of the foot and big toe joint.
Distal soft tissue realignment can be carried out on its own, although it is usually performed at the same time as an osteotomy.
Arthrodesis involves fusing together two bones in your big toe joint (metatarsophalangeal joint). This procedure is usually only recommended for people who have severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint, such as severerheumatoid arthritis, or where there is advanced degeneration of the joint.
After arthrodesis, you will not be able to move your big toe at the metatarsophalangeal joint (the base of the big toe).
Excision (Keller’s) arthroplasty:
An excision arthroplasty involves cutting out the bunion and part of the bone of the joint at the base of the big toe. This creates a false joint that later heals when scar tissue forms. The procedure involves pinning the joint in place with wires, which will be removed around three weeks after surgery is carried out.
An excision arthroplasty can only be used in certain circumstances, and is usually reserved for severe, troublesome bunions in very elderly people.
Minimally invasive bunion surgery:
The National Institute for Health and Clinical Excellence (NICE) has recently published information about a new, minimally invasive surgical procedure that can be used to treat bunions. However, as the procedure is new, there is currently little reliable evidence of how effective or safe it is.
Whichever type of surgery you have, you will be under a local anaesthetic or general anaesthetic. One or more incisions will be made near the big toe so that bone-cutting instruments can be inserted. These are used to remove the bunion and to divide one or more bones located at the front of the foot.
The procedure aims to repair the tilting of the big toe and uses wires, screws or plates to keep the divided bones in place. It may be carried out using X-rays. X-rays use small doses of radiation to take images of the bones.