Bunion Surgery is a vast topic. A Great deal of information is available but much of it is confusing or contradictory. You may get information from your doctor, friends, internet and/or family members. This section is designed to cut through the clutter, help you organize the information into categories and assist you in making an informed decision. It is advisable to read my other pages on Bunions.
The surgical procedures
There are a number of different ways to perform bunion surgery. The best procedure for one person is not necessarily the best for another. Some procedures allow you to walk much sooner and you may not have to use crutches. Other procedures may require you to use crutches or wear a boot for a few weeks.Just because your friend knows someone who had bunion surgery and was jogging two weeks later, doesn’t mean that the procedure they had is anything like what you need. Conversely, some difficult bunion corrections can take two or three months before the patient can walk comfortably in an athletic shoe. There is no reason to assume that this is what you will experience. Each person must be evaluated on their own, and their procedure individually selected.
Types of bunion surgery:
Generally, bunion surgery can be classified into two major categories:
- Head procedures (at the head of the first metatarsal, around the great toe joint).
- Base procedures (at the base of the first metatarsal, near or at the joint behind the great toe joint).
For a head procedure, the bone is cut (osteotomy) and the head of the metatarsal moved over to correct the bunion. Various types of bone cuts can be performed depending on the necessary correction. The most common type of bone cut creates a V- shaped cut, often also referred to as a Chevron or Austin Osteotomy.Once the bone is shifted into its corrected position, a screw or a pin is inserted across the bone cut to hold it in place. Head procedures are usually appropriate for a mild to moderate bunion, or for patients who do not feel they can be non-weight bearing after surgery.
Above and below are two diagrams depicting the movement/shifting of bones performed during a Chevron osteotomy. A Chevron type osteotomy is the most common type of head osteotomy.
The x-rays bellow are a before (left) and after (right) of a head osteotomy procedure. Notice the lack of visible pins or screws. That’s because absorbable pins were used, and they are not visible on x-ray.
Base procedures are performed around the base of the 1st metatarsal (bone behind great toe). There are several versions of this procedure, and even hybrid versions that are not exactly head or base procedures, I’m not going to cover these. Base procedures are usually appropriate for moderate to severe bunions.
Three common versions of Base Procedures:
Base Wedge Procedure – involves cutting a wedge out of the bone, then closing the open space, thus swinging the first metatarsal back into a closer position to the 2nd metatarsal.
Crescentic Osteotomy Procedure – involves making a semi-circular cut and rotating the 1st metatarsal bone toward the 2nd metatarsal.
Lapidus bunionectomy – Fusion of the joint at the base of the 1st metatarsal into a more straight alignment.
Above, is a before and after example of a bunion corrected via a base wedge procedure.
Below, is an example of a bunion corrected via a Lapidus procedure.
IMPORTANT! All base procedures will require some kind of metallic fixation, usually plates and or screws. Most of the time this hardware is left behind and does not require removal.
Overall, there are many variables in selecting a bunion procedure. The key is to identify the particular components of your deformity and select a procedure to address the combined components that constitute your bunion.
There is substantial medical research showing which bunion procedures are most effective in specific situations. After examining your lower leg and foot, reviewing your biomechanics and x-rays, and learning about your level of activity, I will be able to select a procedure (or combination of procedures) that is in your best interest. If you have read the pages on bunions in my website, you will be able to fully understand why I recommend a particular approach.
Where is the Surgery Performed
I perform most of my surgery at Texas Health Presbyterian Hospital of Allen, although I am also on staff at several other hospitals. Most hospitals and surgery centers in this Metroplex are equipped for these procedures. In some parts of the country it is acceptable to perform this surgery in the doctor’s office. Bunion surgery in an office setting is considered below the standard of care (a legal concept) for this area.
Recovery from surgery
Weight bearing on your foot depends on your procedure. A head procedure allows for immediate weight bearing. However, whether you actually feel like placing full weight on your foot, depends on you.Usually, after surgery, you will be fitted with either a post-op shoe or a boot. You will also be given either crutches or a walker. Mostly, with a head osteotomy, the crutches or walker are just a comfort and stability aid, and you will discontinue their use whenever you are comfortable. With a base procedure, you will be instructed to remain non weight bearing for approximately 6 weeks (an average). Use of crutches or walker, maybe even a wheel chair or a knee scooter, will be mandatory.
You will have a bandage on your foot, which you are not to get wet or remove.
Office visits and bandage changes will occur weekly for the first 4 weeks (average)
One week after surgery you will have your dressing changed and a post-op x-ray performed.
Second week after surgery your sutures will be removed.
X-rays will be repeated periodically until your bone heals.
Your first shoe after surgery will be an athletic shoe. Gradually, as swelling subsides, you will return to other shoes and regular activity.