Surgical Therapies

When the pain from a bunion is not relieved by these therapies, surgical intervention may be warranted. There are many surgical procedures available depending on the location and severity of the deformity. Severity of deformity is generally classified as mild, moderate, and severe. The severity of deformity can dictate where on the bone the deformity needs to be corrected. The surgical procedures to correct the bunion deformity are more complex with severe cases.

When the bunion is mild and there is no significant malalignment of the joint. The simplest surgical procedures for a bunion involve freeing the soft tissue around the joint and removing the bump behind the big toe. More severe deformities are treated by removing the prominent bump and cutting the bone to realign the joint. The bone is then held in place with screws or pins (figure 3). There are many types of surgeries that are used in order to correct the misalignment of the joint and bones. You and your doctor can discuss these procedures and decide which one is appropriate for you.

When the bone is too severely deformed for the above treatments, or the arthritis has destroyed the cartilage in the joint, it is sometimes necessary to remove the joint, fuse it, or replace the joint with an artificial implant.

The bunion surgery itself is painless because appropriate anesthesia is provided throughout. Rest is crucial after the surgery and your doctor will prescribe pain medication. Most patients experience only mild discomfort. Depending on the type of bunion procedure, many patients can walk the same day of surgery. More severe bunions generally require a more complex procedure and can require a longer time to heal. A special surgical shoe is worn during the initial recovery period. Several days of rest and inactivity are required for the foot to heal correctly. Physical therapy may help with post-operative pain and joint stiffness. Many patients are allowed to return to work within one to two weeks, depending on the patient's surgery and occupation. Those with desk jobs, may be able to return to work within one week. Complete recovery typically takes between 6 and 8 weeks, depending on the type of procedure necessary. Once you are back to regular activities, supportive and comfortable shoes should be worn to help prevent recurrence of the deformity. Orthoses are often recommended to maintain the correct alignment of the foot. These often help prevent recurrences by treating what originally caused the bunion. The chance of the bunion returning is kept low by the appropriate surgical procedure, the severity of the bunion before surgery, and patient compliance.