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A bunion, or hallux valgus, develops when the big toe bends abnormally towards the other toes. This can lead to swelling of the joint, causing pain and redness in and around the big toe, and potentially making it quite difficult to walk. Once a bunion has formed, it tends to get worse and can get very painful. What might seem to be a minor inconvenience can really affect quality of life in a major way and many people are relieved to have bunion surgery to try to sort out the problem.

This article on bunion surgery is written by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.


What are the causes?

Bunions tend to run in families and are most common in women. Other factors can also increase the risk of developing bunions, such as arthritis and wearing badly fitting shoes. Activities that put pressure on the toes, such as dancing and wearing high heels, can also increase the risk of developing bunions. Weakness or poor foot function, such as excessive rolling while walking, can also be a risk factor. In some cases, injury to the foot can lead to a bunion.

What are the symptoms?

The main symptoms of bunions include redness, swelling and pain, the feet becoming too wide to fit into normal shoes, and possible effects on the alignment of the other toes, affecting the overall appearance of the foot.

Non-surgical treatments

The discomfort caused by bunions can sometimes be relieved by devices designed to realign the big toe and/or protect the joint. Exercises to help strengthen the muscles in the area and anti-inflammatory medicines to reduce pain and swelling can also be helpful. While non-surgical treatments may relieve the symptoms of bunions, bunion surgery is really the only long-term solution but it is not something that should be rushed into.

Surgery

Bunion surgery is a complicated procedure with a relatively long and uncomfortable recovery period.  Bunion surgery is not a guaranteed cure and can often lead to complications such as calluses and corns depending on the procedure used. As a result, bunion surgery should only be considered when all non-surgical treatment options have been tried.

Types of surgery

There are over 100 different types of bunion surgery, depending on the type and severity of your bunion. Bunion surgery is usually done under general or local anaesthesia as a day case and takes about half an hour.

Bunion surgery involves your surgeon making a small cut over your big toe joint, and then shaving off the piece of bone that is sticking out. If needed, your surgeon will then reposition the foot bone, ligaments and tendons. The bones may be held in place using small screws or wires. Following bunion surgery, the skin is closed with stitches and your foot may be either bandaged or protected with a plaster cast.

Individual approaches to bunion surgery include:

  • Repair of the soft tissues around the big toe
  • Arthrodesis: the damaged joint surfaces are removed
  • Exostectomy: the lump on the toe joint is removed (this type of bunion surgery is mostly cosmetic as it does not correct instability of the joint)
  • Resection arthroplasty: the damaged part of the joint is removed
  • Osteotomy: the joint is cut and realigned
  • Minimally invasive bunion surgery: a new technique that can provide enhanced benefits with less tissue damage and shorter operation and recovery times. However, this type of surgery is not yet widely available and may not be suitable for all types of bunions.

What should I expect after surgery?

Bunion surgery will not completely return your foot to its normal state, but it should correct the deformity that has developed over time. Research suggests that 85% of people who have bunion surgery are happy with the results. However, a bunion operation will not fully restore the strength of the big toe, so instability of the joint may still be a problem and bunions may reoccur.

It can take around six weeks for the joint to heal following bunion surgery, and there are several side-effects associated with bunion surgery, including:

  • Stiffness of the toe – due to possible ligament damage
  • Numbness of the toe – due to possible nerve damage
  • Shorter toe – due to bone being removed
  • Abnormal toe position
  • Persistent pain and swelling – it may take up to six months for post-operative pain and swelling to subside
  • Wound infection or problems with wound healing
  • Some people experience overloading of other areas of the foot (beneath the ball of the foot or the smaller toes) to compensate for the big toe (known as transfer pain or metatarsalgia)

The best results are possible only if you follow the advice of your surgeon. Keeping off your foot after a bunion operation, resting with your leg raised and wearing comfortable, sensible and supportive shoes are all important. Once you have gone to the trouble of bunion surgery it is best not to revert to shoes that put pressure on your toe area, even when you have healed well. Reoccurrence of the bunion is possible and a second bunion surgery is likely to be more complicated and have a lower chance of success.

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