How Are Bunions Corrected?

If you’ve ever researched bunion surgery or talked to people you know who have undergone bunion surgery, you may have seen a wide variety of surgical options and post-operative experiences.  This is because there are numerous ways to correct a bunion, and each bunion should be critically evaluated prior to surgical correction.

A bunion is an increase in the angle between the first and second metatarsal bones, which leads to lateral deviation of the great toe and a prominence of the 1st metatarsal head.  Many people have bunions, but not all bunions are painful or limit activities.  As a bunion progresses or worsens, the big toe may begin to push on the second toe, and can cause a hammertoe of this digit, or eventually a “crossover toe” where the second toe overlaps the big toe.  There is at least some hereditary component to bunions, although this is not fully understood.  Additionally, shoes can play a role in your development of a bunion, with narrow width shoes and high heels influencing bunion development the most.  

When your bunion is painful, limiting the activities you enjoy, and you have failed conservative treatments, surgical correction becomes indicated.  When this is the case, various surgical techniques may be recommended.  It is important to have a complete radiographic and clinical evaluation of your bunion to have a better understanding of why your surgeon is recommending the procedure they are.  Below are a brief overview of a few most common techniques of correcting a bunion and some of their indications.

1st metatarsal osteotomy procedure: This procedure involves making a cut in the 1st metatarsal bone, most commonly in the head of the bone, and shifting the end of the bone laterally.  This is fixated most commonly with a screw or plate, and effectively removes the prominent medial bump and corrects the bunion deformity.  This procedure is popular because it allows immediate protected weight bearing post-operatively, and most patients will progress to normal shoes in 6 weeks.

Lapidus bunionectomy: This procedure was first described in 1911, and has been used in various forms since.  It involves fusing the joint behind the big toe joint, called the first tarsometatarsal joint.  This technique has gained popularity in recent years as it allows for de-rotation of the 1st metatarsal, and can provide powerful correction of more severe bunion deformities.  This technique has also shown a lower recurrence rate.  The recovery from this procedure does often require a short period of non-weightbearing after surgery, followed by protected weight-bearing for a minimum of 6 weeks.   

1st MPJ arthrodesis: This procedure allows for powerful correction of severe bunion deformities with significant arthritic changes at the great toe joint.  Sometimes, the arthritic changes in the joint are progressed to an extent where simply correcting the angular deformity will not lead to pain relief at the level of the joint.  Thus, your surgeon may recommend an arthrodesis procedure, as this can help solve both problems in a single procedure.

Minimally Invasive Bunionectomy: This procedure involves very small incisions, and a rotary burr to create an osteotomy, or bone cut in the 1st metatarsal.  This section of the bone is then translated laterally and fixated with screws.  This procedure has gained popularity due to its small incisions and potential for powerful correction with limited exposure.  

These are the most common procedures used, but there are over 100 described ways to correct a bunion, so it is important to discuss your bunion with your surgeon and understand their recommendations prior to surgery.  If you are experiencing pain related to a bunion, contact our offices for a comprehensive evaluation and treatment plan to help keep you active and pain free.  The surgeons at Castle Rock Foot & Ankle Care all have comprehensive training on surgical correction of bunions, and are trained and experienced in all of the above techniques and more.

Author

Dr. Evan Smith Dr. Evan Smith is a Board-Qualified foot and ankle surgeon, providing personalized, high-quality care to the Castle Rock community as a physician with Castle Rock Foot & Ankle Care. Dr. Smith received a Bachelor of Science degree in Biology from Illinois Wesleyan University. He then went on to earn a Doctor of Podiatric Medicine degree at Des Moines University College of Podiatric Medicine and Surgery in Des Moines, Iowa, where he received The American Board of Podiatric Medicine Graduate Merit Award. Following medical school, he completed a three-year foot and ankle surgical residency program at Legacy Health in Portland, Oregon, gaining comprehensive training in all aspects of foot and ankle surgery. Dr. Smith takes pride in connecting with his patients and providing personalized care to get patients back to the activities they love.