Bunion Correction

Bunion Surgery

Bunions are a prominence on the medial (inside) of the foot caused by a structural deformity of the first metatarsal in effect increasing the inter-metatarsal (IM°) angle.

This is usually caused by genetics, however can be made worse with other conditions like improper shoes, athletic activity, and trauma.  A bunion results in a dislocation of the first metatarso-phalangeal joint (MPJ) which can eventually lead to arthritic changes in this joint.  Before the onset of arthritic changes, the joint usually causes pain because of impingement of the nerves in the region.  This can lead to difficulty wearing normal shoes, participating in athletic activity, and ultimately a lifestyle limited by pain.

Most shoes (particularly for professional women) are not designed with consideration of the bunion deformity.  Thus, the condition will escalate in women who are required to wear professional shoes.  If left untreated, bunions usually continue to get worse.  With increased time, bone quality, healing potential, and overall health deteriorates making bunion surgery a difficult consideration later in life.

The Procedure

Bunion surgery involves a few basic steps.  The first step is dissection and exposure of the bony deformity.

This step requires an incision on the medial side of the foot over the MPJ.  This incision is then deepened to the level of the joint capsule.  This is a layer of ligamentous tissue that is thick and covers the entire joint.  The capsule is incised to expose the joint (it will be repaired later).  At this time, the bump is removed with a bunionectomy.  To definitively correct the problem however, an osteotomy has to be performed to correct the Inter-metatarsal Angle (IM°).  The bone is cut and shifted laterally to reduce the angle.  The osteotomy is then fixated with a compressive screw.  The tissues are repaired and the skin is closed.

During the procedure, if your surgeon notices that extra steps are required to improve the outcome of the procedure, these steps will be performed in addition to the bunion surgery.  These can include a tendon transfer, sesamoid release, sesamoidectomy, bone or tissue graft.

If there is an angular deformity of the joint in the great toe as well, your surgeon may perform an Akin Osteotomy.  This procedure involves removal of a wedge of bone which allows for straightening of the tip of the toe in relation to the base of the toe.

This procedure can also be performed by itself, without a bunion correction.  If you have discussed doing an Akin Osteotomy by itself with your surgeon, this consent will provide permission to perform the procedure by itself, without bunion correction.

Possible Complications Specific to Bunion Surgery

Recurrence

There is a chance that the bunion deformity can recur if the procedure that is being performed is a head osteotomy and it has been determined that a base procedure may provide a more definitive, permanent solution.  This has been discussed with you during your pre op visits and reviewed in detail.  The decision to perform a head vs. a base osteotomy is sometimes due to limitations of the patients ability to participate in the recovery requirements for a base procedure, or the patients choice to perform a simpler head procedure, and possibly perform a second base procedure should a recurrence occur.

Hallux Varus

This complication can be due to contracture of the tissues on the side of the bunion, causing a drifting of the toe in the opposite direction of the original bunion deformity.  It can also be caused by overcorrection, which although an effort is made to avoid, sometimes can happen.  Almost all hallux varus complications can be resolved with either conservative or surgical revision.