Bunion Surgery - Indications, Procedure, and Risks

Introduction

The scientific term for a bunion is hallux valgus. It is an enlargement of the bone or tissue around a joint at the base of the big or the little toe. The latter's bunion is also colloquially called a bunionette or the tailor's bunion. Bunions form when the joint is overstressed for a long time. Primarily seen in women, they are more likely to wear tight, pointed, and confining shoes that constrict the toes. Genetics may also play a key role alongside pathological conditions such as arthritis affecting the base of the big toe.

What Is Meant by Bunion?

A bunion is a bony bump structure present at the side of the big toe joint. These bumps usually develop on the outside edge of the foot. They are seen at the portion of the joint where the toe meets the foot, also called the metatarsophalangeal joint.

What Is Bunion Surgery?

Bunion surgery, also known as bunionectomy, is a procedure performed to correct bunions. This surgery has many forms, the most common being repositioning the big toe to eliminate pain and enhance function.

Can Bunions Be Managed Nonsurgically?

Before surgery is considered, comfortable footwear, splints, orthotics to reposition the big toe, and padding are recommended. If the problem is caused by arthritis, medication may help manage pain and reduce swelling. If the treatments mentioned above are unsuccessful, a surgical option is considered.

What Is the Aim of Bunion Surgery?

The goal of surgery is principally pain relief and correction of the deformity as far as practically feasible. It must be noted that bunion surgery is not a cosmetic procedure.

What Determines the Type of Bunion Surgery?

The type of surgery depends upon the following;

1. The severity of the bunion.

2. Age of the patient.

3. The general health of the patient.

4. The activity level of the patient.

5. Condition of the bones.

6. Presence of connective tissue disorders.

Who Needs Bunion Surgery?

The surgery is suggested only if there is pain in the bunion or there are any functional disturbances. The candidates for this surgery are:

• Big toe, which tends to drift towards the smaller toe.

• Stiff big toe.

• Pain which disturbs the regular activity.

• Swelling and inflammation of the big toe.

What Are the Types of Bunion Surgery?

The types of surgery are listed below.

• Mild Bunion: This involves the removal of the enlarged portion of the bone in the affected toe, realigning the deformed muscles, displaced tendons, and stretched or torn ligaments in proximity to the toe joints.

• Moderate Bunion: The bone needs to shift its original position in this type of surgery. Bone cutting depends on the severity and location of the affected area of deformity and pain. The surrounding tendons and ligaments may also be affected and need repositioning.

• Severe Bunion: This type of bunion surgery involves removing the enlarged bone fragment, cutting, reshaping, recontouring, and realigning the bone to correct any deformities. The affected tendons and ligaments are also addressed to be placed in their original position.

• Arthritic Bunions: If a joint is damaged beyond repair, as is often seen in arthritis, it may need to be fused, thus allowing the bones to heal together. This eliminates both movement and the pain resulting from it. Implants may occasionally be used in the reconstruction of the big toe joint.

Why Is Bunion Surgery Needed?

Bunion surgery is necessary for the following reasons,

1. Severe foot pain while walking, wearing flat, comfortable shoes.

2. Conventional methods cannot manage chronic big toe inflammation with painful swelling.

3. Toe deformities.

4. Drifting the big toe inward.

5. Inability or restriction attempting to bend and straighten the big toe.

What Are the Potential Postoperative Risks?

Several complications can happen, as with any surgical procedure, which may include the following;

• Stiffness of the affected joint.

• Numbness of the toes.

• Swelling that does not subside with anti-inflammatory medication.

• Delayed wound healing postoperatively.

• Infection of the surgical site.

Other complications may include;

• Recurrence of the bunion.

• Nerve damage.

• Continued pain.

• Overcorrection of the problem causes the big toe to extend away from the other toes.

How Is the Patient Prepared Preoperatively?

• The procedure for surgery is explained thoroughly to the patient, any doubts or apprehensions are cleared, and informed consent is obtained.

• Complete medical history is recorded.

• Complete physical examination, blood tests, or other diagnostic tests also rule out other systemic diseases.

What Does a Bunion Surgery Procedure Involve?

Bunion surgery is an outpatient procedure that rarely requires a hospital stay. Surgeries are usually performed under ankle block anesthesia, and general or spinal anesthesia is seldom used.

Bunion surgery follows the following steps;

1. All clothing is removed, the patient is given a gown to wear to prepare for the surgery, and an intravenous line is inserted in the arm or hand.

2. The skin over the bunion surgery site is disinfected with an antiseptic solution, and local anesthetic agents are used.

3. This numbs the area of surgery.

4. Occasionally, general or spinal anesthesia may be used.

5. Cutting, realigning, and possibly removing affected portions of the bone, stretched or torn ligaments, and malaligned tendons are also addressed.

6. The surgical site is sealed using stitches, and a sterile bandage or dressing is placed.

How Is the Postoperative Patient Recovery?

• Postoperative observation is done in the recovery room, and the recovery process depends on the type of anesthesia.

• The circulation and sensation of the foot are constantly monitored to ensure no lasting loss or abnormality is evident.

• As soon as the vital signs are stable, the patient is either shifted to their hospital room or discharged.

• The surgeon advises specific instructions for foot care at home during the first few weeks after surgery. A special surgical shoe or cast may be placed to protect the foot.

• The foot needs to be kept elevated to reduce pain and swelling. Applying ice and limited walking or exertion on foot is prevented or restricted.

• Pain reliever medications, such as Aspirin, are prescribed for soreness. Antibiotics to help prevent infection of the surgery site may also be prescribed.

What May Be the Postoperative Emergencies?

• High-grade fever.

• Redness at the surgical site.

• Swelling and continued pain.

• Bleeding and delayed healing.

• Purulent or pus drainage from the surgical site.

• Increased pain that does not subside with medication.

The foot may need continuous support from dressings or braces for six to eight weeks postoperatively. In addition, exercises and physiotherapy are recommended to help regain the original strength and range of motion as before the surgery was necessary.

What Are the Risks and Complications Related to Bunion Surgery?

The risks related to this surgery are:

• Recurrence of bunions.

• Nerve damage.

• Infection.

• Inflammation.

• Wound-healing issue.

• Pain and stiffness.

Conclusion

Bunion surgery is performed in order to facilitate discomfort and restore the deformation induced by a bunion. A bunion is also called a hallux valgus. It refers to the growth of the bone near a joint on the floor of the big toe. Bunions usually begin when the joint is stressed over a long time. Most of them are formed in females because they wear tight and confining shoes. Bunions may also be inherited or formed because of underlying orthopedic conditions such as arthritis.