Bunion Surgery

Introduction

It is important to note that bunion surgery should not be done for cosmetic reasons. If your bunion is not painful, you do not need surgery.

Most people can slow the progression of bunions and find pain relief with simple measures such as wearing wider shoes and wearing pads in shoes. However, if these simple treatments do not relieve the symptoms, then bunion surgery may be recommended.

Bunion condition before surgery (left) and after surgical correction of bunion deformity (right).

Indications for bunion surgery

  • Significant foot pain that limits everyday activities.
  • Chronic big toe inflammation and swelling that does not improve with rest or medication.
  • Toe deformity – a drifting of the big toe to the smaller toes, with the potential for the toes to cross over each other.
  • Toe stiffness – inability to bend and straighten the big toe.
  • Failure to obtain pain relief with changes in foot wear or find relief from non-steroidal anti-inflammatory drugs (NSAIDs).

Peri-operative patient education

Once surgery is recommended, Dr Lane will discuss the proposed surgical procedure with you. Educational leaflets supplied by the Australian Orthopaedic Association are also supplied. If there are any further concerns, the staff at are happy to take calls and if needed, a further explanation is encouraged with Dr Lane.

If there are any significant medical conditions you may be reviewed by further specialised physicians and anaesthetist prior to surgery.

Surgical procedures

The common goals of most bunion surgery include:

  • Realigning the metatarsophalangeal (MTP) bones at the base of the big toe.
  • Relieving pain.
  • Correcting the deformity of the bones making up the toe and foot.

In the majority of cases, bunion surgery includes correcting the alignment of the bones and repairing the soft tissues around the big toe. There are many types of surgical procedures performed to correct the big toe deformity and Dr Lane will use the most appropriate surgery to give the best outcome, which may include:

Repairing the tendons and ligaments around the big toes

In some cases, the soft tissue around the big toe may be too tight on one side and too loose on the other. This creates an imbalance that causes the big toe to drift toward the other toes.

Surgery can shorten the loose tissues and lengthen the tight ones. This type of procedure usually included with some form of bone alignment surgery, osteotomy, and is rarely done alone.

Osteotomy

In an osteotomy, the surgeon makes small cuts in the bones to realign the joint. After cutting the bone, the surgeon fixes the new break with pins, screws, staples or plates. In some cases, a small wedge of bone is removed to provide enough correction to straighten the toe.

As discussed above, osteotomies are normally performed in combination with soft tissue procedures, as both are necessary to maintain the big toe alignment.

Arthrodesis

An arthrodesis involves removing the arthritic joint surfaces and then fusing the bones together with screws, wires or plates. This surgery is usually used in patients with severe arthritis or bunions and for patients who have had previous unsuccessful bunion surgery.

Ostectomy (Bunionectomy)

An ostectomy involves removing the bump from the big toe. It is usually performed as part of an entire corrective surgery that includes osteotomy and soft tissue procedures. Ostectomy is rarely used on its own to treat bunions because it does not realign the joint. If the surgeon performs ostectomy without other procedures the bunion deformity usually returns.

Joint replacement

This is usually limited to patients with low demand activities who may have pre-existing medical conditions e.g. in rheumatoid arthritis, which limits their activities. It is not often recommended.

Pre-operative Instructions

Anti-inflammatory drugs such as Feldene, Naprosyn, Nurofen, Brufen, Indocid, Voltaren, Mobic and Celebrex should be stopped 5 days before surgery. These drugs increase the risk of bleeding. Aspirin or other blood thinning drug usage prior to theatre should be discussed with Dr Lane as this would depend on the patients underlying medical condition. The foot to be operated on should be free of cuts, scratches and sores as this can increase the risk of infection. If there is damage skin in the area that has to be operated on, then it is highly likely that the operation will be postponed.

Almost all bunion surgery is done as a day procedure. Our reception staff will give you instructions when to attend hospital, depending on your surgery time. You are advised to take any foot X-rays, Medicare and private health care cards. Do not eat or drink anything 6 hours prior to your procedure.

Once your details are taken in the admissions area:

  • You will be admitted by the duty nurse and baseline observation taken.
  • Theatre gowns given to wear.
  • The foot will be inspected by the nursing staff, an anti-septic applied to the skin and the leg and foot covered in a sterile drape.
  • The other leg will have a TED stocking applied to reduce the risk of thrombosis after surgery.

You will be taken from the day hospital to the theatre complex by the nursing staff and then into the anaesthetic bay. There you will meet your Dr Lane and the anaesthetist.

Bunion surgery can be performed under spinal anaesthetic and twilight sedation or general anaesthetic.

Procedure

When in theatre, a single dose of intravenous prophylactic antibiotics is given reduce the risk of post-operative infection. A tourniquet is applied to the lower leg which provides a blood-less field for surgery.

The leg and foot below the tourniquet is prepped with anti-septic and sterile drapes, with a window for operating site, laid over patient.

This incision is usually along the inside of the big toe. Depending on the complexity of the operation, more than one incision maybe needed to correct your deformity.

The surgical time is dependent on the extent of the surgery required to correct the foot malalignment. It usually takes 1 to 2 hours.

The wound is closed with sutures and local anaesthetic injected to aid post-operative pain-relief.

Once surgery is complete, sterile dressings, bandages and a splint applied.

After the surgery, you will be taken to the recovery room. Once adequately awake, observation normal, able to eat and drink and are comfortable, you will be discharged from the hospital.  You will have a script for pain relief medication and be wearing a surgical shoe that will allow you to walk on your heel. It is important that you have someone who can take you home.

Postoperative Instructions

The success of the surgery will depend in large part how you follow your Doctors instructions at home.

  • Dressing Care – You will be discharged from hospital with bandages holding your toe in the correct position. Be sure to keep your dressings dry and when you are showering and bathing, cover your foot with a plastic bag.
  • Sutures – Your dressings and sutures are removed about 2 weeks after the operation- usually in Dr Lane’s rooms. At that time, further waterproof dressings will be applied for the next 3 to 4 days.
  • Medications – Dr Lane injects long-acting local anaesthetic around the incision site at the end of the time of surgery, which should keep you comfortable for up to 24 hours. You will also receive a script for pain medication to relieve surgical discomfort.
  • Swelling – Keep your foot elevated as much as possible for the first 2 weeks after surgery. It is possible to have some swelling up to 6 to 12 months after bunion surgery.
  • Bearing weight – It is important that you follow strict instructions about whether and when you can put weight on your foot. If you put weight on your foot too early or without proper support, the bones can shift and bunion correction lost. Dr Lane will supply you with the appropriate medical footwear which will enable you to walk on your heels and not on the operative site. You may also require walking aids such as crutches, knee walker or wheelchair – particularly if both feet involved.
  • Driving – If the right foot is involved or both, then you will be unable to drive for 6 weeks. If the bunion surgery is just on the left foot then you are able to drive an automatic car at 2 weeks after the operation once you have been seen by Dr Lane.

It will take several months for the bones to fully heal.  At the 6-week post-operative stage, you will be reviewed by Dr Lane and if all well, be able to wear shoes or sandals that you find comfortable.  Hydro-therapy may be helpful and occasionally referral to a physiotherapist may be necessary.

Risks

Bunion surgery, like any surgical procedure, is associated with risks.  

General risks (rare)- associated with Anaesthetic:

  • Death.
  • Heart attack.
  • Stroke.
  • Pneumonia.

Local risks (uncommon)- associated with bunion surgery.

  • Infection.
  • Bleeding 
  • Nerve injury.
  • Failure to relieve pain.
  • Failure of the bones to fully heal or unite.
  • Stiffness of the big toe joint.
  • Recurrence of the bunion.
  • Deep Venous Thrombosis (blood clots).

Patients with diabetes, obesity, pre-existing multiple medical conditions and smokers will have an increased risk of adverse complications.