This week we will focus on the types of surgical procedures used to correct painful bunion deformities that have not responded to conservative care. To reiterate, conservative treatment options should be considered and exhausted when possible before surgery becomes a reality. Types of conservative care include injections, padding/offloading and orthotic therapy. When conservative therapy fails your Podiatrist may recommend surgical correction through one of the procedures described below in attempt to realign the big toe and decrease the level of pain you have been experiencing. It is important to keep in mind when reviewing these procedures that your Podiatrist will select the right procedure for you based on the severity of your deformity.
Soft Tissue Procedures: A soft tissue procedure used for bunion correction is one that attempts to release any tendons and tighten the capsule around the involved joint, both of which are involved in deviating the big toe towards the lesser toes. By releasing these pieces of soft tissue the bones within the big toe will straighten out, align with the lesser toes and decrease the space that has been created between the first and second long bones in the foot. Typically, these procedures are used on patients who have mild deformities and minimal pain over the bump on their big toe. Soft tissue procedures can be performed alone, but are always performed when more corrective procedures are also performed.
Bone Procedures: There are two types of bone procedures that can be used to correct your bunion deformity. There is one procedure where cuts are made into the first long bone of the foot and another procedure where cuts are made in to one of the two bones in the big toe.
Procedures that make cuts into the first long bone of the foot are used for moderate deformities where there is a more significant deviation of the big toe towards the lesser toes. Patients who require such procedures typically have moderate pain that would not adequately reduce with only a soft tissue procedure. In bone procedures, a “V-shaped” cut is made in the first long bone of the foot allowing the bone to be shifted over, aligned with the lesser toes and held in place with a pin or screw.
Procedures that make cuts into one of the two bones in the big toe are used when one of those two bones are a contributing factor in the deformity. A wedge cut is made in one of the bones in the big toe and the bone is de-rotated and properly aligned with the long bone in the foot as well as with the lesser toes. It is stabilized with a pin or screw; the same pin or screw being used for fixation of the bone cut made in the long bone of the foot as described above.
Fusion Procedures: A fusion procedure is used when patients have big toe joints that are arthritic and destroyed, thus they cannot function even if the bones are placed in a corrected position, as would be done with a bone procedure. A fusion procedure removes any material within the joint space that is destroyed and places the long bone in the foot and the first bone in the big toe together, end-to-end. A pin or screw is used for fixation and after 6-8 weeks of healing, the joint is fused and motion is permanently eliminated. Elimination of movement at the joint significantly decreases pain in patients with such conditions.
As with any surgical procedure the risks and benefits should be considered and discussed with your Podiatrist. Complications with any of the bunion procedures described above can include infection, scarring, recurrence of deformity, and transfer pain among others, although the risks of any such complications are minimal. Patients should expect anywhere from 2-8 weeks of recovery depending on the procedure selected and they should expect pain during recovery; although pain is a personal thing and depends on the patients tolerance!
