A bunionectomy is a surgical procedure to remove a bunion, an enlarged joint at the base of the big toe. This operation also corrects hallux valgus, the associated deformity that occurs when the base of the metatarsal bone angles away from its normal position. Most bunions are treated without surgical intervention, but in cases of severe enlargement and foot deformity, where more conservative methods are insufficient to relieve pain and avert or overcome disability, a reparative operation may be necessary.
The surgical goal is to remove swollen tissue and part of the affected bone in order to straighten the big toe. During most bunionectomies, the affected joint where the metatarsal bone joins the middle of the foot is fused. This is known as a Lapidus procedure. In some cases, an artificial joint is implanted during bunion surgery.
The Bunionectomy Procedure
A bunionectomy is typically performed on an outpatient basis under local anesthesia with mild sedation. General anesthesia may be used in particularly complex operations or because of patient preference.
For several weeks after surgery, patients require supportive splints or casts and assistive devices, such as crutches or canes, until they are able to put weight on the surgical site. In almost all cases, patients require custom-made orthotics after surgery. These orthotics ensure stability and make sure that the affected foot is kept in the correct position to avoid a recurrence of the problem. Patients are typically unable to wear regular shoes for weeks to months after the operation, but most can resume their normal activities in 6 to 8 weeks.
When a patient requires a bunionectomy on each foot, most podiatrists recommend that the operations be performed at different times. A hiatus of many weeks or months between surgeries helps to ensure a safe and complete recovery.
Risks of Bunionectomy
Like all surgical interventions, a bunionectomy carries some risks. In addition to the general surgical risks of infection or adverse reaction to anesthesia or medication, possible complications of a bunionectomy may include:
- Stiffness or limited mobility of the big toe
- Under- or over-correction of the toe
- Delayed healing
- Nerve damage leading to pain or numbness
- Persistent swelling
- Arthritis or poor circulation at the site
- Recurrence of the bunion
There are wide variations in reported satisfaction with bunion surgeries. It appears that although a relatively substantial percentage of patients who undergo bunion procedures are not completely satisfied with the results, most experience pain relief and regain the ability to resume normal activities after surgery.