If a bunion causes severe problems, surgery is often the only effective treatment. The most suitable type of surgery will depend on various factors, such as how much the position of the bones in the foot has changed.
In many people who have bunions (medical term: hallux valgus), they don’t cause any problems – or only minor problems. In others, the foot becomes increasingly deformed and hurts, making it hard to walk. Conservative (non-surgical) treatments for bunions include wearing well-fitting shoes and using splints. But there’s a lack of good research on how effective these measures are. If bunions become a real problem and don’t get better, surgery may be considered. The aim of surgery is to
- relieve the pain,
- improve the stability of the foot,
- enable you to walk normally again,
- improve the appearance of the foot and
- prevent the development of osteoarthritis and hammer toes or claw toes.
What does the surgery involve?
There are various types of surgery for bunions. Most of them involve correcting the tendons, ligaments and joint capsule in order to improve the position of the big toe. After that, the first metatarsal bone (the foot bone just behind the big toe) – and sometimes also the proximal phalanx (the bone at the base of the big toe) – are cut and re-positioned so that the toe is straight again. In more severe bunions, other kinds of surgery might be needed. For instance, the joint at the base of the big toe – or the joint at the base of the first metatarsal bone – can be fixed in place.
The foot is usually stabilized using metal plates, screws, wires or special bandages. Bunion surgery lasts about 30 to 100 minutes. You usually have it in the hospital and then stay there for a few days. But it can also be done as a day procedure, which means you don’t have to stay overnight in the hospital.
What happens after the surgery?
The foot has to be kept stable in the first few weeks after the procedure. This is done using bandages, and sometimes a splint too. You also wear a special shoe that takes pressure off the front of the foot. Although you can start to gradually put weight on the foot again immediately after the operation, you should only walk a little bit and regularly put your foot up in order to prevent swelling. If there’s a lot of swelling, lymphatic drainage massages are sometimes offered. How much you’re allowed to use your foot will depend on the type of operation that was done and how painful it is. Because you can’t move around much in the first few weeks after the operation, some people need help at home – for instance, with household chores or shopping. One option is to organize nursing care at home during that time.
Once the wound has healed enough, you can start doing toe exercises. After surgery, it takes about 4 to 6 weeks for the bones to become stable enough to make full use of the foot again. In the first year, the foot is more prone to swelling. The type of treatment you have after surgery will depend on what was done during surgery.
What factors play a role in the treatment decision?
The surgical options, and whether surgery is considered at all, will depend on
- how bad the symptoms are,
- how severe the misalignment is,
- whether the bunion is related to osteoarthritis,
- what kinds of sports, work-related and everyday activities should still be possible,
- what (temporary) negative effects the surgery could have,
- whether the person also has other medical conditions such as vascular (blood vessel) disease, diabetes, nerve disorders or rheumatic disease.
Different doctors often specialize in different types of surgical procedures. For that reason, different hospitals also often recommend different types of surgery. Sometimes it’s only possible for doctors to decide exactly what to do once they have already started the operation and looked inside the foot.
If hammer toes or claw toes have already developed, these deformities can also be corrected during the operation.
How effective is surgery?
Surgery straightens out the toes and the midfoot, bringing the bones back into the correct position. The symptoms often improve as a result. Many people can use their foot a lot better and find it easier to walk after surgery. But some are disappointed with the outcome of surgery, for instance because their foot still hurts or because they can move their foot even less than before. Bunion surgery usually causes the joint at the base of the big toe to stiffen. This means that it becomes harder to do things like rolling the foot in a smooth heel-to-toe movement.
Only a few studies have compared the various surgical approaches with each other. Their results suggest that the commonly used approaches are similarly effective.
Bunions may form again after surgery. To try to prevent this from happening, people are advised to avoid wearing tight shoes.
What are the possible side effects?
Like any type of surgery, bunion operations can lead to inflammations, infections and damage to nerves or blood vessels. If the wound becomes infected, further surgery might be needed. Nerve damage can cause part of the toe to become permanently numb. Other, rare complications include osteoarthritis of the metatarsal bone and the death of bone tissue (necrosis).
Because you can’t move your leg much after the operation, the risk of thrombosis is greater during this time too. To prevent this complication, anticoagulant (anti-clotting) injections can be prescribed. The foot may still hurt in the first few days and weeks after surgery. But the pain usually goes away.
Feet are generally quite prone to wound-healing problems because their blood supply isn’t as good as in other parts of the body, and you regularly put your weight on them when walking. If someone already has blood circulation problems due to other medical conditions, such as peripheral artery disease (PAD) or diabetic foot, foot surgery can lead to wound-healing problems or the development of a chronic wound. For this reason, people who have poor circulation in their feet may be advised not to have bunion surgery.
Smoking also increases the risk of wound-healing and bone-healing problems because it affects the oxygen supply to the tissue. This risk can be reduced by quitting smoking for at least a few weeks before and after surgery.
Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). Hallux valgus. AWMF-Registernr.: 033-018. April 2014.
Klugarova J, Hood V, Bath-Hextall F, Klugar M, Mareckova J, Kelnarova Z. Effectiveness of surgery for adults with hallux valgus deformity: a systematic review. JBI Database System Rev Implement Rep 2017; 15(6): 1671-1710.
Wülker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int 2012; 109(49): 857-867; quiz 868.
Zirngibl B, Grifka J, Baier C, Götz J. Hallux valgus. Ätiologie, diagnostische und therapeutische Prinzipien. Orthopade 2017; 46(3): 283-296.
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