Bunionectomy (Bunion Surgery)

Overview

Bunionectomy is a surgical procedure to correct a bunion deformity at the base of the big toe. Multiple surgical techniques exist depending on the severity of the deformity, ranging from simple bony prominence removal to complex osteotomies that realign the metatarsal bone. The goal is to reduce pain, improve function, and restore more normal alignment of the first metatarsophalangeal joint.

Indications

This procedure may be considered when:

• •Bunion deformity with persistent pain not relieved by conservative treatment
• •Significant limitation of walking or daily activities due to bunion pain
• •Difficulty finding comfortable footwear due to deformity
• •Progressive worsening of the deformity
• •Development of secondary problems such as hammertoes or metatarsalgia
• •Cosmetic concerns when combined with functional limitations

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative planning includes weight-bearing X-rays to assess deformity angles
• •The procedure is performed under general, regional, or local anesthesia with sedation
• •Surgical approach depends on the type of bunionectomy being performed
• •Mild deformities may be treated with exostectomy (removal of the bony bump) alone
• •Moderate deformities often require a distal metatarsal osteotomy (e.g., chevron)
• •Severe deformities may need proximal metatarsal osteotomy or fusion procedures
• •The metatarsal bone is cut, repositioned, and fixed with screws, plates, or staples
• •Soft tissue balancing (capsular repair, tendon releases) is performed as needed
• •The incision is closed and a surgical dressing is applied

Risks

As with any surgical procedure, potential risks include:

• •Recurrence of the bunion deformity
• •Overcorrection (hallux varus, where toe points inward)
• •Stiffness of the big toe joint
• •Persistent pain or discomfort
• •Nonunion or delayed healing of the osteotomy
• •Infection
• •Nerve injury causing numbness
• •Hardware irritation requiring removal
• •Transfer metatarsalgia (pain under adjacent metatarsals)
• •Avascular necrosis of the metatarsal head (rare)
• •Blood clots

Recovery Expectations

Recovery follows a gradual progression:

• •Weight bearing restrictions vary by procedure type from immediate to 6-8 weeks non-weight bearing
• •A surgical shoe or boot is typically worn for 4 to 8 weeks
• •Swelling may persist for several months
• •Return to regular footwear may require 2 to 4 months
• •Physical therapy may be recommended for range of motion and strengthening
• •Return to most normal activities occurs by 6 to 12 weeks
• •Return to high-impact activities or high heels may require 4 to 6 months or longer
• •Full recovery with final cosmetic result may require 6 to 12 months

Alternatives

Depending on individual circumstances, alternatives may include:

• •Wider, more accommodating footwear with a large toe box
• •Padding, cushioning, or bunion shields
• •Custom orthotics or arch supports
• •NSAIDs for pain and inflammation
• •Toe spacers or splints (may provide comfort but do not correct deformity)
• •Corticosteroid injections for associated bursitis
• •Activity modification to reduce irritation

Sources

• AAOS OrthoInfo – Bunion Surgery
• Mayo Clinic – Bunion Surgery
• Cleveland Clinic – Bunion Surgery