Introduction
A bunion is a bony overgrowth near the big toe that must be removed and realigned to correct the foot deformity. This frees the patient from the symptoms, and they can walk without difficulty.
There are various types of this surgery, and non-surgical treatment of a bunion is also available. The surgeon opts for surgery only when the conservative treatment modalities fail to relieve the pain.
What Is Bunionectomy?
Bunionectomy refers to the surgical removal of a bunion. Hallux valgus is another term to describe a bunion. This deformity occurs when the forefoot is under pressure for a long time. It usually affects the big toe and angles inwards towards the second toe.
What Are the Reasons for a Bunion to Form?
The exact reason for a bunion is not known. Some factors that play a role in forming a bunion include:
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Heredity.
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Flat feet.
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Abnormality in the alignment of the bone.
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Ill-fitting footwear.
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Excessive flexibility of the joints.
It more frequently affects women than men. Poor-fitting of the footwear is not the only cause of a bunion. The reason is most probably attributed to the problems within the foot that are even worsened by the footwear.
Who Needs a Bunionectomy?
The surgery is not recommended as the first option for anyone who develops a bunion. First, certain conservative methods are tried and then switched to surgery if the pain does not subside. The candidates suitable for the surgery include:
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When daily activities like walking get affected due to severe foot pain.
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Swelling and inflammation on the big toe that is not relieved by medications.
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When pain does not subside even after changing the footwear.
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When the toes cross over each other due to the inward angle of the big toe.
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When the patient is unable to bend the big toe due to its stiffness.
What Are the Types of Bunion Surgery?
Bunionectomy surgery consists of many types. The most common among them include:
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Osteotomy - The surgeon cuts the joint near the big toe and then rearranges it to the original position.
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Exostectomy - The surgeon removes the bunion but does not involve rearranging the toe back to the old position.
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Arthrodesis - Arthritis also causes a bunion to form. Here, the arthritic joint is removed and replaced with screws or metal plates till healing is complete. This procedure is helpful in patients with severe arthritis or a severe bunion.
What Are the Non-surgical Measures to Treat a Bunion?
Some of the lifestyle modifications are recommended to be tried before deciding on surgical treatment.
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Wearing footwear that is comfortable for the patient, preferably shoes, as it can avoid too much pressure on the foot.
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Using an orthotic (a device fitted into the shoes to correct the deformity).
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Using ice cubes on the area of inflammation to reduce pain and swelling.
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Exercises like stretching the toes can improve joint mobility.
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If arthritis is the cause of a bunion, appropriate medications prescribed by the physician are consumed to relieve the symptoms.
If the above measures do not successfully bring relief, surgery is the only option to cure the condition.
How to Prepare a Patient for Bunionectomy?
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The patient signs a consent form as a sign of willingness for the surgery.
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Several tests like blood count, urine test, and foot X-ray are taken to confirm the diagnosis.
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Avoid having food and water about eight hours before the surgery.
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If the patient is under medications such as Aspirin (blood thinner), it has to be stopped a week before the surgery.
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Allergies to anesthesia or medications are informed to the doctor to prevent complications.
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Avoid smoking or alcohol consumption.
How Is Bunionectomy Performed?
The surgery of removing a bunion aims to:
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Provide pain relief.
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Make the patient walk without any difficulty.
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Enhances the appearance of the deformed foot.
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Stabilizes the foot.
A bunionectomy is of two types: open-foot bunionectomy and minimally invasive bunionectomy.
Open-Foot Bunionectomy:
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Local or general anesthesia is administered.
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A five to six-inch incision or a cut is made on the foot to expose the joint.
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Another incision is made between the big toe and the second toe.
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After complete visualization, the bunion is removed.
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The big toe bones are realigned and held in a new position with screws, pins, plates, or wires.
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The incision is then closed with sutures.
Minimally Invasive Bunionectomy:
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The surgery is done under local anesthesia.
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Most preferred surgery for bunion removal.
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It takes less than two hours to complete the surgery.
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Here, three incisions one inch long are made on foot.
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The bunion is removed, and the big toe is repositioned to the original site.
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Sutures are placed to close the incisions.
The open-foot type is the traditional procedure and is not used often. The surgeon usually chooses the minimally invasive type, which is painless and comfortable for the patient.
What Are the Complications Associated With Bunionectomy?
The following complications are associated with bunion surgery.
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Infection.
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Injury to the surrounding nerve in the foot during the surgery.
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Sometimes, the bunion does not resolve and forms again, even after surgery.
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Persistent pain.
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The bone fails to heal completely.
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The big toe joint becomes stiff.
Most of these complications are usually treatable; if any of these changes are noticed, the patient must inform the doctor immediately. The doctor is consulted regularly at the follow-up schedule, and the progress of the condition is noted.
How Is the Recovery After Bunionectomy?
The recovery depends on the type of surgery that the patient has undergone.
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In open-foot bunionectomy, the recovery is slow. The patient experiences severe pain for a few months to years. Painkillers are given to the patient for a long time and may become addicted. The patient wears a hard cast to the knee for about three months after surgery. The foot is then brought back to function slowly after complete healing. Due to intense pain and delayed recovery, this surgery is not preferred.
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In minimally invasive bunionectomy, the patient experiences minimal pain, which fades off in a few days. The patient can resume normal functioning within a few days after the surgery.
Most bunions resolve after the surgery. But some of them recur, and the patient's progress worsens. Predicting which bunions worsen from those that heal is not easy. Continuous review by the doctor after the surgery is followed to detect changes at an early stage and treat them appropriately.
Conclusion
Bunions pose a painful problem to the big toe, making the affected individual difficult to walk and also giving an unsightly appearance to the foot. The specific cause for these bunions remains uncertain. They have to be treated once noticed or may worsen the condition. The treatment can be conservative or surgical. If pain is the primary concern, then surgery is done. The success rate after surgery is good if properly maintained and regular follow-ups with the surgeon.
