Conservative Treatment
Non-surgical bunion treatment options may include:
- Medications to help alleviate pain and symptoms
- Ice packs to reduce inflammation
- Broad-toed shoes that fit properly to reduce the compression of the toes.
- Bunion pads, cushions, and splints to alleviate pain and protect the foot
- Properly fitted shoes that match the shape of the feet
Surgery
The surgical method of removal of a bunion is known as bunionectomy. The goal of bunion surgery is to restore the normal position and function of the big toe. However, bunions can recur if the causation is not corrected.
Surgical complications may include infection, blood clot formation, bleeding, and unrelieved pain and nerve damage. Surgery is also recommended when conservative measures fail to treat the symptoms of bunion.
There are many surgical options to treat a bunion. The common goal is to realign the bones in the foot, correct the deformity, and relieve pain and discomfort. The surgery is usually performed as a day procedure, under the effect of a light general anesthetic and a regional nerve block. Osteotomy is a common type of bunion surgery and involves realigning the bones around the big toe. There are three main types of osteotomies and the foot and ankle surgeon will select the appropriate procedure based on the severity and type of the bunion.
- Akin osteotomy
Akin osteotomy is a surgical procedure that corrects sideways deviation of the big toe. A small cut is made at the base of the big toe, and a wedge of bone is removed to straighten the big toe. The bony fragments are then stabilized using a screw or staples. This procedure is often used in conjunction with the other procedures below. - Chevron osteotomy
A chevron osteotomy is usually recommended for mild to moderate bunion deformities and can be performed minimally with keyhole incisions. An incision may be made over the big toe, the joint capsule opened, and the bunion removed. The metatarsal bones are shifted to bring the big toe into its normal position. The bunion is shaved, and the soft tissues are realigned to correct the position. Akin osteotomy may be performed if necessary. The mobility of your big toe is examined, and the capsule and wound are closed with sutures. - First Metatarsophalangeal Arthrodesis
This is a procedure usually used for severe bunions with arthritis and involves fusing the two bones that form the big toe joint. Pain and deformity are controlled but movement of the big toe is decreased following the procedure. - Proximal First Metatarsal Osteotomy
This osteotomy is usually recommended for moderate to severe bunions and is a very powerful corrective procedure with good long-term results. An incision along the big toe, the joint capsule is opened to expose the bunion and then the bump is removed. The first metatarsal bone is then cut, and the surgeon will correct the cut bone with plates and screws. The joint capsule and surgical wounds are then re-approximated using dissolvable sutures keeping your toe in a straight position. Crutches or a walker are usually recommended for 4-6 weeks after surgery.
Following bunion surgeries, patients should elevate the foot and restrict walking as much as possible to minimize swelling and pain. Post operative shoes may be prescribed to protect the surgery for up to six weeks.