Bunion Surgery

Bunions or hallux valgus as they are medically described are an oftentimes painful, three-dimensional deformity of the big toe joint. Bunion deformities are complex in nature, and it’s rare that two deformities are exactly the same; imbalances of tendons, ligaments and joint capsules contribute to the deformity. Typically, surgery is to be considered when a patient continues to experience pain despite going through avenues of conservative therapy and nothing seems to resolve the signs and symptoms. As bunion surgery is an elective surgery; it is recommended for patients who are healthy or otherwise have their medical problems controlled. In patients who smoke, it is strongly recommended for them to quit prior to considering bunion surgery. 

The Surgical Journey

During an initial evaluation, your individualized problems and circumstances will be evaluated. Your health and associated needs will be discussed in detail. A review of prior treatments attempted, and further conservative measures will be discussed. Multiple physical examinations will be performed and weight-bearing X-rays in multiple views will be used to assess the contributing factors to the deformity. After a review of personal health, all physical examinations and radiographic findings, the appropriate procedure will be determined. In preparation for your surgery, you may be asked to visit your primary care physician/pediatrician to have lab work and other preoperative examinations to assess if you are a candidate for elective bunion correction surgery. 

The surgical procedure itself is low risk, typically performed under general anesthesia or sedation anesthesia with a local anesthetic. In most cases, the surgery runs from 1-2 hours, including the OR setup time, the time for anesthesia to take effect and wear off. For the first 4 days after surgery, there will be expected pain and swelling. It is strongly advised to take pain medication as needed in that time period, especially the night following surgery as the local anesthetic will have worn off by then. 

In the postoperative period following surgery, it is strongly advised to keep the surgical dressing clean, dry and intact, especially when showering. Use a cast bag while showering to avoid the post-operative dressing from getting wet. Cast bags can be purchased at most large pharmacies and medical supply stores. Depending on the procedure performed, your weight-bearing status will be discussed and is typically immediate weightbearing in a special shoe or boot with weight only to your heel. In other instances, you will be asked to not put any weight on the limb and use the assistance of a knee scooter, crutches or a wheelchair to get around for the initial two weeks after surgery. 

Following bunion surgery, once determined that the bone is healed, it is very important to start an aggressive physical therapy plan in order to regain mobility and to help break up any scar tissue that may have formed following surgical intervention. This is strongly advised in order to regain full functionality and decrease any scar tissue-associated pain. The objective of bunion surgery is to allow you to return to your daily activities with pain-free motion of your big toe joint. An added benefit may be for you to be able to enjoy fitting into most of your favorite shoe gear, which may have not been possible prior to surgery. 

The Types of Bunion Surgeries

• Fusion procedures when it comes to bunion surgery are a great option for the right patient,  offering a more permanent fix to the deformity. In some cases they may require a slightly longer healing time, but the after-effects are worth the wait. It is worth noting despite no longer having motion at one of the joints of the foot, functionally, patients do very well in terms of return to activities. 
• The classic osteotomy procedure was performed by making bone cuts and shifting over the bunion bone and holding it in place with a screw, and allowing it to heal in a better alignment. 
• Now, the exostectomy procedure is performed by surgically cutting away the excess “bunion” bone, followed by smoothing the bone down. This procedure also involves releasing some soft tissue structures around the bunion in order to allow for better correction of the bunion. However, with the exostectomy procedure, there are, at times, concerns for the return of the deformity in some patients. This is a good procedure for someone who is not a candidate for osteotomy or fusion procedures. 
• Joint space-producing procedures are performed on patients who typically have a lower daily step requirement. It is helpful to decompress the big toe joint, allow for additional motion, and improve symptoms associated with the bunion deformity. 

Risks and Complications

Some of the common risks of bunion surgery are similar to most other elective surgery of the foot and ankle, including but not limited to pain, swelling, infection, damage to nerves or vessels and blood clots. Although the risks associated with bunion surgery are rare, prior to every surgery performed, an in-depth conversation with the surgeon will take place. It is important to keep in mind that, in some instances, complications will take place. That being said, it’s essential to know that your surgeon and their team will be there to support you through any complication and your individual healing journey. 

Healing requires a concerted effort involving patients, their family, and other caregivers to ensure the best healing possible. It is important to recognize specific signs and symptoms such as fever, chills, shortness of breath, chest pain, or calf pain when they present. It is important to call your provider immediately or go to the nearest emergency department if you experience these signs or symptoms. Additionally, worsening pain, swelling, redness, warmth, and white or yellow drainage following the initial few days of surgery may warrant urgent medical attention as well. 

Cost and Insurance Considerations

The costs associated with bunion surgery depend on your specific insurance plan, your associated copays, deductibles and out-of-pocket maximums for the year. An in-depth discussion will take place with you and a member of the Modern Orthopaedics billing department about the specific fees associated with all planned procedures to prevent any surprise bills. Elective bunion surgery is covered by insurance when it is performed on a patient that has pain and deformity warranting surgical correction.

Alternative Treatments

Conservative therapy, which some patients find helpful,  can include customized foot orthotics, steroid injections, padding the bunion site using bunion shields, over-the-counter pain medications, and icing the bunion site. Having physical therapy performed 2-3 times per week in order to help improve the motion of the joint may also be helpful. The conservative therapy mentioned above may be helpful in decreasing the signs and symptoms associated with the bunion however, unfortunately, it cannot correct the deformity. Only surgical correction allows for that possibility. Surgery is used once all conservative therapy has been attempted at one time or another without obtaining satisfactory improvement in pain and improvement in functional capacity.

Contact Us

If you require bunion surgery, reach out to us at Modern Orthopaedics of New Jersey!

Frequently Asked Questions

Can you walk immediately after bunion surgery?

Following most bunion surgery procedures, a patient may be able to walk on their heel using a special shoe or boot. In more involved procedures, it may require up to two weeks of non-weight-bearing with knee scooter or crutch assistance for mobility. 

What are the downsides of Lapiplasty?

The Lapiplasty bunionectomy procedure provides excellent correction of bunion deformities; however, it requires two weeks of non-weight-bearing to the surgical foot using a knee scooter, wheelchair or crutch assistance for ambulation. As well, it generally requires an approximately 3-month healing course. 

Is Lapiplasty better than regular bunion surgery? 

The answer to this question is that it is completely dependent on the patient, their needs, and the extent of their deformity. It is an excellent procedure for the right candidate. 

How long does it take to recover from bunion surgery?

Depending on the type of bunion surgery that is performed, the recovery time usually varies somewhere between 3 weeks and 3 months. 

How painful is bunion surgery?

Like most elective foot and ankle surgery, during the first 4 days post-operatively, it is expected that there will be significant amounts of pain. The pain will, however, be well controlled using a short course of pain medications. 

Do you use anesthetics for the surgery?

The surgery is usually performed using a combination of either general or sedation anesthesia with local anesthesia. 

How long does the operation itself last?

The time of the surgery is procedure-dependent and varies between 20 minutes and 2 hours.