How is a bunion treated?
As a general rule, a bunion does not require any treatment other than a soft shoe with plenty of room for the front of the foot.
A wide toe box will provide protection for the affected area.
Shoes that have a seam or lace that crosses the bunion area should not be worn.
A soft arch support or a sling may take pressure off the second toe.
Surgery may be necessary if the patient has a severe deformity that causes constant pain, a dislocation of the second metatarsophalangeal joint (at the base of the great toe), or hammer toes. Bunion surgery should be chosen only when conservative treatment has failed. It should never be performed for cosmetic reasons.
There are many surgical procedures for the treatment of bunions. The severity of the condition will determine which operation is chosen. The surgery is usually performed with a local anesthetic block, and as a rule does not require an overnight hospital stay.
The Chevron Procedure
The chevron procedure is generally used to treat a large bunion deformity in which there is minimal angulation of the great toe. A "V", or chevron shaped cut, is made near the end of the bone, which allows the surgeon to slide the head of the bone laterally, or toward the little toe. This produces some narrowing of the foot, and at the same time, some correction of a mild bunion deformity.
The Distal Soft Tissue Procedure and Proximal Metatarsal Osteotomy
A distal soft tissue procedure and proximal metatarsal osteotomy is the most commonly performed operation. In thisImage of Chevron Procedure procedure the metatarsolphalangeal joint is realigned by:
releasing the contracted tissue on the lateral (little toe) side of the joint.
shaving off the large bunion on the medial (great toe) side of the joint.
plication (tightening) of the tissue, which will hold the great toe in a neutral or straight position.
A cut is made in the base of the metatarsal bone so that the first metatarsal can be shifted toward the second, correcting the angle between the two. This cut is called an osteotomy, and it is fixed with a screw. This operation can correct a more severe deformity than is possible with the chevron procedure.
The Arthrodesis Procedure
An arthrodesis is a procedure that corrects the deformity of the toe, but eliminates motion in the metatarsophalangeal joint. It is generally used for those with advanced arthritis in the joint when a joint-sparing operation cannot be performed. In this operation, the articular cartilage is removed from the arthritic joint and the two surfaces of cut bone are fixed to each other with a screw and a plate. Although this causes the joint to lose its motion, the deformity is corrected and pain is eliminated.
What types of complications may occur?
The complication rate for bunion surgery is approximately 10%. These complications include:
An under correction or over correction (hallux varus) can occur.
The deformity can return.