Bunions are often times genetic.  Other biomechanical anomalies may contribute to bunion formation including but not limited to: flat feet, excessive flexibility of ligaments, abnormal bone structure and/or certain neurologic conditions.  Others feel poor fitting shoe wear can contribute to bunion formation as well.

Yes.  Bunions can range from very mild requiring a simple procedure to severe requiring a major reconstructive procedure.

Choosing the appropriate type of bunion surgery is critical to avoid recurrence of the bunion and to assure a successful, pain-free foot.  Clinicians measure the angles between certain bones in the foot to help decide what specific type of surgery is appropriate.

Bunion surgery is almost always elective.  Surgery is indicated for pain and/or progressive deformity that interferes with shoe wear and activities, and when non-surgical measures have failed.  Cosmetic correction, while generally achieved with surgery, is usually a secondary consideration.  Other considerations as to the timing of bunion surgery include age, general health, and foot circulation, as well as setting aside dedicated time for recovery.  While shoewear options are improved with bunion surgery, predictable decreases in overall shoe size cannot be guaranteed, and studies have shown that up to one-third of patients still cannot wear some types of shoes.

This type of reconstructive bunion surgery is for patients with deformity and entails bony corrections of both the distal end of the first metatarsal bone and the proximal phalanx to realign them.  The osteotomies are held with screws or staples which typically do not require removal. The procedure takes about 1 hour, is outpatient and allows weight-bearing as tolerated in a walker boot immediately post-operative.  The walker boot is used for 4-6 weeks and then you will be transitioned into a regular shoe.  Protective dressings, bunion splints and toe spacers will be used in the post-op period and information on where to purchase these will be provided.  Recovery time is about 2 months before you are walking comfortably and increasing your shoe selection. Sports activities and running are generally resumed 3 months postoperatively.  Expect swelling to persist for up to 6 months.

As with any surgical procedure complications can occur.  Some possible complications may include, but are not limited to: Joint stiffness through the great toe (1st MTP joint); numbness along the incisions; prolonged swelling; delayed wound healing; delayed or incomplete bony healing (nonunion); infection.

Download the Minimally Invasive Bunion Realignment Post-Operative Guidelines for full details.

Bilateral MIS bunionectomies can be done at the same time to decrease recovery time.  However, you will be more restricted in your post-operative activities.

Yes, that is usually not a problem.  However, they must be evaluated carefully.  Make sure you schedule another appointment before surgery.  Do not wait until the morning of your surgery to mention it.

Your surgery generally takes place at the New England Baptist Outpatient surgery center.

You will have sedation anesthesia with a local foot nerve block.

You will get a dose of antibiotics before surgery.  Also, patients are started on one 325 mg aspirin once a day for 4 weeks.

No.  Bleeding is minimal with use of a tourniquet during surgery.

Read carefully the “What to expect and how to prepare for surgery” handout.

After surgery, you will be weight-bearing as tolerated in dressing and walker boot.  Crutches will be provided for balance. When you have adequately recovered in the outpatient post-anesthesia area and have passed the criteria, you will be discharged home with outpatient instructions

For the first two weeks you must rest, get sleep, eat well, and drink plenty of water.  Your body will have greater metabolic demands on it to heal.  Keep the bandage clean and dry, keep your foot elevated to the level of your heart, and take pain medication as needed.

Discuss this with your rheumatologist, but it is generally recommended that you stop immune suppressive modulators (eg. Methotrexate, Enbrel, Humira) for two weeks before and two weeks after surgery.

Small spots may appear on the bandage.  You may reinforce the dressing with an ace wrap obtained from a pharmacy.  While highly unlikely, excessive bleeding through the bandage is of concern and you should call the office to be seen.

You can drive once off narcotics using a post-op shoe as you feel comfortable.

That depends on what you do and the procedure performed.   Sedentary desk workers may return as soon as one to two weeks post-surgery.   On the other end of the spectrum, construction laborers are typically out of work for 2-3 months.  You will be provided out of work notes or restricted duty notes as necessary during your recovery.  Family leave paperwork can also be submitted.

About 1-3 percent of patients will have a delayed union or non-union.  This can be even greater in patients who have additional medical problems, have poor bone healing factors, or are smokers.  To enhance your chances of healing you should not smoke.  For a delayed union you may be prescribed a bone stimulator along with prolonged immobilization.   For an established non-union, you may require revision surgery and bone-grafting to try to get the bones to heal.

Like any surgery, complications can develop.   Fortunately, they are rare for most patients but not zero.  These include infection, bleeding, numbness, blood clots, tendon injury, delayed union, nonunion, malunion, or chronic pain and swelling.  Appropriate recognition and medical treatment of these complications generally will allow for a satisfactory outcome.

Recurrence of the bunion deformity can occur in 3-5 percent of patients. It can recur early, within a few weeks, if the osteotomy fixation fails.  In these situations, prompt revision surgery can allow for a satisfactory outcome.  The bunion can also recur later on, many months to years later, and if symptomatic, usually can be corrected with revision surgery.

Get ready for it!   Optimize your physical and mental state and make sure you have allowed yourself the time necessary for recovery.  Certainly, call us if you have any questions. More information can be obtained from the American Orthopedic Foot and Ankle Society website.