Health Library Should I Have Surgery for Bunions?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Surgery may be considered if you have bunions that are causing problems. But athletes, children, and people with health problems such as diabetes, rheumatoid arthritis, neuromuscular disorders (such as muscular dystrophy), or circulatory problems generally are advised to take a conservative approach when considering foot surgery. This information may not apply to them.

Consider the following when making your decision:

• Surgery generally is not considered unless you have already tried changes in footwear and other nonsurgical treatments (such as using pads to cushion the painful area), and these did not relieve the pain.
• Surgery may be appropriate if you have:
  • Severe toe pain that interferes with your daily activities, and nonsurgical treatments have failed.
  • A severely deformed foot that interferes with your daily activities, and nonsurgical treatments have failed.
• The outcome of your surgery cannot be predicted. The success of surgery for bunions has not been widely studied. The specific outcomes and risks vary depending on the type of surgery, your surgeon's experience, and the severity of the deformity.
• Your expectations play a large role in how satisfied you are with the results of surgery. If you want surgery primarily to improve the way your foot looks, you may be less satisfied with the outcome. Up to one-third of people having surgery for bunions are disappointed in the result, despite the pain being less and the toe being straighter.¹

What is a bunion?

A bunion (hallux valgus) is an enlargement of the joint at the base of the big toe. If you have a bunion, you will notice a bump on your big toe joint. The big toe may turn in toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.

See a picture of a bunion.

What are the risks of bunions?

A bunion can cause discomfort and pain and may make it difficult to walk. Shoes may rub on the bunion, causing pain, blisters, calluses, or sores. At the bunion location, a bacterial infection of the skin ( cellulitis) or bone ( osteomyelitis) may occur, especially if you have diabetes or peripheral arterial disease. If you have one of these conditions and sores develop, contact your doctor.

The appearance of a bunion may be embarrassing for some people.

What are the types of bunion surgery?

There are over 100 surgeries for bunions. Research does not indicate which type of surgery is best—surgery needs to be specific to your condition. More than one procedure may be done at the same time.

The general types of bunion surgery include:

• Removal of part of the metatarsal head (the part of the foot that is bulging out). This procedure is called exostectomy or bunionectomy.
• Realignment of the soft tissues (ligaments) around the big toe joint.
• Removal of a small wedge of bone from the foot (metatarsal osteotomy) or from the toe (phalangeal osteotomy) and moving the bones into a more normal position.
• Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped (resection arthroplasty).
• Fusion (arthrodesis) of the big toe joint.
• Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure).
• Implant insertion of all or part of an artificial joint.

What are the possible complications of bunion surgery?

Complications of surgery may include:

• Infection in the soft tissue or bone of the foot.
• Side effects from anesthetic medicines or other medicines used to control pain and swelling.
• Recurrence of the bunion.
• An outward or upward bend in the big toe.
• Decreased feeling or sensation, numbness or tingling, or burning in the toe from damage to nerves.
• Damage to the tendons that pull the big toe up or down.
• A shorter big toe, if bone is removed.
• Restricted movement or stiffness of the big toe joint (may be an expected outcome of some types of surgery).
• Persistent pain and swelling.
• Degenerative joint disease (arthritis) or avascular necrosis (disruption of the blood supply to the bone) after surgery.
• Development of a callus on the bottom of the foot.

Is bunion surgery effective?

The effectiveness of surgery for bunions has not been widely studied. It depends on the type of surgery, the surgeon's experience, and the severity of the deformity. It also depends on what you expect from surgery.

In a review of bunion surgeries, up to 33% of people who had surgery were disappointed in the result, despite the pain being less and the toe being straighter. The reasons are not clear. Some reasons for being disappointed in the results of surgery could be that a person is not able to wear some types of shoes (such as high heels) after surgery, or that the joint is more stiff and has a little less motion compared to the other foot.¹

If you need more information, see the topic Bunions.

Your choices are:

• Try nonsurgical treatments, such as wearing roomy footwear; using pads, arch supports, or orthotics to cushion the painful area; limiting or modifying activities that cause pain; and taking pain medicine.
• Have bunion surgery.

The decision about whether to have surgery takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for bunions. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for bunions.

Check the box below that represents your overall impression about your decision.

Return to the topic Bunions.

Citations

1. Ferrari J, et al. (2007). Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Systematic Reviews (2).

Author:	Shannon Erstad, MBA/MPH	Last Updated: March 6, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
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