Do You Need Bunion Surgery?

Featured Article, Healthy Living
on April 2, 2014
bunion surgery necessary

When you think of all the things that can go wrong with feet, bunions are high on the yuck list. For one, a bunion—its medical name is hallux valgus—is super unattractive. It occurs when your big toe drifts inward towards the second toe. When that happens, a bump, caused by an out-of-position bony joint, appears on the outside base of the big toe.

But if you develop one, take solace in the fact that you’re not alone. “Bunions are very common,” says Anne H. Johnson, M.D., an orthopedic surgeon at Mass General Hospital in Boston, who specializes in foot and ankle surgery.

A survey of 4,249 people over age 30, published in Arthritis & Rheumatism in 2008, found that 28 percent of respondents had bunions. The older people were, the more likely they had the foot problem: 30 to 50 percent of people over 50 had a bunion. And more women (38 percent) than men (21 percent) reported having one. That’s not surprising: Research suggests that women are up to nine times more likely than men to develop a bunion.

Bunions have been blamed on narrow, ill-fitting shoes. But genes also play a role. “The vast majority of people who get bunions have a genetic predisposition,” says Dr. Johnson. That means if mom or grandma had a bunion, you’re more likely to develop one, even if you’ve always worn sensible footwear. “I see patients who have spent their entire lives in sneakers and Birkenstocks and they have bunions,” says Dr. Johnson.

Bunions aren’t just unsightly. A 2011 study in Arthritis Care & Research reported that people with bunions scored lower on measures of vitality, social functioning and mental health.

What’s more, a bunion can hurt if your shoe presses against it. Whether a person experiences pain and how much she feels varies. “Pain is very individual,” says Dr. Johnson. “I will see people who have what you might consider a horrific bunion and they don’t have any pain. And I see women with very mild bunions who complain of severe pain.”

If you develop a bunion, the first line of defense is to switch to wider shoes. “Pain typically occurs when the shoe presses against the bump,” says Dr. Johnson. “If you can alleviate this pressure, you can minimize pain.” Over-the-counter (OTC) non-steroidal anti-inflammatories can ease discomfort. OTC toe separators can keep the big toe from pressing into the second toe. Splints and braces can cushion the bunion to keep it from rubbing against shoes. “These can help you be more comfortable in shoes,” says Dr. Johnson. However, they won’t realign your toe, get rid of the bunion or keep the bunion from getting worse, she adds.

Surgery to remove the bunion may be considered if pain worsens, isn’t eased by wearing wide shoes and/or interferes with everyday activities. “If somebody says ‘I have this terrible bunion. It doesn’t hurt but I don’t like the way it looks,’ that is not the reason to do surgery,” says Dr. Johnson.

The type of surgery that’s done will depend upon the surgeon and the bunion. “There are many different ways to fix a bunion,” says Dr. Johnson. “A mild bunion will require a different procedure than a larger deformity.” Whichever surgical approach is used, “the goal is to correct the angle between the first and second toes and realign the big toe in relation to the foot,” says Dr. Johnson. During surgery, the surgeon will reposition bones by cutting them and securing them with screws; release a tendon that is pulling on the big toe; and tighten soft tissue over the bunion, explains Dr. Johnson.

Bunion surgery is usually done on an outpatient basis. The patient often receives a nerve block and is sedated for the procedure, which takes about 60 to 90 minutes.

Potential complications include infection, blood clots and anesthesia risks. But the surgery has its own challenges. “The most common complication is that the deformity is either overcorrected or under corrected,” says Dr. Johnson. If the bunion is over corrected, the toe can drift in the opposite direction, she explains. If the deformity is under corrected, the bunion can recur. In both instances, a second surgery would be needed.

Restoring normal anatomy is an art. “It can be a difficult balance to achieve,” says Dr. Johnson. “Foot surgery is not easy to do and it is not easy to have.” And there is no guarantee: Even if surgery is a success, the bunion can recur if tissues in the foot loosen over time.

Recovery is every bit as challenging as surgery. “It’s a long haul,” says Dr. Johnson. You’ll need to wear a special boot or a cast after the operation. Because you’ll either be non- or partial-weight bearing for about six weeks, you’ll likely need to use a cane or crutches. Typically, you’ll undergo six weeks or more of twice-weekly physical therapy. “The average woman is not back in a regular shoe for about three or four months,” says Dr. Johnson. And though some healthcare providers recommend quick fixes or tout new procedures, it’s best to be wary for now. Stick with traditional surgery until a procedure is “tried and true,” advises Dr. Johnson.