A bunion (Hallux Valgus) is an enlarged or prominent bone on the outside of the first, big toe joint. Most bunions are inherited and worsen as the joint responds to abnormal pressure on the foot from tight, restrictive, or flat shoes without support.
Pain can range from dull to sharp depending on the amount of joint damage as well as the level of irritation and compression of the surrounding nerves.
Depending on the severity of the condition, either conservative treatment options and lifestyle readjustments or surgical treatment are necessary to treat bunions.
Each patient is different, and the question of conservative treatment versus surgical correction really depends on the particular type of foot problem, age and lifestyle. The right treatment must also meet the patient’s expectations in regard to resolution of their problem(s) and future functionality. If conservative treatment fails, the option to not have surgery is just as important as the surgery chosen by your surgeon.
We always recommend conservative treatment first, such as lifestyle changes, before recommending surgery. However, depending on the severity of discomfort or pain, surgical treatment to correct a patient’s bunions may be the best option.
A number of conservative treatment options are available for those suffering from painful bunions before settling on surgical treatment, including the following:
Wearing different shoes could help to relieve some of the pain that comes with bunions. Try a larger sized shoe, allowing for the width of your thumb at the end, and a high enough toe box to give your toes extra space.
Anti-inflammatory medication can help with the chronic pain that comes with bunions, but are not much help with the acute pain.
Over-the-counter bunion cushions and padding can be worn over the foot to help ease discomfort. Cushioning layers can fit easily in everyday shoes and ease shoe pressure and irritating friction.
Temporary arch supports or custom molded orthotics can minimize the pressure placed on the bunion, getting rid of some discomfort while wearing shoes. These can be considered a viable short-term solution without surgical intervention.
During bunion surgery, the bone causing the pressure is remodeled or smoothed down, and then repositioned to prevent recurrence. Fixation of the bone is commonly a metallic device (screw, staple, wire), but we use absorbable devices or natural bone pins. Incisions are minimal and vary (average 2 cm to 4 cm), sutures are placed under the skin and steri-strips (surgical tape) are removed after two weeks.
The procedure is performed at an outpatient facility with the patient under sedation, and the recovery period is anywhere from 4 to 6 weeks.
With the smaller incisions and post operative local anesthesia, some patients only take anti-inflammatories after surgery. We do prescribe stronger pain medication just in case, but with elevation and rest for the first 72 hours most patients have lower than a 5 out of 10 pain level.
The cost of a bunion surgery depends upon a patient’s financial situation. For example, a low $500 deductible with coverage for the procedures may be the only costs. A high deductible with partial coverage afterward can become quite expensive.
Cash pricing includes hospital costs ($1,500 to $10,000), anesthesia costs ($500 to 1500), equipment costs ($500 to $5,000), and surgeon costs ($750 to $2500).
Yes, you can be “put to sleep” for bunion surgery. The general surgery using a laryngeal mask airway (LMA) is very safe and sometimes even safer than sedation with local anesthesia. Office surgeries using local anesthesia are less common now — having the patient relaxed and in a sterile hospital environment is the accepted standard. Some simple bunion surgeries can be performed under local anesthesia only, especially if the patient is at high risk under general anesthesia or sedation.
Bunions rarely grow back after surgery. Bunions do not “grow back” per se, but the hallux (big toe) angulation and metatarsal head (bone prominence inside the foot) can return to a bunion deformity if the incorrect procedure is performed or deforming forces assist its return over time.
Bunion splints, custom molded orthotics and other supportive devices can minimize a bunion deformity, but a true correction without surgery is uncommon.
The type of bunion procedure as well as the type of work will dictate when you can return to work after a bunion surgery. If there is no osteotomy (surgical bone fracture), then full weight bearing can occur after 2 to 3 weeks. If an osteotomy is performed, then full weight bearing can occur after 4 to 8 weeks depending upon which procedure is performed. Heavy work, lifting, and extended walking are safe in restricted shoe gear after 6 to 12 weeks depending upon the procedure.
“I started going to Dr Moore in 2017 after a bad experience with another foot surgery earlier that year. After evaluation and xrays, Dr Moore presented my options to make the correction and hopefully eliminate the pain that had persisted. The second surgery and after care with Dr Moore went smoothly and no more pain! In December 2019, when it came time to address the same underlying condition on my other foot, I reached out to Dr Moore of course. The procedure included repairing a shredded ligament, put toes 2 and 3 back into the joint, and put pins in place to repair the hammertoe condition. His surgical precision and passion for his craft resulted in a beautiful outcome! And, I followed his very specific instruction for post surgery, which has now given me two feet with no pain, and the ability to wear closed toe shoes! Dr Moore, Birgitta and the entire staff are wonderful!”
In this video, our patient discusses her experience with a cosmetic bunion surgery at Moore Foot and Ankle Specialists.
Is your bunion condition impacting how you walk, or causing you daily irritation and pain? Moore Foot and Ankle Specialists can help. Contact us today!
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