Surgery relieves bunion pain and deformity

Bunions aren’t just unattractive lumps on your big toe. They’re a common, progressive foot deformity that can become quite painful. But many people don’t take them seriously and delay treatment for years. Conservative treatment may help to relieve the symptoms, but bunions get worse over time, and surgery is the only way to fix the deformity.

“It’s not uncommon for patients to wait until they absolutely can’t stand it anymore,” says Dr. Fred Hainge of Hainge & Groth Foot and Ankle Clinic of Colorado Springs. Not only that, but waiting can mean that arthritis sets in. It’s much harder to fix them if arthritis is present.

Thanks to technological advances, the procedures that Drs. Hainge and his partner Bryan Groth perform are highly successful and have a low risk of complications.

What are bunions?

Symptoms of bunions include a bony bump on the big toe joint, redness and calloused skin at the site, and a big toe that turns in toward the other toes. In advanced cases, the big toe crosses over the second toe.

Bunions are more common in women than in men and in older people. But they can occur in younger people, too. In 80 percent of cases, there is a family history of bunions.

“We are often asked whether shoes cause bunions,” Dr. Hainge says. “In a small percentage of patients, that can be true. More often, shoes make it worse and increase symptoms.” Shoes with a narrow toe box and high heels aggravate bunions.

Properly fitted shoes, arch supports, orthotics, and anti-inflammatory medications may slow the progression of the deformity and relieve discomfort, but surgery is recommended when movement is limited or the pain of a bunion interferes with daily activities.

“If a bunion hurts more than three or four days a week, most people are gratified with surgery,” Dr. Groth says.

Surgical procedures to treat bunions reduce the bump on the side of the foot, correct the deformities in the bony structure, and address any soft-tissue changes that may have occurred.

State-of-the-art bunion surgery

Bunions used to be treated by shaving down the bump on the bone, but that is rarely done today. Now, 90 percent of bunion surgery involves making a cut in the bone that enables the surgeon to realign the joint and the toe into a more normal position. The surgeon usually inserts a small screw into the bone to hold it in place and speed healing.

When a patient comes in, Drs. Hainge and Groth do a complete evaluation, including x-rays and gait analysis. If the patient’s symptoms are relatively mild, the surgeon might suggest conservative treatment, such as wearing shoes with a wider toe box, avoiding stitching or seams that cross over the bunion deformity, and using orthotics.

If surgery is suggested and the patient elects it, a second appointment is set. Because the patient will need assistance for the first week after the procedure, family or friends are invited to attend.

Drs. Hainge and Groth perform the majority of their procedures at outpatient surgery centers and also work at all local hospitals. The patient can choose general or local anesthesia and is given an ankle block that keeps the foot numb for 14 to 18 hours after surgery. Most of the stitching is done using plastic surgery techniques for a good appearance.

Surgery generally takes less than an hour, and the patient on average is discharged an hour after surgery. The patient is fitted with a special bunion shoe. Most people require narcotic painkillers for the first 48 to 72 hours after surgery. Then they can decrease the amount of pain medication until any pain can be controlled with medications like Advil.

Recovering after surgery

Drs. Hainge and Groth monitor patients carefully during their recovery.

“We see them the third or fourth day for an infection check and apply a lower-profile dressing,” Dr. Groth says. X-rays are taken. Sutures are removed after about two weeks.

The patient is seen again after five or six weeks, and X-rays are repeated. If the bone shows signs of healing, the patient can start wearing loose-fitting, stiff-soled shoes and can begin to increase weight-bearing activities.

Soon after surgery the patient will begin range-of-motion exercises to keep the toe from becoming too stiff.

Fewer than 10 percent of patients experience complications, which can include infection, recurrence of the bunion, stiffness, and continued pain due to arthritis. Patients with diabetes or rheumatoid arthritis, or those who smoke, heal more slowly.

Healing does require some time and restraints on activity. Patients usually need to keep the foot elevated for the first 10 days, although limited weight bearing will be permitted and encouraged. By the fourth to sixth week, patients can begin to wear loose shoes. Running and jumping usually can be resumed about 10 weeks after the procedure, but there may be some swelling for three to four months or longer.

Patients usually ask when they can return to work after surgery.

“It depends on the individual,” Dr. Hainge says. “I tell people to give themselves two weeks if they have a sit-down job, mostly for swelling control. People who do desk work can go back to work, keeping the foot elevated. If people have a job where they’re on their feet, it takes six to eight weeks, and they won’t be able to do 10- to 12-hour shifts until about 2½ months.”

Patients with bunions often have other conditions such as knee, hip, or low-back problems. Drs. Hainge and Groth may refer patients to other specialists if necessary.

“We see it all in the feet,” Dr. Groth says.