Have you been putting off bunion surgery because of the daunting months-long, painful recovery? (Besides the fact that even if you go through all that, you might be unhappy with the results.) A new bunion-correction procedure might change your mind. It is much less painful, has a shorter recovery…and could have you wearing stilettos in just eight weeks!
Hallux valgus—the medical term for bunion—afflicts about one-quarter of adults under 65, and about 35 % of people older than that, with women outnumbering men more than two to one. A bunion is a deformity of the big toe joint. The big toe becomes misaligned, bending toward the toe next to it and causing a bony protrusion to develop on the outside of the foot at the base of the big toe. The misalignment and bump typically worsen over time—interfering with the fit and comfort of shoes, especially those with narrow, pointy toes…and swelling and causing pain. Icing the bump, taking anti-inflammatory drugs such as ibuprofen or naproxen, and wearing flat, wide-toed shoes won’t correct the deformity but can relieve or reduce the pain. When that isn’t enough, surgery is the next step.
THE OLD WAY
Traditional bunion-correction surgery typically involves an incision on the side of the foot that is wide enough to allow the surgeon to use a saw to perform bone cuts to both realign the toe and to remove the bony bump. The surgeon then realigns the big toe, often using pins (usually later removed) or screws (usually kept in permanently) to hold the bones in place while they heal.
The problem with this procedure is that the surgeon usually has to perform the cuts within the toe joint itself, which can reduce its ability to move and bend freely even after healing is complete. So while the bunion may be eliminated—as well as most, if not all, of the pain—often range of motion in the toe is significantly reduced.
Recovery for traditional bunion surgery also is long and painful—usually involving a splint, crutches, staying off the affected foot as much as possible for several months, plus keeping it elevated most of the day for the first several weeks.
Of course, if bunion pain has been interfering with quality of life anyway, this kind of recovery may seem worth it. But now that there’s a much better option, you may not have to…
Minimally invasive bunion surgery (MIS), also called a percutaneous procedure, actually has been around since the 1970s. However, only recently have improved techniques and instruments made the procedure so successful and the outcome so predictable. MIS not only has a shorter, less painful recovery period than traditional bunion surgery, but because the procedure does not involve performing the bone cuts within the toe joint, the toe’s range of motion is not compromised—so those stilettos are not out of the picture!
MIS—HOW IT’S DONE
Surgery: The procedure is performed under anesthesia, and the anesthesia used varies from surgical center to center. Rather than the large incision of traditional bunion surgery, MIS involves only small keyhole incisions and a kind of X-ray machine that is used to help guide the surgeon. And instead of a saw moving back and forth, the surgeon cuts away the bump with a burr—an instrument similar to what dentists use—that allows for smaller, more precise cuts. After the bone is cut, it is shifted to correct the toe alignment and secured with screws.
Recovery: The patient goes directly into a postsurgical weight-bearing shoe that allows him/her to walk immediately after surgery. While patients tend to have much less pain after MIS than with the traditional procedure, typically a prescription pain medication may be needed for the first several days—usually less medication and for a shorter period of time than with traditional bunion surgery. At about two weeks, stitches and other surgical dressings are removed, and the post-surgical shoe is worn for another four to six weeks or so. After that, back to regular shoes!
If you have certain foot conditions, such as big toe arthritis or another foot condition that is contributing to your bunion, you may not be a candidate—but it’s likely that condition would make you not a candidate for traditional bunion surgery, either. Otherwise, anyone who can have traditional bunion surgery qualifies to have MIS. Most insurance companies cover bunion-correction surgery.
Finding a surgeon near you who performs MIS may take some searching. The company Wright Medical, developers of a minimally invasive bunion surgery procedure called PROstep, list surgeons who perform MIS on its website.
And if you don’t have a bunion—yet—here are some tips to prevent one.