Bunion Removal: Preparation, Procedure and Recovery [Dr. Nephi Jones]

I'm Dr. Nephi Jones. I'm originally from Southwest Iowa, and I am a podiatrist or foot and ankle surgeon here at Brookings Hospital System with the Avera Medical Group.

What is a bunion?

A large population of people have bunion deformities, maybe even 50% of the population has some form of a bunion, whether it's a mild asymptomatic bunion, or if it's a severe bunion that also is asymptomatic. But a bunion is basically a malalignment of the big toe joint compared to the rest of the foot. So, that bump on the side of your foot on the inside, that's usually the bunion. That's usually what most people consider where most of their pain is at when they talk about bunions.

What causes a bunion?

There's a lot of different things that cause bunions. Most of it can be genetics, mom or dad or grandma and grandpa passed that gene down along the lines. It can be from an underlying neuromuscular disease like MS or some other neuromuscular disease. Things like rheumatoid arthritis can lead to bunion deformity, as well as hammertoes that usually accompany bunions. Traumatic events, you've had some significant trauma in the foot can lead to a bunion deformity, muscle imbalance, tendon imbalance. Other deformities such as a flat foot can cause progressive worsening of bunion deformities. Sometimes shoe gear can lead to bunion deformities. It's usually in people that are predisposed to having a bunion or already have a bunion. And when they wear closed-toed shoes like high heels, fancy dress shoes, it accentuates that bunion deformity. So, over the years, it takes many years, but over the years, it can progressively worsen a bunion.

What are the symptoms of a bunion?

When people present to my office with a symptomatic bunion, it's usually pain around the big toe joint. There's that bony prominence that causes pain in shoe gear. People typically have difficulty finding shoes that are comfortable, they have difficulty doing activities they used to be very active in now they can't because they constantly have pain around their bunion deformity. So, usually, that's the main symptom is pain and inability to do normal activities or find normal shoe gear.

Can bunions be prevented?

It always depends on what's the underlying cause of the deformity. Typically, we can't prevent the bunion from forming, but we can slow the progression because it is a progressive disease. We can do different things to slow how fast it forms and hopefully prevent it from being painful. So, when we think about prevention, we think about tow spacers, good supportive shoes, extra wide, extra depth toe box shoes, inserts. There's many different bunion sleeves or bunion correction braces that are out there on the market. They claim to prevent bunions or fix them, but we ultimately know that without surgery, they can't truly be corrected with conservative braces and things. But they can reduce symptoms, which is a big part of bunions.

Who will benefit from bunion correction surgery?

Most people are good candidates to have a surgical correction of a bunion deformity, but the big key with that is it should be symptomatic. It should not be a cosmetic thing. We see some patients come in wanting bunions corrected that aren't symptomatic, they aren't painful. And at that point, we have the discussion that if it's not painful, we don't do anything with it because we can create problems by trying to fix it when it's not painful. And we can ultimately cause pain and a new deformity if we try to fix it.

What should patients know when considering surgery?

So before surgery, we always talk about all the conservative measures or the things we can do that don't require surgery to prevent pain and discomfort. And then we have to talk about the risk associated with surgery. So, anytime we do surgery, there's always risks associated. The big risks that are associated with bunion correction surgery is infection. Anytime you make an incision in the skin, there's the potential that you can cause an infection. Postoperative pain and swelling is probably the next most common, postoperative complication. Swelling and pain can persist for several months after surgery just depending on how compliant the patient is with being non-weight bearing in their postoperative activities and things.

Recurrence of the bunion is real, it does happen. Typically, it takes many, many years like 20 or more years for a bunion to recur, but it is a complication that can recur soon after surgery. So, we always make sure they understand the bunion can come back. We're doing this to prevent problems now and reduce pain and discomfort, but it is a possibility. Blood clots is always a risk because, after surgery, you're non-weight bearing. So, you're not using your leg or your foot, you're not using those muscles that help return blood flow to the heart. And so, there's always a risk of blood clot.

How long is the recovery following surgery?

From the time we do the procedure until you're back to normal activity and hopefully, pain-free can be up to about three months. When I do bunion correction surgery, I have the patient non-weight bearing for six weeks. After that period of time, we get them into a boot or a postoperative shoe where they weight bear in that for at least another month. And then we get you into a good supportive shoe and insert, and walking without any braces or anything. So, in that time period, we're looking at 12 weeks or so before you are completely back to normal shoe gear and living a pain-free life.

How can bunion surgery impact someone's life?

We see people who have severe bunions that can't go on walks anymore, they have a hard time going to the store. Once we correct their bunion deformity, they're able to do their normal daily activities without pain, they're able to go back to work, they're able to go to the store. They can start exercising again without pain and discomfort. And they have an easier time of finding shoes that work for them. When the correction is successful and patients are pain-free, they're able to go back to normal daily life activities, pain-free, and happy.