Bunion Surgery

Bunion surgery, also called hallux valgus correction or bunionectomy, corrects the misalignment of the big toe joint through surgical reconstruction. This procedure realigns the joint, removes excess bone growth, and corrects the angle of the toe to restore normal foot anatomy. The surgery aims to reduce pain and improve mobility, allowing patients to wear regular footwear comfortably.

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Dr. Zackary Chua
MBBS (Aus) | MMed (Singapore) | MRCS (Glasgow) | FRCSEd (Orth)

Indications for Bunion Surgery

Several conditions and symptoms may indicate the need for surgical intervention when non-surgical treatments have not provided adequate relief.

  • Progressive Joint Misalignment: The big toe drifts toward the smaller toes, causing visible deformity and increasing pain during walking and standing activities.
  • Persistent Pain: Daily activities become difficult due to constant discomfort in the big toe joint that does not respond to conservative treatments like padding or shoe modifications.
  • Limited Motion: The big toe joint becomes stiff and restricts movement, affecting standard walking patterns and balance. This limitation can lead to compensatory gait changes.
  • Chronic Inflammation: Regular episodes of swelling and redness around the bunion area persist despite using anti-inflammatory medications and conservative care.
  • Secondary Toe Problems: The bunion causes overlapping toes or additional deformities in neighbouring toes, leading to corns and calluses. These secondary issues can create additional pain points.

Benefits of Bunion Surgery

Bunion surgery offers several improvements to foot function and daily life.

  • Improved Mobility

    Correction of the joint alignment allows for a better range of motion in the big toe, facilitating standard gait patterns and balance.

  • Pain Relief

    The realignment of the toe joint eliminates the pressure points that cause chronic discomfort when walking or standing.

  • Toe Position

    The procedure corrects the position of the big toe, preventing it from pushing against or overlapping other toes, which helps maintain overall foot structure.

  • Joint Health

    Surgical correction helps prevent progressive joint damage and reduces the risk of arthritis development in the big toe joint.

Surgical Techniques

Osteotomy

This technique involves making specific bone cuts to realign the big toe joint. The surgeon creates controlled breaks in the metatarsal bone, repositions it, and secures it with screws or plates. The location and angle of the cuts vary based on deformity severity and joint characteristics.

Arthrodesis

This method fuses the big toe joint by removing the damaged joint surfaces and joining the bones together with metal plates or screws. The procedure suits patients with severe bunions accompanied by arthritis. The fusion creates a stable joint but eliminates joint motion.

Minimally Invasive Surgery

This approach uses small incisions and specialised instruments to correct the bunion deformity. The surgeon performs bone cuts and realignment through tiny openings, reducing tissue trauma and scarring. This technique requires specific expertise and equipment.

Preparing for Surgery

  • Medical Assessment: The pre-operative evaluation includes blood tests, heart function assessment, and medical history review. Patients undergo physical examination and imaging studies to determine the surgical approach. The surgeon evaluates underlying health conditions that may affect surgery or recovery.
  • Medication Review: Blood-thinning medications require adjustment or temporary discontinuation before surgery. Anti-inflammatory medications need to be stopped according to pre-operative guidelines.
  • Fasting Guidelines: Patients must not consume food or drink for 6-8 hours before surgery. Following specific anaesthetic protocols, clear fluids may be allowed up to 2 hours before the procedure.

Step-by-Step Procedure

Anaesthesia Administration

The anaesthetist administers either general anaesthesia or regional nerve blocks based on the surgical plan and individual factors. Monitoring equipment tracks vital signs throughout the procedure.

Surgical Site Preparation

The foot is cleaned with an antiseptic solution, and sterile drapes isolate the surgical area. The surgeon marks anatomical landmarks and planned incision sites on the skin.

Incision and Exposure

An incision is made along the side or top of the big toe joint. Careful dissection exposes the underlying bone and soft tissues while preserving nerves and blood vessels.

Bone Realignment

After removing excess bone growth, the surgeon makes precise cuts to realign the metatarsal bone. The corrected position is temporarily secured with guide wires before permanent hardware placement. X-rays confirm alignment during the procedure.

Hardware Fixation

Screws, plates, or other fixation devices hold the realigned bones in place. The choice of hardware depends on the surgical technique and bone quality. Some devices remain permanently, while others may require removal later.

Incision Closure

The soft tissues are repaired, and the incision is closed in layers with appropriate sutures. A sterile dressing and protective bandage cover the site, and a post-operative shoe or boot supports the repair.

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Post-Surgical Care and Recovery

Immediate Post-operative Care

Patients are monitored for several hours after surgery, receiving pain management and ice therapy. The foot remains elevated to reduce swelling.

Early Healing Phase

Patients keep the dressing dry, follow weight-bearing restrictions, and use crutches or a knee scooter as needed. Suture removal occurs if necessary, and physical therapy progresses from gentle movement to strengthening exercises.

Full Recovery & Return to Activity

Recovery continues over several months. Patients gradually transition to regular footwear, starting with wider, supportive shoes. High-impact activities resume after bone healing is complete.

Potential Risks and Complications

Bunion surgery, like any procedure, has potential risks. Infection may develop in the bone or soft tissues, sometimes requiring antibiotics. Nerve damage can cause numbness or altered sensation around the surgical site. The big toe may become stiff or lose some range of motion. Hardware issues may require the removal of screws or plates. Blood clots are also a possible complication during recovery.

Frequently Asked Questions (FAQ)

How can I determine if bunion surgery is right for me?

You may be a good candidate if you have persistent pain, a worsening deformity, or difficulty walking despite non-surgical treatments. However, individuals with uncontrolled diabetes, poor circulation, or other medical conditions may require additional evaluation before surgery.

Can a bunion return after surgery?

Bunions can recur, mainly if the underlying foot structure is not addressed or if improper footwear is worn after recovery. Following post-operative instructions and wearing supportive shoes can help reduce the risk of recurrence.

Does bunion surgery increase the risk of arthritis?

Bunion surgery does not cause arthritis, but if the joint was already damaged before surgery, arthritis may still develop over time. However, realigning the joint can help improve function and may slow further joint deterioration.

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Dr. Zackary Chua

MBBS (Aus)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A distinguished Senior Consultant Orthopaedic Surgeon specialising in both adult and paediatric orthopaedic care.

  • Dr. Chua graduated from the University of Adelaide, Australia, with a Bachelor of Medicine and Bachelor of Surgery. He completed his Orthopaedic Specialist training under NUHS in Singapore in 2017.
  • In 2019, he was awarded the HMDP award, which enabled him to pursue a fellowship in Foot and Ankle Surgery at Oxford University Hospital NHS Trust in the UK.
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