There are many ways to surgically correct a bunion deformity, but in general terms the different operations can be thought of, or classified, as being designed to address small, medium or large deformity.
Not surprisingly, the complexity of the procedure grows with the severity of the deformity. Surgical decision-making in bunion surgery also depends on a number of other factors, including a patent’s age, general health, foot shape, associated pathology affected other parts of the foot and the condition of the joints directly involved in the reconstruction. An excessively mobile joint is handled quite differently from a stiff and arthritic one, for example. Sometimes a realignment operation may need to be accompanied by a fusion of the joint at the base of the big toe if there is significant associated stiffness or osteoarthritis. Common to all hallux valgus (HV) correction operations is a combination of soft tissue/ligament rebalancing and bone surgery, the latter involving trimming of thickened bone along with, and most-importantly, bone repositioning.
When bunion deformity is mild to moderate in severity, an osteotomy (bone cut) through either the neck or along the length of the first metatarsal will allow for bone to be repositioned and then fixed with buried screws in a new/corrected position. Ligament rebalancing about the joint at the base of the big toe, which includes a lengthening of tight tissue and a tightening of loose tissue, completes the realignment and allows for fine-tuning of the position of the toe.
Following these types of operations, it is possible to take full body weight on the foot wearing a post-operative shoe and this is typically retained for six weeks.
In the case of severe deformity, and particularly when this is accompanied by excessive mobility at the joint at the base of the metatarsal, it is often necessary to complete what is known as a Lapidus Procedure. This involves a realignment and fusion of the basal joint. This is a powerful procedure which can address even the worst of deformities, but post-operatively it is not possible to take weight on the foot for eight weeks and it takes a little longer to fully recover.
As with any operation, it's important to consider the relative merits and balance the benefits versus the risks, before making a decision to go ahead.
Dr Newman can provide you with more information about the operation at the time of your appointment.