A former orthopedic surgeon-employer and good friend, Dr. George Rakolta, once told me that as a surgical practice, “in many ways we are defined by how our patients (and in this instance, we’re talking about women patients) talk about our work.”
While that certainly holds true in all aspects of orthopedic surgery, it is especially veracious when it comes to surgery of the feet.
Dr. “George” also said, when it comes to surgery of the feet and bunionectomies in particular, “you better get it right, for you will be fodder for beauty-shop discussion.”
So, let’s talk about the bunionectomy - a common surgical procedure performed by orthopedic and podiatric foot specialists.
To understand bunionectomy surgery, you need to understand bunions - how they are caused and what they look like. Understand there are many different types of bunions and bunion procedures, so we’ll limit this article to the procedures most commonly seen.
So, just what exactly is a bunion?
A bunion is typically defined as an enlargement of the joint and soft tissue that is formed by the great toe and the first metatarsal bone of the foot. This enlargement is usually the result of excess bone formation along the medial (inner) margin of the metatarsal head, and can be caused by chronic pressure from ill-fitting or narrow-toed shoes as well as a genetic predisposition.
Bunions may or may not be accompanied by some level of angular deformity of the foot caused by the spreading of the metatarsals, known as “splaying,” which can result in an abnormal widening of the foot. This widening can also cause abnormal forces to be placed on the big toe itself, causing it to tilt abnormally toward the second toe, effectively increasing angles and pressure on the joint.
Bunions can affect both sexes, but are found much more frequently in women than men. They can be found in literally all age groups, from adolescence to the elderly.
When it comes to bunions and surgery, it is important to know the cause as well as exactly what is going on with the foot in terms of anatomy changes, so that the proper procedure is performed. For example, in cases where there is a bunion in the presence of normal foot anatomy, simple removal of the excess bone is usually a cure.
In cases of bunions with splaying (widening) of the foot however, merely removing the excess bone or “bunion” without also correcting the anatomical abnormalities and angular deformities is an invitation for failure and recurrence of the problem because the bunion is, in essence the symptom, and not the overall problem.
When angular correction is necessary, the foot specialist usually performs an osteotomy, which is a pre-determined cut through the metatarsal bone. This is done with a small precision power saw. This osteotomy allows the surgeon to literally “slide” the distal portion of the bone (the part nearest the big toe), toward the second metatarsal, effectively narrowing the foot.
Once the bone is in the desired position, it is stabilized by using pins or small screws. If pins are used, they may be removed in several weeks. Screws are typically small enough to be left permanently in place without problem.
After surgery, you may be required to wear a special boot or shoe, and weight-bearing may be limited, until the osteotomy heals. Your foot may also be swollen for several weeks, and it may take up to three months before normal footwear can be used. As time progresses, wearing footwear in wider widths may be beneficial for the short term.
So, while there are always risks to any surgery and outcomes can vary from patient to patient, it’s easy to see that if a procedure like this doesn’t ultimately meet with a woman’s utmost approval, what kinds of future discussions she may have with her friends and the local beauty shop.
If you think you suffer from this problem, consult your doctor or foot specialist for further advice.
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care.