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Bunion and Bunion Surgery
What you need to know
WARNING:
Surgical Procedure
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What is a bunion? It is when the bone to the big toe or the first metatarsal moves outward or increases the angle between the second metatarsal known as the inter-metatarsal angle. A normal angle is less than about 8 degrees. When this angle becomes larger, the bunion deformity will worsen over time in most cases. The big toe or Hallux will drift and move in the opposite direction towards the second toe.
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When should you have bunion surgery? There is no hard and fast rule but Dr. Bregman believes there are 2 situations where you should consider having surgery. 1) It is painful on a regular basis or it is causing the second toe to become painful or partially dislocated. Many people with a bunion will not complain of pain on the bunion but complain of pain underneath the second toe. Often times a hammertoe is associated with a bunion and may need to be addressed during the bunion surgery. There is also a term called hypermobile first ray this is present in about 20% of bunions and means that the bunion is unstable at the proximal joint and should be addressed by fusion/Lapiplasty procedure.
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What are the different types of bunion surgeries? There are dozens of procedures that are available to the foot and ankle surgeon but Dr. Bregman has chosen 3 procedures that he feels are the best available today that can fix any bunion! These are the Scarf bunion procedure, the Lapiplasty procedure and the MIS Mini-Buniom procedure which is minimally invasive bunion procedure where a small less than 1” incision is made to perform the procedure.
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Each of the above procedures has its own
advantages and disadvantages:
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The Scarf is a great procedure which can correct very large deformities. It does require a longer incision which is made on the inside of the foot along the bunion deformity, so it is not seen. It heals in about 8 weeks and allows immediate weight-bearing and you can begin exercising after about 4-6 weeks. Full return to activity in 10-12 weeks. No cast!
The Lapiplasty is also a great procedure and can correct any deformity and is primarily indicated when there is hypermobility of the bunion. It can provide “3-D” correction but it is not always indicated. It requires at least a week of non-weightbearing and sometimes longer. It fuses the proximal joint or metatarsal cuneiform joint to eliminate the hypermobility and allow for correction in all planes. The procedure uses one or two plates to hold the fusion procedure in place and allows early weightbearing.
MIS or minimally invasive bunion surgery the “Mini-Bunion” is performed with a very small incision on the side of the foot. Through this incision the bone is cut and then held in the correct position by a special plate with screws. Weightbearing is usually allowed after 1 week in a boot which is worn for about 6 weeks. The advantage of this procedure is a small incision and less chance of scar tissue. Dr. Bregman did not jump on the bandwagon when many of the companies started coming out with their version of the MIS bunion procedure and waited till there was one that was clearly the best choice the Mini-Bunion.
The Akin procedure is an adjunct procedure that may need to be done with any of the above procedures and is sometimes needed to provide full correction of the big toe. This can be done vis a minimally invasive technique or open depending on the technique being done from the start. A small wedge cut is made in the Hallux or big toe to allow it to sit straight and if done with MIS technique does not use hardware to fixate it or we use a staple when done the traditional way. You can see examples on the website xrays.
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