Bunions: When Is It Time For Surgery?

In Conditions by Alnoor Ladhani, Chiropodist

Bunions are a relatively common foot deformity, most easily identified by a large bump growing to the inner side of each foot’s big toe. These bumps, mostly hereditary in nature, are not just a cosmetic concern.  As they grow larger, they can cause severe pain when walking or after prolonged standing, as the feet will no longer comfortably fit in the shoe.


Although corrective surgery for bunions (also known as bunionectomy) is widespread, many people are understandably wary of considering surgery as a first-line treatment. Usually, the problem is left to grow for a while – but how do you identify when it’s time to act?


Bunions Involve More Than Meets the Eye


Although bunions are often thought to be simply unsightly, their full repercussions involve both skin and bone tissue. As the bunion grows, it pushes the big toe’s metatarsal bone inwards, eventually impairing flexibility and movement – as it will become impossible to bend. Eventually, the second toe may become dislocated as well, which may cause bigger calluses and balance problems.


The cumulative bone deformities caused by bunions may not be visible to the naked eye, but they have a very tangible effect in the patient: constant pain. At the end of the day, the decision to undergo a bunion removal surgery is most often determined by the amount of pain experienced.


What Other Options Can Be Explored?


Before opting for surgery, there are limited options to deal with bunions and most of these constitute management rather than removal. The first line of management usually involves switching to bigger shoes and choosing models with a round tip rather than a pointy one. In the case of women, a common suggestion is to stop wearing high heels.


Painkillers, steroid injections, and NSAIDs can help manage the pain, while foot massages or soaking feet in warm water may help with swelling –  but only until a certain point. Orthotics and bunion pads may, arguably, stop or delay bunion growth, but they offer little in terms of a permanent solution – and will not reverse the damage already done.


When Is Surgery the Way To Go?


Pain resistance is a very personal issue, but as a general rule, once the pain is bad enough to keep someone from walking more than a few blocks a time, or if swelling in the toes becomes permanent, then it’s time for surgery. It is important to consider that impaired mobility would get in the way of physical activity, which will in turn have detrimental effects on overall health.


What Is Bunion Surgery Like?


Traditional surgical bunion removal is a complex procedure, which involves returning the displaced metatarsal bones to their original place and straightening the big toe, as opposed to simply removing the visible “bump”.


This procedure requires full anesthesia, an overnight stay at the hospital, and a long recovery time: it can take up to a year to regain full mobility after the most invasive types of bunion removal.


Nowadays, minimally invasive procedures (keyhole surgery) is also regarded as a good option against bunions – but this will depend on the extent of the injury, its precise type, and the likelihood of it forming again. As a general rule, the more extensive the deformity is, the more complicated it will be to get rid of it – which constitutes an additional reason for operating sooner rather than later.


Choosing to undergo surgical bunion removal is a personal matter, as a careful assessment of the effects of chronic pain versus the acute care needed will have to be performed by each candidate.