When Do Bunions Require Surgery?

A bunion looks like a big lump on the outer base of your big toe joint. But that bump isn’t a lump; it’s the joint itself. If you have bunions, your metatarsophalangeal joint (MTP), which is at the base of your big toe, doesn’t sit straight. Instead, it leans outward, forcing your big toe inward.

In their early stages, bunions may be a primarily cosmetic problem. Your toes look lumpy. You may even have trouble squeezing your misaligned toe and bunion into your favorite shoes. But, over time, bunions can cause serious problems.

At Foot + Ankle Specialty Centers, our team of experienced podiatrists diagnose and treat bunions at our four locations in Gilbert, Scottsdale, Chandler, and Phoenix, Arizona. If you have bunions, you may wonder if they need surgery. These questions can help you find the answer.

Is your main problem aesthetic?

Bunion surgery isn’t a cosmetic procedure. If the only real drawback you experience with bunions is an aesthetic one, we recommend a number of other remedies, such as:

• Switching to shoes with bigger toe boxes
• Wearing inserts in your shoes
• Getting customized orthotics to straighten your toes

We also don’t recommend getting bunion surgery simply because you notice that your bunions are getting bigger. You can prevent your bunions from worsening by wearing customized orthotics and roomy footwear and performing toe exercises.

Are your bunions painful?

If you’ve switched to roomier shoes and tried orthotics and bunion pads, but your bunions still hurt, you may be a candidate for surgery. You might benefit from surgery if your bunions hurt so much that it’s hard to walk without substantial pain.

Bunions can cause problems in other areas of your feet. Complications can include:

• Bursitis (inflammation of your bursa)
• Hammertoe (claw-like deformity in the second toe)
• Metatarsalgia (painful, swollen ball of foot)

When bunions cause complications, it may be time for surgery. 

Is your big toe swollen or stiff?

The irritation of a joint out of alignment can cause inflammation in your big toe. Inflammation, in turn, may trigger arthritis in your toe.

If you notice that your toe is chronically red or swollen, try over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). Or, apply wrapped ice pads to your toe to help reduce redness and swelling. Try elevating your feet and resting them to allow them to heal and recover. However, if these measures don’t help, you may need surgery.

Another sign of possibly needing surgery is that your big toe has lost flexibility. If your toe is stiff and can’t easily bend, that’s going to throw off your gait and could lead to joint problems further up your leg and even in your hips.

Is your big toe cramping your other toes?

When your MTP is so severely misaligned that your big toe is crowding your other toes, or crossing over them, surgery is probably your best — and maybe only — option. 

When you come for a bunion consultation at Foot + Ankle Specialty Centers, our expert podiatrists examine your foot, evaluate your gait, and take X-rays and other imaging studies of your MTP and other joints. They customize a treatment plan and only recommend surgery as a last resort.

What kind of bunion surgery is best?

If you’re a candidate for bunion surgery, your podiatrist may recommend one of several options. The best choice for you depends on the severity of your bunion and the type of complications it causes.

Tendon and ligament repair

If your MTP is imbalanced due to overly tight or loose tendons or ligaments, your surgeon may be able to correct your bunion by repairing it. However, usually tendons and ligaments are repaired as part of an osteotomy.

Osteotomy

Your surgeon cuts the MTP joint to realign it. The new alignment is held in place with screws or wedges.

Arthrodesis

If your MTP has developed arthritis, your surgeon removes the damaged areas of the joint surfaces. They then insert screws, wires, or plates to hold the bone surfaces in alignment until healed. 

E​​xostectomy

Your surgeon removes the “lump” on your MTP by shaving down the base of the joint. Because shaving the lump does nothing to realign the toe, an exostectomy is usually performed with an osteotomy, and possibly tendon and ligament repair.

Resection arthroplasty

Your surgeon removes the damaged area of the MTP to increase the space between the bones. However, resection arthroplasty may reduce the pushing power of your big toe, so is rarely done unless the patient has failed prior bunion surgery.

If you have bunions, find out how to live more comfortably with them or correct them surgically if necessary. Schedule a bunion evaluation today by phoning our office nearest you or using our convenient online booking form.