There are many different surgical procedures that can be performed. The decision to perform one type of surgery or another is based upon the extent and magnitude of the bunion deformity, the presence of arthritis in the big toe joint, and the space between the first and second metatarsals, which is called the intermetatarsal angle.
It is very rare that a bunion can be treated by simply shaving down the bump of the bone. Invariably, the deformity will recur and both the bunion and the hallux valgus will return. Therefore, the shaving of the bunion, called an exostectomy, is performed in conjunction with a cut of the first metatarsal bone, which is called an osteotomy.
Depending on the severity of the deformity, this osteotomy can be done either at the end of the metatarsal (a distal osteotomy) or, if the deformity is more severe, the osteotomy is performed at the base of the first metatarsal (a proximal osteotomy).
One of the more common distal metatarsal osteotomies that is performed is called the chevron osteotomy. Typically a small screw is inserted into the bone to hold the metatarsal head in place and speed up bone healing. Following a chevron osteotomy, walking is permitted in a surgical shoe the next day after surgery and the shoe is worn for approximately three to four weeks before a more comfortable walking/running type shoe is worn.
Another procedure involves a proximal metatarsal osteotomy. This operation is performed for a more advanced deformity. Screws are inserted into the metatarsal to hold the bone cut secure and speed up bone healing. Walking is permitted in a surgical shoe following surgery. The shoe is worn approximately five weeks.
For very severe bunion deformities where there is considerable angulation between the first and second metatarsals, an osteotomy of the metatarsal may not be sufficient, and for these patients, the joint between the first metatarsal and the cuneiform bone is fused with screws, called the Lapidus procedure. This realigns the metatarsal completely and stabilizes the bone, preventing mobility and recurrent deformity.
An osteotomy is not performed for patients who have arthritis of the big toe joint associated with a bunion deformity. The deformity is corrected through the joint either with a fusion of the joint or by removing a portion of the joint (an arthroplasty). Fusion of the big toe joint is an excellent operation since it corrects the deformity, prevents the bunion from returning and eliminates the arthritis simultaneously.
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