Bunion Surgery Options and Advancements

What is a Bunion?

Bunions come in all shapes and sizes.  They are largely genetic resulting from a looseness of the great to and midfoot joints resulting in a shift of the bone and bunion formation.  Although genetics are the primary cause, shoes and other factors can accelerate and worsen bunion problems.

Conservative management:

  • Well-fitting, supportive shoes
  • Custom functional orthotics, stabilizing the medial column of the foot and slowing down the progression of the bunion deformity.
  • Bunion night splints
  • Padding over the prominent bone
  • Toe alignment splints
  • Injections and pills don’t play much of a role in managing a painful bunion.

Conservative management of Hammer Toes are exactly that:  management.  It is not typically curative or designed to fix the problem.  At some point, surgery is recommended.  Surgery is usually recommended when the deromity becomes painful, affects shoe choice, and when the discomfort limits activities.  Surgery is discouraged if there is no pain, and when cosmesis is the main driving force.

Bunion Surgery Work-up:

Because bunions come in all shapes and sizes, the surgical treatment must include a varied approach.

The choice of bunion surgery depends on:

  • The size of the bunion deformity
  • The laxity of the bone and how loose the foot bones are
  • The angle of the cartilage of the great toe
  • Deformity of the great toe bones and/or bunion only
  • The length of the metatarsal bone leading to the great toe

Surgical bunion treatment:

Simple bumpectomy

This is the simple, minimalist approach.  This is the wrong surgery for most people, but can be effective when chosen wisely.  Easy recovery with this procedure.  Usually not great long term correction, how ever.

Classic Chevron type osteotomy

This is the most common procedure done to correct bunion deformities.  It includes shaving the prominent bump, but also includes a shift and realignment of the head of the metatarsal and the big toe joint.  This is fixated with pins or screws; our choice at UFAI is usually a 2-screw fixation, which is very stable and allows for earlier weight bearing and range of motion.  We usually allow weight bearing protected in a walking boot right away after this surgery.

Reverdin type osteotomy

This procedure can correct some angular problems in the region of the deformity, having it’s strongest correction on the joint position/alignment.

Akin phalangeal osteotomy

When there is alignment problems within the toe itself and it is angulated strongly toward the 2nd toe, this procedure removes a wedge near the base of the toe that swings the toe into a straightened position.

Base wedge osteotomies

Though these procedures are considered somewhat unstable, they can be good to correct higher angled bunion deformities.  When these are done with wedge bone grafting and screw or plate fixation, they can provide solid correction, still maintain good metatarsal length, and can be relatively stable.  Recovery includes a period on crutches, usually about 4-6 weeks.

Lapidus procedure (wedge corrective fusion of the 1stmetatarsal cuneiform joint)

This procedure gets to the root of many bunion pr oblems.  By correcting and stabilizing this joint at the base, strong correction can be achieved.  This usually affords excellent long term correction.  This is usually the procedure of choice for younger people with a hypermobile midfoot joint.  This requires cast and crutches for 4-6 weeks or so after surgery.

The University Foot & Ankle Advantage:

Bunion Surgery has become more refined over the years.  At the University Foot & Ankle Institute, we custom-design the bunion surgical procedure and experience for the individual.  Every foot and circumstance can be unique an no one procedure is well suited to all foot types.  At University Foot and Ankle Institute, we are flexible in using the appropriate combination of procedures to achieve quick recoveries as well as the best long-term outcome.

Dr. Bob Baravarian

Dr. Bob Baravarian

Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as co-director of University Foot and Ankle Institute. He is Editor Emeritus of the international medical journal, Foot and Ankle Specialist.

Dr. Baravarian been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),

Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
Dr. Bob Baravarian

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