ORTHOPEDICS + SPORTS MEDICINE
Bunion Surgery
Realigning the great toe to relieve pain, restore shoe comfort, and correct the underlying deformity.
A bunion is a bony prominence that forms at the base of the great toe as the first metatarsal drifts toward the inside of the foot and the toe angles toward its neighbors. Shoes rub against the widened joint, and the change in alignment shifts weight onto parts of the forefoot that were never meant to carry it.
Bunion surgery corrects that alignment. Depending on the severity of the deformity and the condition of the joint, the procedure may involve cutting and repositioning the bone, rebalancing the surrounding soft tissues, or fusing a joint that has worn out.
At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, surgery is considered when pain persists despite roomier footwear, padding, orthotics, and activity changes, or when the deformity is progressing and beginning to crowd the smaller toes. The goal is to restore alignment and comfortable weight-bearing while preserving as much motion at the joint as the deformity allows.
The Big Toe Joint and Bunion Formation
The big toe begins at the first metatarsophalangeal, or MTP, joint. This joint is formed by the first metatarsal bone of the foot and the first bone of the big toe.
In a bunion deformity, the first metatarsal gradually shifts toward the inside of the foot while the big toe angles toward the smaller toes. The metatarsal head becomes more prominent along the inner side of the foot, creating the bump commonly recognized as a bunion.
The medical term for this deformity is hallux valgus. As alignment changes, pressure within the joint and against footwear can cause inflammation, pain, and callus formation. The big toe may eventually overlap or crowd the second toe.
Why Bunions Develop
Bunions can be influenced by inherited foot shape, joint flexibility, ligament balance, and the way force passes through the foot. Certain types of footwear may aggravate symptoms by placing pressure on the prominent joint, but shoes are not always the underlying cause.
Arthritis and inflammatory conditions can also contribute to deformity. Some patients develop bunions on both feet, although one side may be more painful.
Symptoms can include:
- Pain over the prominent joint
- Redness or swelling
- Difficulty finding comfortable shoes
- Limited or painful big-toe motion
- Calluses beneath the forefoot
- Crowding or crossing of the toes
- Pain during walking or prolonged standing
The size of the bump does not always indicate how much the bunion affects function. A smaller deformity can be painful, while a larger one may cause few symptoms.
When Is Surgery Considered?
Nonsurgical treatment cannot realign the bones, but it may reduce pressure and make symptoms manageable. Options can include wider shoes, protective padding, changes in activity, medication, orthotics, and treatment for inflammation.
Surgery may be considered when pain continues despite these measures and interferes with walking, exercise, work, or normal footwear. It may also be appropriate when the deformity is progressing or causing additional problems with the smaller toes.
Bunion surgery is generally not recommended for appearance alone. Patients should consider the procedure because the deformity is painful or functionally limiting and because they are prepared for the necessary recovery.
Planning the Correction
The surgeon examines the entire foot rather than focusing only on the bump. Toe position, joint motion, arch structure, calluses, ligament stability, and walking mechanics can all influence the surgical plan.
Weight-bearing X-rays are especially important. Images taken while standing show how the bones align under normal load and allow the surgeon to measure the angles between the first metatarsal and the big toe.
The evaluation also determines whether arthritis is present and whether deformities such as hammertoes need to be addressed. Correcting one area without accounting for the rest of the forefoot could leave pressure or imbalance unresolved.
What Happens During Bunion Surgery?
Most bunion procedures involve an osteotomy, which means the surgeon makes a controlled cut in the bone. The metatarsal or toe bone is repositioned, and screws, plates, or other fixation may be used to hold the corrected alignment while the bone heals.
The prominence along the side of the metatarsal may be removed as part of the procedure. Removing the bump alone does not usually correct the shifted bones and may allow the deformity to return.
Soft tissues around the joint may also be balanced. Tight structures can be released, and weakened tissues may be repaired or tightened to help the toe remain centered.
The exact operation may include:
- Realigning the first metatarsal
- Correcting the position of the big toe
- Removing the bony prominence
- Balancing ligaments and other soft tissues
- Correcting an associated hammertoe
- Addressing arthritis within the joint
For severe deformity or instability near the base of the first metatarsal, the surgeon may correct and fuse that joint. If the big-toe joint has advanced arthritis, fusion of the MTP joint may be recommended instead of preserving painful motion.
Protecting the Correction During Recovery
Bunion surgery changes the alignment of bone, so recovery must allow enough time for that bone to heal. A surgical shoe, boot, splint, or cast may be used to protect the foot.
Weight-bearing instructions depend on the procedure. Some corrections allow protected walking on the heel soon after surgery. Others require limited or no weight on the operated foot for a period of time.
Patients must keep the dressing dry and avoid changing the position of the toe unless instructed. The dressing may help maintain alignment during early healing.
Swelling can remain for several months, especially after standing or walking. Elevation is particularly important during the first weeks and may continue to be useful as activity increases.
Physical Therapy and Returning to Shoes
Physical therapy is not required after every bunion procedure, but it may be recommended when the foot or ankle becomes stiff, walking mechanics need attention, or strength has declined during restricted weight bearing.
Rehabilitation may work on:
- Big-toe and ankle motion
- Foot and lower-leg strength
- Balance
- Walking without a limp
- Gradual progression into regular footwear
Transitioning back to shoes depends on bone healing, swelling, and the procedure performed. A wide, supportive shoe is generally introduced before narrow or less structured footwear.
Return to exercise also occurs gradually. Low-impact activity may resume before running, jumping, or sports that place greater force through the forefoot.
When to See a Foot and Ankle Specialist
A bunion should be evaluated when pain regularly limits walking or shoe wear, the big toe is moving toward the smaller toes, or calluses and pressure areas continue to develop.
Not every painful bump is caused by a typical bunion. Arthritis, gout, a bony growth, or another forefoot condition can produce symptoms in the same area. An examination and weight-bearing X-rays help establish the diagnosis and determine whether the deformity requires treatment.
Summary
Successful bunion surgery depends on understanding why the toe has shifted and selecting a correction that matches the foot’s structure. The procedure may involve bone, ligaments, tendons, and nearby joints rather than a single prominent area.
Dr. Christopher Dillingham evaluates these relationships before recommending surgery, giving the correction a clear functional purpose and a recovery plan suited to the work performed.