The Center for Podiatric Care and Sports Medicine

Considering the Pros and Cons of Bunion Surgery: Treatment Options and Recovery

Posted by on Monday, June 26th, 2017

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People with a predisposition toward bunions start to notice abnormal developments around their big or small toes by the time they reach their twenties or thirties. Bunions can strike at any age, however, according to the Manhattan podiatrists at The Center for Podiatric Care and Sports Medicine. Kids can even develop surprisingly adult-like bunions at very young ages. “We recommend that parents hold off on surgical considerations until the child has reached skeletal maturity and the growth plates have closed,” says Dr. Josef J. Geldwert, DPM. He says this occurs between 13-15 for girls and 15-17 for boys. In the meantime, there are conservative measures that may prevent the bunion from getting worse.

Is it time to get your bunion fixed, or are you too young to worry?
Is it time to get your bunion fixed, or are you too young to worry? Image Source: Flickr user Esther Max.

What Causes Bunions?

About 23 percent of people ages 18-65 have bunions. You’ll know you have one when a bump develops on the big or small toe joint, causing the affected toe to drift out of alignment toward the other toes. Contrary to popular belief, it’s not a new growth of bone; it’s a shifting of the toe joint that can only be truly corrected through surgical means.

It’s a common misconception that bunions are the result of wearing high-heeled shoes. “Bunions do occur ten times more often in women,” explains Dr. Geldwert, “but you needn’t look far to find examples of men with bunions. Falcons’ receiver Julio Jones is just getting back to training after four months of bunion recovery. At least half of all cases have a direct genetic component.” He also points out that athletes sometimes develop bunions after sustaining repeated trauma.

Bunions are an unsightly cosmetic issue, but they can also be extremely painful. Or, they may start off painless and gradually become quite uncomfortable. Unfortunately, there’s no telling which “type” of bunion you have. “We take a wait-and-see approach in cases where the bunion has not caused severe pain or deformity,” Dr. Geldwert says. Bunions can progress very quickly once they reach their tipping point. When that happens, there are far fewer treatment options, so it’s best to have an NYC podiatrist monitoring your feet with advanced digital imaging as soon as possible.

Should You Delay Bunion Surgery?

Bunion surgery can be daunting because:

  • The results are not guaranteed
  • It costs a lot of money out-of-pocket
  • Recovery can be slow and sometimes painful

There are alternatives to surgery, however. Many patients respond very well to the use of custom insole orthotics—which slows bunion progression, addresses underlying biomechanical stressors (like pronation), and offloads some of the pressure from the joint. Chronic inflammation at the toe joint can be immediately relieved by a cortisone injection. There are also pads and night splints to keep the foot better aligned.

What are the Benefits of Early Bunion Surgery?

On the other hand, there are many reasons why a person may choose to have surgery, even if they are younger than thirty-years-old. “Most of the time, patients want an end to pain and an easier time shopping for shoes that fit properly,” says Dr. Geldwert. “Then, of course, correcting the abnormal look of a bunion is a major factor, particularly in younger patients who want to go to the beach and wear sandals and restore self-confidence.”

There are over one-hundred different surgeries for bunions, but the general approaches to fixing a bunion include:

  • Removing a portion of the bone
  • Cutting and realigning soft tissue around the joint
  • Cutting into the bone itself to realign the joint
  • Removing or reshaping the bone in the joint
  • Fusing the big toe joint
  • Fusing the metatarsal joint to the mid-foot
  • Removing the metatarsal joint and inserting an implant

Traditional methods require an incision down the top of the big toe joint, with possibly an additional incision between the first and second toe. The bones can be stabilized using wires, screws, pins and plates during initial healing and can be removed later. Newer methods involve making a tiny incision on the side of the foot with dissolvable sutures under the skin to eliminate scarring. Tiny screws are all that’s needed to add stability.

“For us, the most important thing is that we make you feel better,” says Dr. Geldwert. “You can go to a plastic surgeon and get your bunion fixed if you only care for looks. Foot specialists are in the business of human anatomy and correcting the underlying root cause of deformity. We’re into pain management and correcting biomechanics, so you can get back to what you love as soon as possible and have the best chance at staying pain-free and bunion-free.”

Can a Bunion Come Back?

Past research has suggested that up to 10% of surgically fixed bunions return within three years. After twenty years, this number increased to 47%, due to a hypermobile first ray and an improper lateral release. Still, “these studies were done in the eighties and nineties,” Dr. Geldwert reminds us. “So I tell patients to take them with a grain of salt.”

He explains, “Procedures and techniques have come a long way just in the last decade. In my practice, I would think of a 1-2% recurrence rate as high. The implants available to us and the tools we use are fantastic nowadays. Our insight into active recovery and getting patients moving right away is key to the wonderful results we’re seeing. Most importantly, it’s about choosing the right approach for the individual patient. We spend a great deal of time and research determining what will give our patients the best outlook for the future—and that’s what sets a Manhattan foot surgeon apart from a generalist or a cosmetic surgeon.”

Recovering After Bunion Surgery

Bunion surgery can be done under light sedation and local anesthesia, so there is no “hangover” or tube down the throat. The outpatient procedure sends people home right after surgery. Patients can bear weight immediately in a special surgical shoe, and some patients drive the following day. Most patients schedule bunion surgery on a Thursday or Friday and return to work in four to five days—as long as they aren’t expected to stand or walk all day. “You won’t be running for about two months,” Dr. Geldwert warns. “For our active athletes, that’s really the hardest part! But you will be feeling so much better by the one-month mark, once much of the swelling goes down.” Most patients are able to tolerate high heels three months post-op. Contact The Center for Podiatric Care and Sports Medicine for questions about bunion treatment and surgery in NY.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.