The Center for Podiatric Care and Sports Medicine

Latest Advances in Bunion Surgery

Posted by on Thursday, June 20th, 2013


Here at our NYC Center for Podiatric Care and Sports Medicine, we find there are many misconceptions about bunion surgery — primarily because people are not aware of the latest advances and technology. In the past, bunions required painful bone-crunching surgery, but that is not the case anymore.

Often, we treat bunions as an outpatient procedure and patients may return to work within days. There are over 100 different types of bunionectomies and techniques, so that is why it is important to choose a podiatric surgeon who understands the pros and cons of each treatment to give you the best possible care.

“Foot pain is not normal, including bunions, which can be very uncomfortable and, in some cases, even debilitating,” says APMA President Dr. Matthew Garoufalis. “There are numerous conservative and surgical treatment options today’s podiatrist can provide to patients with bunions.”

Bunion Surgery Of The Past

For many years, bunion surgery was not for the faint of heart. Sufferers of red bony bumps on the big toe would have to endure detachment of the toe joint, sawing of bone and stitching back together while under general anaesthesia. Only one foot would be operated on at a time, so patient would not be completely incapacitated. Even so, the recovery after bunion surgery could take up to three months of hobbling on crutches. Scarring was likely and open toe shoes were out of the question for at least a year. It’s no surprise many women opted not to have the second foot done after the first one had healed.

New Advances In Bunion Surgery

“Keyhole” procedures that went into the foot through a small opening have been around for many years, but were avoided by surgeons who worried that a conservative treatment may not prevent bunions from returning. “Older techniques involved cutting the bone and not using any form of fixation, such as pins and wires, to hold the new alignment of the toe in place,” Dr. Joel Vernois told the UK Mail.

By contrast, the new keyhole procedure for severe bunion deformity leaves permanent screws to fix the joint, but they are inserted through four tiny 3mm incisions around the big toe, so there is minimal scarring and post-operative pain is significantly reduced. Only a local anesthetic is needed, which also reduces complications.

The instruments used in the procedure were originally developed for facial surgery, so they are very fine and rotate at a high speed to make very precise cuts. Using a small drill called a burr and a wire, the toe is pulled back into alignment and small screws are implanted to hold the bones there. The wire is then removed, while the titanium screws permanently stay in place, without causing any discomfort. If necessary, lumps in the bone can be filed down. The speedy 30-minute procedure is done using x-ray guidance, so the surgeon can see what’s going on inside the foot at all times.

At our center, we have another technique we use that doesn’t require titanium screws at all. The Osteotomy Sparing Mini-Tightrope procedure is done by making tiny 1mm incisions through the first and second metatarsal bones and threading two sets of fiberwire suture made from a strong, hair-thin mesh wire through the openings on either side of the metatarsals. Once the sutures are in place, they are tightened to pull the bones into proper alignment. After the short procedure, patients wear a postoperative shoe or walking boot. Stitches are removed in a few weeks and most patients report little to no pain during recovery.

Other Types of Bunionectomies

“The procedures are designed to remove the ‘bump’ of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred,” explains Dr. Ira Fox. “In selecting the procedure or combination of procedures for a particular case, the surgeon will take into consideration the extent of the patient’s deformity based on the X-ray findings, age and activity level of the patient and other factors.”

In most cases, surgery is needed to correct a bunion. Lifestyle modifications, insoles and extra padding can only go so far in the treatment of bunions. Less severe bunions may be treated with an exostectomy, which shaves or thins the bump on the head of the first metatarsal bone using a surgical saw. This procedure is used when there is no angular deformity or big toe drifting.

People often ask us whether lasers can treat bunions. While lasers are being used in a number of late-breaking medical procedures these days, it is not conducive to bunion foot surgery. There is no removal of a “bunion” in the way a corn or a callus is removed. Rather, a “bunion” refers to the misalignment of the bones in the feet. Therefore, cutting and mending is the only approach. Lasers can aid in soft tissue growth removal and healing, but as Dr. Neil M. Blitz explains, “A laser would actually be detrimental to bone cuts, as the heat of the laser would burn the bone, thus prevent proper healing.”

If you have any questions about the latest advances in bunion surgery, please contact our NYC office. Our foot doctors have performed over 4,000 bunion corrections over the last 30 years, ranging from simple repairs to the most complex.


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.