When conservative measures don't work to alleviate bunion pain, your podiatrist might recommend surgery.
During bunion surgery, the bones are positioned correctly and screwed into place using an FDA-approved headless screw that doesn't require removal after surgery. This procedure is successful in 90-95% of patients, and most patients are able to walk a mile again just six weeks after surgery.
Prior to and following the bunion surgery, a gait analysis, x-rays, along with appropriate laboratory and vascular analysis may be necessary. When we recommend surgery, we will usually recommend the newer more advanced procedures known as Arthroplasty and Osteotomy.
There are many recent innovations that help make this procedure successful. Generally this procedure can be done under a local block anesthesia (an injection of Liodocaine, Marcaine or Dexamethoasone). An Osteotomy (cutting of the bone) is best performed utilizing a small titanium screw that has a hole down the center which allows for a very small incision to be made. These screws are very strong and will allow the bone to knit at a much faster rate and also allowing for earlier weight bearing. The screw is used to hold the bone in its new, corrected position. It is intended to stay within the foot and behind the joint for long term stability. Sometimes, however, this screw may become loosened and may have to be removed at a later date. The screw is only removed if it is causing irritation and this can be accomplished with a local anesthetic and a small incision on an outpatient basis.
Another innovation that has helped the advance of this procedure is the ankle tourniquet (a device that stops the blood at the ankle while the surgery is being performed). Following this procedure good splinting is needed to allow the toe to remain in a good straight position, utilizing the Angus bunion splint. In addition, earlier ambulation is encouraged with the use of the newer Cast Walkers. Full leg shower guards can be used with the walking boots. When the surgery is performed this way immediate ambulation is allowed, faster healing ensues and markedly reduced pain is usually the post operative course. When post operative analgesics are needed, Advil, Tylenol, or Cataflam are recommended, or some of the newer anti-inflammatories such as Voltaren.
Below is a video of an actual surgery performed by Dr. Richard Jacoby.
Warning, this is a graphic surgical procedure.