What is a bunion?
A bunion is when the big toe moves towards the 2nd toe and the bone behind the big toe (closer to the ankle), 1st metatarsal, moves inwards causing a bump on the inside of your foot. The medical Latin term for a bunion is Hallux (big toe) abducto (big toe moving towards the 2nd toe) valgus (big toe rotates inward).
At the North Texas Foot and Ankle we use the following criteria as a guideline when determining if surgery is indicated:
The surgical procedure
There are a number of different ways to perform bunion surgery. The best procedure for one person is not necessarily the best for another. Some procedures allow you to walk much sooner meaning you may not have to use crutches. Depending on your foot type the procedure can have a greater risk for return of the bunion deformity. Other procedures may require you to be on crutches for a few weeks – but may offer a better long-term result.
Types of bunion surgery:
Generally, bunion surgery can be classified into two major categories:
For a head procedure, the bone is cut and the head of the metatarsal moved over to correct the bunion. Various types of bone cuts can be performed depending on the necessary correction. Head procedures are usually indicated for a mild to moderate bunion, or for patients who do not feel they can be non-weight bearing for any length of time.
Head Procedure Bunionectomy – bone is cut just behind the joint and moved over.
Fixated with screw (shiny area center of bone behind great toe joint).
Base procedures are performed around the base of the 1st metatarsal (bone behind great toe). They include cutting a wedge out of the bone (base wedge), making a semi-circular cut and rotating the bone (crescentic osteotomy) and fusion of joint behind great toe joint (Lapidus bunionectomy). Base procedures are usually indicated for a moderate to severe bunion.
Lapidus bunionectomy – procedure performed at the base of the 1st metatarsal.
Overall, there are many variables in selecting a bunion procedure and the key to success is finding an experienced surgeon who understands each variable and who has the skills to perform all types of procedures. Some surgeons may not have the skills to perform base type procedures and offer head procedures as your only choice.
There is substantial medical research showing which bunion procedures are most effective in specific situations. At the Foot and Ankle Center of Washington, we perform an examination of your lower leg and foot, review your biomechanics and x-rays, and give you an understandable and complete explanation of what choices you have, including what type of procedure is in your best interest.
Who Should Perform Your Surgery?
The most important criteria to ensure good outcome for your bunion surgery is to choose the right surgeon. The qualities that make for a good bunion surgeon are:
Not all Surgeons are Created Equal:
Be very careful in choosing the right surgeon. It is particularly important to avoid those that make unrealistic claims regarding bunion surgery. If you see or hear the following statements we suggest you consider another surgeon:
Podiatric Surgeon or Orthopedic Surgeon?
Both Podiatric and Orthopedic surgeons perform foot surgery. The question often arises as to who is more qualified. The reality is that it depends on the surgeon. There are exceptional Podiatric foot surgeons and exceptional Orthopedic foot surgeons. Conversely, there are mediocre surgeons in each profession.
From day one of their training, Podiatric surgeons know they will be treating foot and ankle conditions, thus early on they receive in-depth education on foot and ankle conditions as well as broad education in general medical conditions. The first years of medical education for MDs, DOs, and DPMs are generally the same. In fact, in many cases, the students are taught by the same teachers or in the same class room. This general training in medicine allows both the Orthopedist and the Podiatrist to detect medical conditions affecting the lower extremities as well as deal with surgical patients who have medical conditions. Unlike other specialties, Podiatric surgeons receive significant training in biomechanics during their education allowing a unique view of how foot surgeries can affect the lower extremity.
Board certified Podiatric Foot and Ankle surgeons are the surgical specialists of the Podiatric profession. American College of Foot and Ankle Surgeons (ACFAS) members are graduates of accredited U.S. Podiatric medical schools, who have completed surgical residency programs of up to three years.
Fellows of the College are certified by the American Board of Podiatric Surgery, the surgical board for foot and ankle surgery recognized by the Joint Committee on the Recognition of Specialty Boards. Many have additional fellowship training in various aspects of foot and ankle surgery. All ACFAS members are dedicated to surgical excellence in the treatment of foot and ankle disorders.
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