By Stephanie Stephens, AARP
Bunions are a major problem for millions of Americans. Gayle Lloyd’s right foot has been bump-free ever since October 2021, when the St. Leonard, Maryland, resident decided to have the protrusion removed with minimally invasive surgery.
Like approximately one-third of American adults, Lloyd, 63, had a bunion — a painful, bony bulge at the base of the big toe that occurs when the joint slips out of alignment. Older adults are more likely to develop the bothersome bumps, and bunions tend to affect more women than men, research shows.
Some people can find relief from the pain and pressure bunions can cause with over-the-counter medications, roomier shoes and padding that acts as a barrier. There are also medical procedures, like the one Lloyd had, that in some cases can help to fix the problem.
AARP asked four orthopedic foot and ankle surgeons to explain who might benefit from bunion surgery and what to expect from the outpatient procedure. Here’s what you need to know if you’re considering getting rid of a bunion.
IS IT TIME?
You may be a bunion surgery candidate if your bunion foot hurts a lot and limits your daily activities such as walking, the American Academy of Orthopaedic Surgeons (AAOS) says. Maybe your big toe is inflamed, swollen, stiff or “drifting” toward other toes — even crossing over — and pain medication isn’t helping with symptom relief.
If you’re hoping to stave off surgery — and know that like with any surgery, there are risks to bunion removal, which is why AAOS stresses that surgery should be reserved for deformity with pain, and not for cosmetic reasons — try using protective pads that cushion the painful area (you can find these in drug stores).
Switching shoes can also help. Opt for something with a wide- or open-toe box and a soft upper fabric, says Carol Frey, M.D., codirector of West Coast Sports Medicine/UCLA Sports Medicine Fellowship, in Manhattan Beach, California — think clogs, moccasins and sandals. There are also shoe inserts that can help to distribute the pressure more evenly in your feet when you walk.
Again, if these measures do not work and your quality of life is impacted, ask your doctor whether surgery can help.
WHAT ARE THE TYPES OF SURGERIES?
When it comes to bunion surgery, options run the gamut, so expect a “custom-tailored” approach, says Rebecca Cerrato, M.D., who directs the fellowship program at The Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore.
Your doctor will snap X-rays of your foot and take into consideration your lifestyle and other factors to determine the best procedure for each individual patient. “There’s not one bunion or bunion surgery,” Cerrato says.
Even with the different variations out there, AAOS says most bunion surgeries tackle the same thing: They correct the alignment of the big-toe bone and repair the surrounding soft tissues. Here are three basic approaches:
• Exostectomy: During this procedure, the surgeon removes (shaves off) the bump from the big toe. This, however, does not fix the root cause of the bunion, so it’s usually done in combination with another procedure that repositions the big toe. Exostectomies, alone, are done infrequently and usually for very minor bunions.
• Osteotomy: The surgeon makes a few small cuts in the bone to realign the joint and, in some more severe cases, to remove a wedge of bone. Pins, screws or plates hold the newly straight bones together.
• Arthrodesis: This approach, generally reserved for people whose bunions are caused by arthritis, involves removing the arthritic parts of the big-toe joint and holding them together with screws, wires or plates while they heal.
Some of these surgeries — typically those involving mild to moderate bunions — can be performed using minimally invasive techniques, which often leads to a “shorter, easier recovery,” explains Jonathan Kaplan, M.D., of the Hoag Orthopedic Institute in Orange County, California. Active patients tend to make especially good candidates for minimally invasive approaches, says Elizabeth Cody, M.D., at the Hospital for Special Surgery in Stamford, Connecticut.
To determine whether you’re a good candidate for minimally invasive surgery (MIS), Kaplan recommends doing a thorough physical exam with your surgeon. Patients with poor bone density, or osteoporosis, may not be good candidates for MIS, Cody says, “since the technique and large screws used may place them at higher risk for fracture and other complications.”
Sometimes bunions come back, even after they’ve been removed. However, “no study shows a higher risk of bunions coming back with MIS,” Cody notes. A bunion is more likely to return if “a good initial correction isn’t achieved with surgery,” she points out. What’s more, bunions removed by way of exostectomy have a greater risk of recurrence, Kaplan says.
WHAT TO EXPECT AFTER SURGERY
Some people, like Lloyd, have no pain after the procedure, but Cerrato says once the anesthesia wears off, patients typically report discomfort that can be controlled with prescription or over-the-counter drugs. “Within one to two days, most aren’t taking anything,” she says.
Immediately following surgery, be diligent about elevating the foot and icing as directed to reduce swelling. “Sleep with two pillows under the foot for the first six weeks, and expect some swelling for six months,” Frey suggests.
Recovery is different for everyone, but it typically takes about six to 12 weeks for the bones to heal, according to the Cleveland Clinic. Lloyd waited two weeks to put weight on her foot in an orthopedic boot, and she didn’t drive for six. A few months after her surgery, she was back to horseback riding and yoga.
“Most people will self-limit activities based on how they feel, and pain will help guide them back to activity, along with their doctor’s advice,” Kaplan says.
Outcomes for bunion surgeries are “really improving,” he adds — most patients report relief from pain. So if you’re bothered by a bunion, and not just by its looks, talk to your doctor about the benefits and risks of getting it removed.
“There’s no harm in seeing someone, having a conversation and asking, ‘Is this the right thing for me to do?’ ” Kaplan says.
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