That unsightly lump or bump on the inside of your foot behind your big toe is known as a bunion. This is the hallmark of having an unstable foot. When your foot won’t work in a stable position the bone behind your big toe (1st metatarsal) drifts toward the inside of your foot. As the bump on the inside of your foot gets bigger, the big toe gradually slips off of the metatarsal and drifts toward the 2nd toe. Think of it this way: a table has a broken leg. That table is no longer stable in that area. If you begin to stack objects on the table, eventually the weight over the missing leg will build up and the table will tilt. The bones along the inside of your arch are very important to maintaining a stable foot when you walk. Having a bunion makes other areas of the foot unstable leading to hammertoes, arthritis in the back part of your foot, heel pain, inflamed tendons, on and on.
Because your bunion involves an unstable foot, surgery to correct the bunion has to take into consideration this issue of stability. There are many different surgeries for correcting a bunion ranging from simply removing the lump, correcting the bone in various places, or fusing the joint at the base of the metatarsal. Planning bunion surgery requires a thorough evaluation of your foot at rest, standing, and walking. At Desert Foot Surgeons, I perform video gait analysis on all patients with bunions. I am currently involved in a research project that will show other foot surgeons how to determine exactly where to correct a bunion for the most stable result.
Bunion surgery is very complicated because of the stability issue. Other surgeons promoting aesthetic bunion surgery state that their surgery will work to, “maintain or enhance the mechanics of the foot”. Many of these aesthetic foot surgeons also tell patients they can walk immediately after surgery. That means that they are either just removing the bump or correcting the bone near the lump. Medical research has shown that this approach to bunion surgery makes the big toe less stable leading to further loss of a stable 2nd toe causing a hammertoe and those other problems we talked about above.
My approach to bunion surgery is to use science and apply to your problem. You and I will talk about the best surgery to correct your problem. If you cannot cooperate with the recovery I will work with you to get to the point that you can manage the rehabilitation or suggest alternatives. It is these alternatives that you need to understand. When alternatives are chosen you are making sacrifices. In the case of a bunion you are usually sacrificing stability. Think of the table with one broken leg. If you repair the table leg with duct tape the table is still unstable and will eventually tilt and possibly break completely when objects are placed on the table.
As far as cosmetic bunion surgery, the placement of the scar has to allow the surgeon to clearly see the bone being worked on. I don’t want you to have an ugly scar, so whenever possible I will hide the scar. But fair warning, the bigger the bunion the less likely it will be to hide your scar.
When considering cosmetic surgery, remember the goal is to make your lump or bump look better and relieve pain. If the scar can be hidden it will, but the key to correcting your problem is choosing the correct surgical procedure based on a thorough exam including gait analysis. Performing an alternative surgery requires sacrifices be made on your part and the part of your surgeon. When all is said and done, a scar, time off your foot, having to perform physical therapy are reasonable things in order to make pain go away and prevent the problem from returning.