The medical name for the big toe is the hallux. A number of conditions can cause a deformity known as a bunion to form on the big toe. This condition occurs when the big toe begins to bend towards the second toe, inserting itself under or on top of the toe. When this occurs, a large bump begins to develop on the big toe, on the side of the foot. This bump is a bunion. The medical name for the condition is hallux valgus, with valgus referring to the fact that the toe has bent. A mild case of bunions can be treated with pain medication and supportive footwear; however, in some cases hallux valgus surgery is needed to correct the deformity.
There are several different types of hallux valgus surgery which can be performed to correct a bunion. To determine which type is most appropriate for any given individual, one or more x-rays are taken of the foot. The degree of bending of the big toe and the angle between the big toe and the second toe, are two measurements which are taken to help determine which surgery will be best.
Other measures taken before surgery include patient evaluation to determine the type of anesthetic to be used, and whether the patient is at risk of complications which might require a hospital stay. Generally, hallux valgus surgery is performed out an outpatient basis, but a patient may stay in hospital one or two days if they are at risk of complications due to another health issue. People with diabetes, for example, are at risk of complications relating to poor circulation, such as infection.
A typical hallux valgus surgery involves two procedures: osteotomy, and exostectomy. The exostectomy is the bunion removal part of the procedure, in which the bone forming the bunion is shaved off in layers. Next, the osteotomy is performed. This procedure is a cut in the metatarsal bone, carried out to correct the bend in the big toe. Both of these procedures must be carried out together, to correct the toe deformity permanently and ensure the bunion does not regrow.
Most bunion surgery involves these two procedures. The main difference between various types of hallux valgus surgery lies in the location of the cut made in the metatarsal bone. In a Chevron osteotomy, for example, the cut is made in the distal portion of the bone, further towards the tip of the toe. In addition, a metal screw is inserted into the bone to provide support during the healing process.
Another type of hallux valgus surgery is the Myerson/Ludloff procedure. This is a proximal metatarsal osteotomy, meaning that the cut in the bone is made nearer to the base of the toe. When the bunion has caused a very severe deformity, a Lapidus procedure may be used. In this type of osteotomy the bone is cut to correct the angle, and then the metatarsal joint is fused using metal screws.
Most people who undergo surgery to treat hallux valgus can walk the day after surgery using an orthopedic shoe. Recovery time is between four and six weeks, depending on the type of surgery performed. Generally, the Lapidus procedure has a longer recovery time, as the fusion of the metatarsal bone may require a longer period of healing.