Foot Health

Top 10 Reasons to Choose Minimally Invasive Surgery for Painful Bunions

Bunions can be very painful whether walking or wearing shoes. Nerves squeezed by the bony growth often fire at night, causing pain and throbbing.

Dr. Hassan Portrail
Dr. Mohammed Hassan
10 March 2022
Before and after of patient with bunion surgery

If you’re one of the five million Americans suffering from painful bunions each year, you already know the correct answer to the question of whether or not treatment is necessary. Heck yes! Bunions can cause so much foot pain that you won’t even want to walk to the refrigerator for a snack, much less take part in your daily activities.

However, pain is subjective. On a scale of one to ten, a bunion could be at either end of the spectrum. It all depends on how long the bunion has been forming and what you intend to do about it.

At the Ankle & Foot Care Center, our doctors are aware that bunion deformities (also called hallux valgus) are the most common foot problems in the nation (second only to ankle sprains). Only about one-third of those with bunions seek help from a podiatrist or foot and ankle specialist. Bunions only worsen over time and the gnarly big toe joint can lead to other conditions, such as a hammertoe and formation of callus on the toe, which would also require treatment. In general, women experience most bunions, mainly as a result of wearing ill-fitting shoes and high heels. Often, genetics play a role. If parents have bad bunions, their children may develop them when they get older.

From the outside, bunions appear as an inflamed bony bump at the base of the big toe. At the beginning of their formation, this bump may be quite small and may not cause a significant amount of pain when walking. There may be some signs of inflammation of the joint, such as redness. Over time, the condition may cause the patient to compensate and develop other foot conditions, such as plantar fasciitis, heel pain, or a stiff big toe, which may lead to trouble fitting into a normal pair of shoes.

Though simply annoying during the initial formation period, bunions are often not very painful at that point. However, as bunions progress, the area becomes increasingly swollen, red, shiny, and tender to the touch. Often, bunions become unsightly and cause patients to feel embarrassed about showing their feet.

Soon, you may develop a callus where the first and second toes rub together from being pushed by the bunion. This may lead to constant burning pain or discomfort that comes and goes. The reason is that we have sensory nerves around the joint and swelling often places pressure on those nerves, causing them to send abnormal signals. 

It’s bad enough that bunions can be extremely uncomfortable when walking or wearing tight shoes. In addition, nerves being compressed by the bony growth often wait until the nighttime to fire off, which causes soreness and throbbing.

However, there are several methods of non-surgical treatment you can try. These foot care options include:

  • Start using contrast bath therapy to improve pain and swelling
  • Apply bunion pads to limit your foot from rubbing on your shoe
  • Wearing wider shoes with custom orthotics
  • Stretch your foot
  • Get cortisone injections
  • Practice physical therapy

Often, conservative treatment will allow the patient to resume their normal activities and lead to pain free mobility; however, there are cases in which the patient’s big joint has severe arthritis, loss of cartilage, and displays signs of “bone on bone” on x-ray scans. In such cases, conservative treatment may or may not work, as the joint has been destroyed and the patient would be better off opting for surgery. 

What are the different types of bunion surgeries available?

There are several procedures that can be used to treat bunions, ranging from minimally invasive techniques to traditional osteotomies, in which a healthcare professional removes part of the bone and surgically realigns the remaining bones. The physician will also use pins or screws to maintain the bones in the corrected position to allow the bone to heal properly.

Meanwhile, an exostectomy is a different type of surgery for bunions wherein the physician eliminates the bony growth overlying the joint of the big toe that causes pain and jams the joint when walking. In such cases, the patient is not able to fully extend the toe, partly due to the presence of the bony growth, and exostectomies are used, along with other methods like osteotomies, to accurately align the toe.

Minimally invasive bunion surgery or “MIS Bunion Surgery” is another type of surgery for bunions that was first appeared in the mid-19th century. However, motivation for such surgeries quickly diminished because the first procedures of this type yielded poor results due to the surgeons’ lack of experience. Surgeons used 5-6 cm incisions for bunion surgeries. These procedures often led to cosmesis issues, swelling, and lengthy post-operative recovery times.

Minimally invasive bunion surgery involves making small incisions to realign the bone. Due to improvements in technology, minimally invasive surgery has become a modern mainstay of surgical treatment for painful bunions. The surgery is performed on the same day at a surgical center. It usually takes a few hours from the time a patient comes into the surgery center to the time he/she is released. Patients will have to walk using a walking boot for the first few weeks and then return to the office for a follow-up after two weeks. There are many advantages to performing a minimally invasive surgery, such as:

  1. Small incisions
  2. Less discomfort
  3. Minimal scarring
  4. Less blood loss during surgery
  5. Lower complication rate
  6. Aesthetically pleasing
  7. Faster recovery
  8. Patient can return home the same day
  9. Most insurance plans cover the cost of surgery
  10. High success rate

Although minimally invasive surgery is a wonderful tool for correcting painful bunions, not all patients are candidates. Being a candidate for this procedure depends on the level of deformity caused by the bunion. For example, some patients may have a deformity that is so severe that it would require a traditional surgical approach with a larger incision to achieve a proper correction. In addition, the patient’s overall history, physicals, x-rays, and activity level play a role in determining whether the patient is a candidate for minimally invasive surgery. Patient expectations would also be taken into account. If the patient is young, athletic, and concerned about having a thick scar, he/she may benefit from the less invasive procedure. On the other hand, if the patient is in their mid-sixties and has late-stage arthritis of the joint, a traditional approach with a longer incision would serve the function better as the surgeon would be able to expose the joint, examine it, and decide what type of implant would be best to provide optimal stability.