One question I often get regarding the treatment of painful bunions is why does surgery have to involve cutting the bone and moving it over, rather than just simply shaving the 'bump' off. This is certainly a fair question, and I feel that it bears some explanation for the readers of this blog as well.
One thing that people need to understand is that the 'bump' that causes pain in a bunion is actually not really a bump that needs to be simply shaved. It is actually the normal side of the bone (1st metatarsal) that is protruding into the skin because the entire bone itself is angled too far towards the skin. By looking at the bone on the right side of the illustration below, one can see that the thick long bone below the big toe is positioned at too far of an angle away from the long bone next to it (2nd metatarsal).
Shaving the side of the bone can accomplish a very short term reduction in the prominence and relieve pain. However, the side of the bone will simply grow back after a period of time, leading to a return of the bunion. This time maybe a few months or maybe a few years, but the end result is nearly always a return of the bunion in most cases. Very minimal bunions can be corrected in this manner with other tissue balancing procedures, and this is often used in elderly patients who are not healthy enough to heal from the bone reconstruction.
True bunion correction requires that the bone be repositioned back to a more even, parallel angle with the 2nd metatarsal next to it. This requires making a specific cut in the bone and sliding the cut portion over towards the 2nd metatarsal. If the bunion is moderate, the cut can be made at a more stable place up by the far end of the bone towards the big toe. If the bunion is severe or is unstable, the cut will need to be performed at the base of the bone so more angle correction can be achieved, or the joint at the base of the bone may need to be fused after correcting the abnormal angle. Either one of these two latter procedures require a little more recovery time and effort to protect the bone from the movement as they are both more unstable than the procedure at the other end of the bone for moderate bunions.
Once the angle of the bone is changed, the bunion should be corrected for a long time. Some people do require long term prescription orthotic shoe insert use to keep the foot structure stable, as a bunion is essentially a complex deformity that develops slowly from foot instability. With flat, unstable feet, there is a chance that the bunion could return after many years if the angle of the bone slowly slides back over. For most people, this is not an issue as bone correction typically resolves the problem in the long term. However, some people do need extra preventative support to keep the bunion from reforming after years of foot use.
I hope this has clarified this question for everyone and has explained why bunions must be reconstructed in order to be fixed for the long term.