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 may be a few months or may be 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 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 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.

6 Comments
What you are referring to is a Tailor's bunion, located below the base of the 5th (little) toe. In essence, a Tailor’s bunion (also called a bunionette) is either an enlargement of the end of the outer long bone of the foot (5th metatarsal), or it is a spreading or bowing of this bone away from the foot. The result either way is pressure of the joint at the base of the little toe against the skin on the outside of the foot. Tight shoes will initially aggravate this site, causing skin irritation where the rubbing occurs. Eventually, the irritation will spread to the tissue underneath the skin, and a protective body called a bursa may develop to pad the surface between the skin and the prominent bone. In time, this bursa can become inflamed, as well as the tissue covering the joint under neath it, leading to bursitis and capsulitis respectively. In advanced cases, pain and irritation can develop even in the absence of a shoe, simply with pressure from barefoot walking. Treatment for Tailor’s bunions can vary. Changing the shape and width of shoes worn on a daily basis is the first element of treatment. With some people, however, even roomier shoes will cause discomfort. This is mainly due to the inflammation occurring under the skin. The inflammation itself can be treated with anti-inflammatory medications or injections for at least temporary pain relief. In order to permanently correct a Tailor’s bunion, surgery is needed. Unlike a traditional bunion at the base of the big toe, surgery can just involve removal of the bone prominence. If the side of the bone is simply enlarged, the surgeon can shave the enlarged portion off. However, if the bone position is abnormal and angled outward, a procedure to return it to a correct position is required. In this procedure the bone is cut and moved in such a way that the normal position is restored, and screws, wires, or a plate are used to hold the bone down so the cut end can heal.
by Dr. Kilberg March 27, 2019 at 07:56 PM
Mine is not on the big toe it is on the other side near my little toe. Would the solution be the same
by Shirley March 24, 2019 at 11:37 AM
I will be 60 years old this year,and my bones are not real strong. I have severe bunions on both feet. 2 podiatrist recommended bone fusion and 1 recommended bone shave. I'm still very active, but is surgery worth it at my age?
by Debbie hogg February 12, 2018 at 11:01 PM
I'm 75 had the bunion shaved no pain just a very stiff big toe. Don't like the scar on the top of my foot. The right foot 15 years ago had a pin put in the big toe a the cut was on the side. the bunion have not came back. Afraid this one will come back. Don't think I can stand to have this again. I love shoe. a little disappointed with the result. Look like only part of the bunion have been shaved off. I could walk in 4 week's.
by Bertha Jones December 19, 2017 at 09:28 AM
I had this procedure done 1 year ago and I just head it done over because it didn't look like the doctor said it would. I don't know if this time is going to be what he promised or not I have to wait and see but I don't have the confidence that I had when he did it the first time.
by viorica Felipe October 8, 2017 at 05:00 PM
Just had surgery on my foot. No pain the big toe im sure was shaved. Because the toe is turned inward not straight. Can I put a brace to keep my toe straight so that it want go in any further. Its been 4 week after surgery.
by Bertha October 1, 2017 at 03:14 PM
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