Bunions look much different when you look at your foot than they do when we look at your x-rays. Just looking your foot, it looks like a large bump is sticking out.  However, when we look at your x-rays we can see that the first and second metatarsals are very often out of alignment.  

 

This causes the whole foot be wider than it should be.  It is because of this problem that fixing the bunion requires several different elements.  Of course we always have to remove the bump itself and/or enlargement.  

 

But then the next stage would be to determine how much correction is needed to get the first metatarsal back in line with the second metatarsal.  It is this portion of the correction that determines whether or not it is a head procedure or a base procedure.  For a mild to moderate bunion, a head procedure often will offer excellent correction.  But for moderate to severe bunion or if there is pronounced hypermobility of the forefoot (including potential pain near the base of the second toe), then it is time to consider realigning the whole bone at the base of the metatarsal.  

 

Doing the work further back (at the base) offers more correction but can require additional time for healing. It is in these instances that we use a special fiberglass cast with a walking cast heel, and we then split the cast  (bivalve the cast) to make it easy for you to go to physical therapy if necessary and for bathing.  

 

Despite this, we do not recommend that you walk around without your cast or cast boot on–early after bunion surgery.  It is important to wait for adequate bone healing before using unprotected weight bearing pressure.  When correction is done further back at the base of the metatarsal there is more potential correction and leverage (which must be minimized to allow for proper bone healing).  

 

We recommend full weightbearing x-rays to show the extent of a bunion deformity and allow for the weightbearing deforming pressure.  

 

If you have questions or would like xray evaluation regarding potential bunion or foot surgery, 

please contact our clinic at Issaquah Foot & Ankle Specialists: Dr. Brandon Nelson and Dr. Timothy Young.