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Bunionplasty, is an aesthetic, cosmetic approach to surgically correct bunions. Unlike traditional bunion surgery, with bunionplasty, there is a specific focus to minimize, limit or hide incisions for a more plastic surgery result while also correcting the underlying bony malalignment.

The rise of cosmetic surgery has also influenced foot surgery as women with bunions are seeking out plastic surgery of the foot so that their feet are visually attractive. Women who wear high heels and pointy toed shoes tend to be the main candidates for bunionplasty as the shoes gear tends to promote the formation of bunions.

What is a Bunion?

The medical term for a bunion, is hallux abducto valgus. In latin, this translates to a big toe that is malpositioned and rotated. A ‘bunion’ describes the enlarged prominent 'knobby' area on the inside of the foot, at the base of the big toe.

Many incorrectly believe that a bunion is an extra growth of bone. While there may be some excess bone, the bunion is really a structural malalignment of the the big toe joint, causing the big toe to deviate towards the smaller toes, and a metatarsal bone to be pushed in an opposite direction, creating the prominent bone on the inside of the foot.

Bunions vary in sizes, and categorized as mild, moderate, large and severe. Women get bunions more commonly than men, and suspected that shoe gear (high heels and pointy toed shoes) is the cause. Genetics play a role in the formation of bunions as well. Bunions may develop and stay one size, or progress significantly. Some bunions can become so severe that the big toe becomes pushed under the second toe.

Surgical Procedures

There are two key considerations when performing cosmetic bunion surgery. The first, and most important, is the method which surgeons use to realign the deviated bones. The second consideration, is how to surgically gain access the bones while keeping the skin scarring to a minimum.

Skin Procedures

Bunionplasty procedures are divided into three categories, with regard to the skin, and are as follows:


 * Minimal Incision: With this technique, surgeons use small incisions or a micro incisions to gain access to the bone. The advantage of course is less noticeable incisions.  The main disadvantage of this technique is that surgeons have difficulty visualizing the bone to provide correction of the bunion.  As such, this technique is best for minor bunions.  Minimal incision bunionectomies were popular in the 80’s but have become less popular for surgeons.


 * Plastic Closure: A Plastic Closure Bunionplasty calls for special plastic surgery techniques to obtain a more visually aesthetic result.  Surgeons use specific suturing methods by running suture beneath the skin, and/or using absorbable sutures to hold the skin together during the healing process.  Some techniques now utilize needle-free liquid bonding agents (rather than skin sutures) to hold the skin together during the healing process.   Plastic surgery closure can be used for all bunionplasty techniques, but is best when lengthy incisions are needed.


 * Hidden Incision: Here surgeons place the incision in natural skin fold lines to have the incision blend into the skin.  A Hidden Incision Bunionplasty calls for the incision to be placed on the inside of the foot so that incision is not visible from the top of the foot, and allows for the incision to be placed at the transition of the thicker skin of the bottom of the thinner skin of the top of the foot.   Surgeons can gain good access to the bones for realignment, and are more commonly used for smaller mild to moderate bunions.

Bone Procedures

The main correction of bunionplasty happens below the skin, and that’s the method with which surgeons use to correct the bunion. There are hundreds of bunion surgery operations described, however, surgeons only rely on a handful of procedures today. Procedure selection depends mainly on the following factors: size of bunion, age of patient, and surgeon experience.

Simply explained, the bunion is corrected by shaving any prominent bone and performing a bone cut or fusion procedure to realigned the deviated metatarsal bone. The size of the bunion is probably the determining factor in the which procedure is used.  Bone work procedures are divided into two types:
 * Osteotomy Bunionectomy. These are procedures where the bone is cut and either moved over to better the alignment, or a pie shaped wedge is removed to reshape the bone.  Different orientations of the bone cuts can be performed, and common names are: Austin (V shaped cut), Reverdin (L shaped cut), Scarf (Z shaped cut), and Wedge (Pie shaped wedge).    Smaller bunions tend to be treated with bone cuts closer to the big toe joint, where only the top part the bone is moved over. Larger bunions involve longer or more elaborate bone cuts further away from the big toe joint.   The repositioned bone is held in placed with surgical hardware - and most commonly that involves surgical metal screw(s) and or plate(s).  The ability to walk after osteotomy bunionectomy depends how stable the surgical correction is.  Most often patients walk after bunion surgery, however bone cuts further away from the big toe joint may require casting and crutches.
 * Osteotomy Bunionectomy. These are procedures where the bone is cut and either moved over to better the alignment, or a pie shaped wedge is removed to reshape the bone.  Different orientations of the bone cuts can be performed, and common names are: Austin (V shaped cut), Reverdin (L shaped cut), Scarf (Z shaped cut), and Wedge (Pie shaped wedge).    Smaller bunions tend to be treated with bone cuts closer to the big toe joint, where only the top part the bone is moved over. Larger bunions involve longer or more elaborate bone cuts further away from the big toe joint.   The repositioned bone is held in placed with surgical hardware - and most commonly that involves surgical metal screw(s) and or plate(s).  The ability to walk after osteotomy bunionectomy depends how stable the surgical correction is.  Most often patients walk after bunion surgery, however bone cuts further away from the big toe joint may require casting and crutches.


 * Fusion Bunionectomy. This procedure is called the Lapidus Bunionectomy.  Here the ‘entire’ deviated bone is reposition at the base (or bottom) by fusing a non-essential joint in the arch together, at the origin of the bunion.  Correcting bunions via the Lapidus Bunionectomy has been analogized to theoretically repairing the leaning tower of pisa in that the correction takes place that the bottom of the structure.  The Lapidus bunionectomy is indicated for moderate, large, severe, and recurrent bunions.   The repositioned bone is held in placed with surgical hardware - and involves surgical metal screw(s) and or plate(s).  Modern technology has specialized plating systems to hold the bone steady during healing. The ability to walk after Lapidus bunionectomy also depends how stable the surgical correction is.  Historically, this procedure required casting and crutches but modern techniques have allowed patients to place immediate protected weight on the foot.

Recovery

Recovery after bunionplasty typically takes about 6 weeks, because this typically the amount of time it takes for bone to heal. The skin portion of the surgery is healed after 7-14 days, but the bone takes longer and the limiting factor.

The ability to put weight on the foot after surgery is variable, as some can put full weight on the foot immediately in a small surgical shoe, while others require complete non-weightbearing in a leg cast and crutches. Most bunionplasty surgery today can be performed by allowing early weightbearing in a protected shoe, but this depends on the size of your bunion, technique used, and surgeon protocols.

Performing Bunionplasty in the Absence of Pain.

People do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes and/or if the bunion is simply unsightly. The concern with performing a bunionplasty when there is no bunion pain prior is that the surgery can result in longstanding new pain. Surgeons strongly prefer and/or require that patients have a painful bunion before they consider any foot surgery. Pain is the most common reason people seek treatment.

'''Risks of Bunionplasty '''

The risks of bunionplasty are the same for any bunion surgery for that matter. However, there may be risks of not having the proper bone work performed at the expense of a more cosmetic outcome. This may happen when a procedure for a small bunion was used on a large bunion and can result in partial correction, or recurrence.

The general risks of bunion surgery include, but are not limited to: infection, pain (temporary or permanent), swelling, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, disability, recurrence, hallux varus, metatarsalgia, unsightly scar, hardware problems, need for revisional surgery, and/or catastrophic loss.  Combination of Procedures: Bunionplasty can be performed in conjunction with a variety of surgical procedures to correct several foot problems. A commonly toe problems may be performed in conjunction, especially involving the 2nd toe, as the big toe and push up against the 2nd toe and create a hammer toe.