Bunions are bone spurs that form on the inner aspect of large joint of the great toe. Many factors can contribute to their formation, however, poorly fitted foot wear is the leading cause. A study conducted by the American Orthopedic Foot and Ankle Society concluded that over 80 percent of women in the United States wear shoes that are too small, and over half of them have bunions. Bunion procedures are designed to correct deformity, re-balance tissues and narrow the foot. Deciding which procedure is best for you depends upon the existing problems that need to be corrected.
Keller Bunionectomy
The Keller Bunionectomy is a procedure which combines soft tissue releases, bone spur removal and resection, or surgical removal, of the proximal, or nearest to the foot, joint surface of the proximal phalanx, or first bone, in the great toe. Because this procedure essentially leaves the great toe/first metatarsal foot bone without a stable joint, it is reserved mainly for those patients who require pain relief, but have little-to-no weight bearing demands on the foot.
The Silver Procedure
The Silver Bunionectomy procedure is categorized as a simple bunionectomy mainly because the procedure only addresses and involves the surgical removal of the bony prominence, or spur, along the medial, or inner aspect of the first metatarsal foot bone a the joint of the big toe. The procedure does not include any attempt to correct angular deformity of the big toe, or the foot in general.
Separate studies conducted by Kitaoka et al. (1991) and Scranton et al (1995) demonstrated dissatisfaction rates over 40 percent and significant five-year follow-up failure rates respectively. The conclusion was that this particular procedure should only be performed on a foot with exostosis, or spur formation, and that does not demonstrate any toe or foot alignment deformity.
The Austin/Chevron Procedure
This procedure typically involves the cutting of the head of the first metatarsal foot bone, together with sliding the head laterally, or toward the little toe, in an effort to functionally narrow the foot, thus improving the ability to correct any existing great toe angular deformity. The term, chevron, describes a v-shaped line. This v-shape configuration is used when cutting the bone, because it provides a stable platform for the metatarsal head to rest upon after re-positioning and offers maximum bone contact for healing.
This procedure allows for different variables to be incorporated into the re-positioning of the bone; shortening, lengthening, dorsi-flexion, or angling upward, and plantar flexion, or angling downward.
The McBride Procedure
This procedure, also known as the Modified McBride procedure, involves the re-alignment of the joint between the great toe and the first metatarsal bone, also called the MTP, or metatarso-phalangeal, joint. The realignment component of this surgery is typically performed in conjunction with a bunionectomy, however, with the added aspect of releasing a ligament and capsular tissue to promote the realignment. The released ligament is then re-attached to a different area on the great toe to further prevent any angular recurrence.
