The type of surgery a person has for repair of his bunion depends on age, activity level, general health and the condition of the connective tissue and bones, according to the University of Rochester Medical Center. The procedures have various names, but the American Academy of Orthopedic Surgeons (AAOS) describes these as the main bunion surgeries, from most invasive to least: arthrodesis, osteotomy, resection arthroplasty, exostectomy, and repair of the tendons and ligaments around the big toe.
Arthodesis
Arthrodesis, also called a Lapidus procedure, is used to correct severe bone deformities caused by bunions or when other bunion procedures have failed. The damaged joint is removed and screws, wires or plates are inserted to hold the bones together. Arthrodesis results in some loss of motion for the big toe, but it's usually not significant.
Osteotomy
Osteotomy is the most common bunion repair procedure. The joint is cut and realigned to the proper position. Hardware may or may not be inserted while the bones are healing. Surgeons perform three types of osteotomies, depending on the type of bunion deformity. The distal chevron osteotomy is used in cases where the bunion bump is at the base of the toe, but the joint is well-aligned. A Scarf or Ludloff osteotomy is used for large joint deformities. Screws maintain joint alignment during healing. A cresent osteotomy is used for joint deformities that require more correction. Screws and pins maintain the joint alignment.
Resection Arthroplasty
Resection arthroplasty involves removal of the damaged joint. Unlike with an arthodesis or osteotomy, no hardware is used to align the joint. A space is left between the toe bones, creating a flexible "scar" joint. Resection arthroplasty is used in cases of severe arthritis or when people have had previous bunion surgery.
Exostectomy
An exostectomy involves removal of the bony bump on the toe joint. This procedure is used in cases where there is no dislocation of the joint--only a lump on the toe bone. Exostectomies do not address the cause of the bunion, so they are rarely performed.
Repair of Tendons and Ligaments
Sometimes bunions are caused by loose tissues on one side of the big toe. This creates an imbalance that makes the big toe shift toward the other toes. During tendon and ligament repair, the tight tissues are lengthened, and loose tissues are shortened. According to the AAOS, this procedure is often combined with an osteotomy.
