Footnotes / Blog

What Are Treatments of Severe Bunion Deformities?

In this post, we continue our discussion on bunion treatment, specifically focusing on procedures for more severe bunion deformities. While mild and moderate bunions are often treated with less invasive techniques, severe cases require more complex surgical intervention.

Diagnosis of Severe Bunion Deformities

Severe bunion deformities are characterized by an intermetatarsal angle greater than 15 degrees. This angle, marked in red in the diagram below, plays a critical role in diagnosing the severity of the deformity. As the intermetatarsal angle increases, correction becomes increasingly necessary to restore the angle to a more acceptable range of 0-8 degrees.

Challenges in Severe Bunion Correction

In severe bunion deformities, the need for surgical intervention closer to the apex of the deformity becomes evident. Procedures like the Austin bunionectomy, which are located farther from the apex, are ineffective for correcting such large angles. As a result, surgeons turn to “base bunion procedures,” which address the deformity more directly.

Base Bunion Procedures

Closing Base Wedge Osteotomy

One common method used in severe bunion correction is the closing base wedge osteotomy. In this procedure:

• A wedge of bone is removed from the bottom of the first metatarsal.
• The metatarsal is then closed down, shifting inward and reducing the intermetatarsal angle to a more acceptable range.

Lapidus Procedure

The Lapidus procedure is another widely used technique, similar to the closing base wedge osteotomy. However, the key difference is:

• The wedge of bone is removed closer to the apex of the deformity, specifically at the metatarsal-cuneiform joint. This placement allows for a more effective correction of the deformity.

Post-Operative Care

Both the closing base wedge osteotomy and the Lapidus procedure require a period of non-weightbearing ambulation for approximately 6-8 weeks. During this time, bone screws and/or plates are often used to stabilize the bones during the healing process.