A Bunion Surgery Technique to Get You Back on Your Feet Faster

Avoid breaking bones, metal plates, complications, and long recovery times

Closeup: Bare feet of working woman, she touching her toes to release pain after long day wearing pointy and narrow shoes - Medical condition called bunions myboys.me/Shutterstock

Our feet carry us everywhere, but debilitating foot pain can seriously slow us down. One source of pain is called a bunion.

A bunion is the result of a toe (usually the big one) slanting and developing a bony bump. This bump and slant combine to make the foot wider and more deformed over time.

Bunions are incredibly common. They’re found on the feet of about one-third of people in the United States. In addition to causing pain, these protuberances can be cumbersome, and often require progressively wider shoes to accommodate their growing girth.

Bunions have a number of causes, but they rarely go away on their own. In fact, they typically get bigger and more deformed with time. Yet many bunion sufferers avoid treatment because surgery can mean months of recovery, confined to a cast or boot with very limited mobility.

That’s because the fix usually involves breaking a toe or a metatarsal. For more serious bunions, the procedure can be even more brutal. Doctors may have to fuse the joint of the big toe or the 1st metatarsal, or other joints in the foot just to straighten out a bunion-laden foot. To hold the proper shape, the wayward toe and metatarsal is often set with pins or screws and metal plates.

Risk of Infection

In addition to pain and long recovery, complications are a concern, particularly infection. Infection is a risk in any surgery, but the foot is particularly bad because it is the part of our anatomy furthest away from our heart. This distance means feet experience slower circulation than other parts of the body, and are therefore open to a greater chance of infection, particularly when they undergo such an invasive procedure.

Hardware compounds the problem. Those metal pins, screws, and plates used in correcting bunions also raise the risk of infection because bacteria likes to bind to metal. And since a broken bone can take months to heal, that risk remains elevated during the healing process.

New Technology and Techniques

New technology and techniques have been developed to correct bunion deformity. One example is called a lapiplasty bunionectomy. This relatively recent surgical method takes a different approach from the bone-breaking method, aiming to stabilize the base of the metatarsal by fusing the joint. The end result is a straighter metatarsal that is more likely to hold its shape in the years to come. Bone fusion time is reduced by the use of multiple metal plates and screws to hold the joint in position.

Bone breaking has been the standard of care for bunion repair since the 1980s. Lapiplasty was first introduced by UChicago Medicine Ingalls Memorial Hospital in 2017, and many doctors across the country have since adopted it.

A lesser-known innovation in bunion treatment is Dr. Glass’s method. This less invasive procedure reduces pain, complications, and recovery time. Instead of breaking a bone or fusing a joint, a small incision is used to cut a tendon, allowing a slanted toe to slide back into its correct, aligned position.

Developed by New York City podiatrist Dr. Andrew R. Glass, the method was featured on CBS News and New York One in 2016.

With only a small incision and no plates or screws, there are far fewer complications, which is part of what makes the method newsworthy. So does the substantial reduction in recovery time. With the bone-breaking technique, recovery can take six weeks to three months to allow enough time for the foot to heal enough to comfortably walk on again. Lapiplasty typically reduces this down to a few weeks, but some fusion procedures can take many months to heal.

With the Glass method, patients are back on their feet in a week or two, sometimes even less. People can walk out the same day of the procedure without crutches or a cast.

Help from a Fluoroscope

Glass’s method combines an older strategy with modern technology. A similar tendon-cutting technique and shaving of bone for fixing bunions was very popular among 1950s podiatrists. But back then, surgeons had to cut the foot open with large incisions to see the inner structures as they worked to correct them. Thanks to the advent of a real-time X-ray machine called a fluoroscope, Dr. Glass was able to give new life to the older procedure with much smaller incisions.

During the 1980s, when the bone-breaking method of bunion removal became the norm, doctors lost touch with the older procedures. Dr. Glass credits his re-discovery and improvement on the old method with the timing of his training. Fluoroscopy was prohibitively expensive when it was first invented in the 1990s. But by the early 2000s, the technology had become more affordable, and Glass began working in an office with a fluoroscopy machine. Years of practice with minimal incision work gave Dr. Glass the means to address the problem from a new perspective.

Yet despite the advantages of Dr. Glass’s method, few fellow podiatrists have adopted the procedure. Perhaps it’s a question of habit, as established surgeons prefer to stick with a procedure they’ve perfected and grown comfortable with over years or decades.

There may also be a financial incentive. Surgeons can charge more for breaking and fusing bones because these procedures take a lot more time than a quick cut of the tendon and shaving of the bone. Don’t forget the additional charges for the special plates and screws designed to set a toe or metatarsal in place.

Shaping the Bone

Whichever way you decide to straighten a toe or metatarsal, it typically involves some reshaping of the foot bone to finish the job. A bunion isn’t just an angled toe. It’s also a bony bump. This extra mass often forms as the deformed foot rubs against a shoe that wasn’t designed to hold it. This constant contact makes the bone grow. Removing the bump requires whittling it down. However, thanks to a fluoroscope, only one small incision is needed to sculpt the bulging bunion.

All of the bunion removal methods mentioned above are covered by insurance, but the Glass method is sometimes only available early in bunion development. When the slant becomes too extreme, breaking a bone may be the only option available to set the toe straight and correct the bunion.

The sooner patients can address the problem, the better their chance for a safer surgery, and a quicker recovery.

NY Podiatric Medicine and Surgery specializes in minimally invasive bunion and hammertoe surgery. Our surgical technique is a one-stitch bunion removal procedure, which refrains from breaking bones or using metal plates, resulting in a faster, safer, and more speedy recovery. We have advanced surgical technology to aid in minimally invasive surgery, and a professional team that prioritizes patient care. Our goal is to get patients back to daily life as quickly as possible. Dr. Andrew Glass, DPM, is a podiatrist with more than 20 years of experience. He is board-certified by the American Board of Multiple Specialties in Podiatry (ABMSP).