After the anesthesia has taken effect, a tourniquet or blood pressure cuff, will be used to temporarily stop the blood flow to the foot. This may be a cuff around the thigh or a tight band around the ankle. This allows the doctor to see the surgical area clearly.
To help reduce the chance of infection, the area will be scrubbed with a special soap, and will be covered with sterile sheets.
For a severe bunion deformity, which is determined by measuring the angle on a x-ray an osteotomy is often performed. This is done by making an incision on the inside of the foot over the bunion area. A cut in the bone near the beginning of the metatarsal is then made. The metatarsal is then angled and the whole toe is moved toward the outside of the foot. This movement narrows the foot. The bump on the inside of the foot may also be removed with a saw, which further narrows it and relieves discomfort from shoe pressure. The cut surfaces of the bones are then held in place with pins or screws so that they may heal together.
Occasionally, the osteotomy is made in the toe bone itself in addition to the metatarsal osteotomy. This also serves to correct the deformity by straightening out the toe, which is then fixed in place with pins or wires.
This type of osteotomy allows for more correction to take place, but involves more surgical time, more time to heal and has a slightly higher risk of poor healing.
Because both the joint capsule and the ligaments also contribute to the deformity of the big toe, they also must be corrected. This correction involves releasing the tissues which are too tight and tightening the tissues which are too loose. The tight tissues are located on the outside of the MTP joint. They can be released through the osteotomy incision or through another incision between the first and second toes. The toe is then repositioned and the inside tissues which are loose are then tightened with stitches to help hold the corrected position.
The incisions on the skin are then closed with stitches and a bandage is applied to the foot.