The McBride bunionectomy is a surgical procedure designed to treat hallux valgus, commonly known as a bunion. The surgery primarily focuses on correcting the misalignment of the big toe by adjusting the soft tissues around the first metatarsophalangeal (MTP) joint, including the release of the adductor hallucis tendon and tightening of the joint capsule. This procedure is often recommended for mild to moderate cases of hallux valgus, where conservative treatments have not been effective.
How Common It Is and Who Gets It? (Epidemiology)
Hallux valgus is a common foot deformity, particularly affecting women, with a prevalence rate of approximately 23% in the adult population. The condition typically worsens with age, leading to pain, difficulty walking, and deformity of the big toe. Genetics, poor footwear choices, and conditions such as arthritis contribute to the development of bunions.
Why It Happens – Causes (Etiology and Pathophysiology)
Hallux valgus occurs when the first metatarsal bone deviates inward, causing the big toe to point toward the second toe. This misalignment may result from several factors, including genetic predisposition, improper footwear (such as high heels or narrow shoes), and biomechanical imbalances in the foot. Over time, these factors lead to inflammation, pain, and the formation of a visible bump at the base of the big toe.
How the Body Part Normally Works? (Relevant Anatomy)
The first metatarsophalangeal (MTP) joint connects the first metatarsal bone to the proximal phalanx of the big toe. This joint is essential for walking, allowing for flexion and extension of the toe. Hallux valgus disrupts the normal alignment of this joint, making it harder to move the big toe and causing pain during activities like walking or standing.
What You Might Feel – Symptoms (Clinical Presentation)
Common symptoms of hallux valgus include:
- A visible bump on the side of the foot near the base of the big toe.
- Pain or tenderness around the affected joint, especially when walking or wearing shoes.
- Swelling and redness over the bunion.
- Limited movement of the big toe joint.
- Difficulty finding comfortable shoes, often due to the prominence of the bunion.
- Corns or calluses caused by the overlapping toes.
How Doctors Find the Problem? (Diagnosis and Imaging)
The diagnosis of hallux valgus is based on clinical examination and imaging studies. X-rays are typically used to assess the degree of deformity, including the hallux valgus angle (HVA) and the intermetatarsal angle (IMA). These measurements help determine the severity of the condition and guide treatment decisions. In some cases, advanced imaging like CT or MRI may be used to assess joint health and underlying structures.
Treatment Options
Non-Surgical Care
Non-surgical treatments aim to alleviate pain and prevent further progression of the deformity:
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- Orthotics and shoe modifications: Using custom insoles and shoes with a wide toe box to reduce pressure on the joint.
- Physical therapy: Exercises to improve foot flexibility and strength.
- Pain relief: NSAIDs or ice to reduce swelling and discomfort.
- Activity modifications: Avoiding prolonged standing or wearing tight shoes.
Surgical Care
When conservative treatments fail, surgical intervention may be necessary. The McBride bunionectomy is ideal for mild to moderate hallux valgus cases. In this procedure, the soft tissues around the MTP joint are realigned, and the adductor hallucis tendon is released to correct the deformity.
Recovery and What to Expect After Treatment
After the McBride bunionectomy, the patient will typically wear a surgical shoe or boot for several weeks to protect the foot during the healing process. Swelling and discomfort are common in the initial stages but generally subside over time. Most patients can resume normal activities within 6 to 8 weeks, though high-impact activities like running or jumping may need to be avoided for a few months to ensure full recovery.
Possible Risks or Side Effects (Complications)
While the McBride bunionectomy is generally safe, potential complications include:
- Infection at the surgical site.
- Hallux varus (misalignment of the toe in the opposite direction).
- Recurrence of the bunion deformity, especially in severe cases.
- Persistent pain or discomfort after surgery.
Long-Term Outlook (Prognosis)
The long-term success of the McBride bunionectomy is typically favorable, with many patients experiencing significant relief from pain and improved foot function. However, recurrence of the deformity may occur in some cases, particularly if the underlying joint instability is not adequately addressed. Patients with more severe deformities may require additional procedures like metatarsal osteotomy or joint fusion.
Out-of-Pocket Cost
Medicare
CPT Code 28292 – McBride Bunionectomy (Correction of Hallux Valgus with or without Sesamoidectomy): $159.49
Medicare Part B covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work alongside Medicare to fill the coverage gap and reduce financial responsibility.
If you have Secondary Insurance such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining balance, including coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.
Workers’ Compensation
If your McBride bunionectomy is required due to a work-related injury, Workers’ Compensation will cover all medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier pays all approved costs directly.
No-Fault Insurance
If your bunion deformity or Hallux Valgus is related to an automobile accident, No-Fault Insurance will typically cover the total cost of treatment, including the bunionectomy and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy terms.
Example
Susan Taylor had a painful hallux valgus deformity and underwent a McBride bunionectomy (CPT 28292). Her estimated Medicare out-of-pocket cost was $159.49. Since Susan had supplemental coverage through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.
Frequently Asked Questions (FAQ)
Q. What is the McBride Bunionectomy?
A. The McBride Bunionectomy is a surgical procedure used to treat hallux valgus (bunion) by adjusting the soft tissues around the big toe joint, including releasing the adductor hallucis tendon and tightening the joint capsule to realign the toe.
Q. Who is an ideal candidate for the McBride Bunionectomy?
A. This procedure is most suitable for patients with mild to moderate hallux valgus deformities, typically those with an HVA of less than 40 degrees and an IMA below 16 degrees, and no significant arthritis in the MTP joint.
Q. How is the McBride Bunionectomy performed?
A. The surgery involves making a small incision over the affected joint, releasing the adductor hallucis tendon, and tightening the joint capsule to restore the toe’s alignment and relieve pain.
Q. What is the recovery process like after the McBride Bunionectomy?
A. After surgery, patients wear a special shoe to protect the foot. Swelling and discomfort may occur in the first week, but they subside over time. Most patients return to normal activities within 6 to 8 weeks.
Q. What are the risks and complications of McBride Bunionectomy?
A. Risks include infection, hallux varus (misalignment of the toe in the opposite direction), recurrence of the bunion, and persistent pain after surgery.
Q. How effective is the McBride Bunionectomy?
A. The procedure is highly effective for mild to moderate cases, with good pain relief and foot function improvement. However, recurrence of the deformity may occur, especially in more severe cases, with recurrence rates up to 72%.
Q. Can the McBride Bunionectomy be combined with other procedures?
A. In some cases, the McBride procedure may be combined with metatarsal osteotomy for better long-term results and to prevent recurrence of the bunion deformity.
Q. How long does it take to fully recover from McBride Bunionectomy?
A. Full recovery typically takes 6 to 8 weeks for most patients, with a return to normal activities. High-impact activities may be restricted for a few months to ensure proper healing.
Q. What happens if the McBride Bunionectomy does not work?
A. If the bunion recurs or pain persists, additional treatments, such as metatarsal osteotomy or joint fusion, may be required to achieve a more permanent solution.
Q. Are there any alternatives to McBride Bunionectomy?
A. Yes, other surgical options include bunionectomy with metatarsal osteotomy or joint fusion, depending on the severity of the bunion and the patient’s needs.
Q. What are the benefits of the McBride Bunionectomy?
A. The McBride Bunionectomy effectively relieves pain and improves the alignment of the big toe, allowing patients to wear shoes more comfortably and regain better foot function.
Q. Can the McBride Bunionectomy be done on both feet at the same time?
A. While it is possible to perform the surgery on both feet simultaneously, it is usually done one foot at a time to allow for proper recovery and to minimize complications.
Q. Is the McBride Bunionectomy a minimally invasive procedure?
A. The McBride Bunionectomy is a relatively minimally invasive procedure compared to other more complex surgeries like metatarsal osteotomy, with a smaller incision and less disruption to the bone structure.
Q. How soon after the McBride Bunionectomy can I start walking?
A. Patients are generally allowed to walk with a surgical shoe immediately after surgery, but weight-bearing is limited initially to ensure proper healing.
Q. Will I need physical therapy after the McBride Bunionectomy?
A. Physical therapy is usually not required, but some patients may benefit from exercises to regain motion and strength in the foot as part of the recovery process.
Summary and Takeaway
The McBride bunionectomy is an effective treatment for hallux valgus, offering significant relief from pain and improved alignment. It is most suitable for patients with mild to moderate deformities and minimal joint arthritis. While complications are rare, the procedure may not be effective for severe cases, and further surgery may be required. Proper patient selection and postoperative care are essential for optimal outcomes.
Clinical Insight & Recent Findings
Recent studies on McBride bunionectomy show that the procedure is highly successful for mild to moderate hallux valgus, providing relief from pain and improving foot function. However, recurrence rates remain a concern in patients with severe deformities.
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic foot and ankle surgeons or podiatric surgeons typically perform the McBride bunionectomy.
When to See a Specialist?
See a specialist if you experience persistent pain, difficulty walking, or deformity in the big toe that interferes with daily activities.
When to Go to the Emergency Room?
Seek medical attention if you experience severe pain, signs of infection, or inability to bear weight on the foot after surgery.
What Recovery Really Looks Like?
Post-surgery, patients will need to avoid weight-bearing for a period and follow up with physical therapy to restore motion and strength in the foot. Full recovery typically takes 6–8 weeks.
What Happens If You Ignore It?
If left untreated, hallux valgus can worsen over time, leading to chronic pain, further deformity, and more invasive surgery. Early intervention is key to improving outcomes.
How to Prevent It?
Avoid tight or narrow shoes, wear supportive footwear, and use custom orthotics to reduce strain on the big toe joint.
Nutrition and Bone or Joint Health
A diet rich in calcium and vitamin D supports bone health and aids recovery after surgery.
Activity and Lifestyle Modifications
Engage in low-impact activities and wear supportive shoes to reduce stress on the foot and prevent further complications. Regular stretching and strengthening exercises can also help maintain foot health.
Dr. Mo Athar
