Regarding the congenital floating bunion in babies, among the parents of children encountered in my clinic, the most common saying I hear is either bunionization of the digit or removal of bone from the foot. However, as parents, they do not want their children to have only four fingers and they do not want to move their children’s feet either. In fact, apart from bunionization and removal of bones from the feet, there are other treatment options for bunions, namely hemi-metacarpal bone grafting and reconstruction, which I will explain in detail below. What is a floating bunion? Floating bunion is a type of thumb hypoplasia, which is characterized by the lack of a metacarpal bone or only a remnant of the metacarpal bone, which simply means that there is no bone inside to support the thumb. This kind of thumb has no function, and it cannot do anything but to swing with the hand, which will have a great impact on the hand’s function if it is not corrected in time. What are the treatments for bunions other than bunionization? Currently, apart from bunionization, there are also metatarsal reconstruction and hemimetacarpal bone graft reconstruction. From my personal point of view, with the exception of V-shaped bunion dysplasia, bunionization is not recommended for all other types of bunions. There are three main reasons for this: 1) four fingers will affect the child’s learning, life, work, social life, etc.; 2) some children may have low self-esteem; 3) many parents have high expectations for the integrity of their children’s fingers and find it difficult to accept their child’s lack of a finger. Although the treatment with bunionization of the digits is relatively simple for the doctor, it is a lifelong event for the child, and I would suggest that parents must give full consideration to their child before making a decision. Although both metatarsal reconstruction and hemimetacarpal bone graft reconstruction fall under the category of five-finger preservation treatment, I personally favor hemimetacarpal bone graft reconstruction. Metatarsal bone reconstruction Metatarsal bone reconstruction is a relatively systematic and complete method, which can preserve all five fingers, and the result is good, but it will have certain impact on the foot, such as surgical scars on the foot, and there is a certain risk of graft resorption and necrosis. Semi-metacarpal bone graft reconstruction Semi-metacarpal bone graft reconstruction is a relatively systematic and complete method to reconstruct the first metacarpal bone from the second metacarpal bone of the child, which not only can preserve the five fingers, but also can reduce the impact on the foot. Semi-metacarpal bone graft reconstruction surgery is divided into two phases, the first phase is mainly to reconstruct the metacarpal bone; the second phase is mainly to reconstruct the function, if the child’s thumb has flexion and lateral deviation, we will correct it during the second phase of the surgery. When is the right time for floating bunion surgery? For this type of surgery, it is important not to be too early or too late. If it is too early, the child’s metacarpal bone will not be the right width, and if it is too late, it will not be conducive to the establishment of thumb function. Generally, we recommend surgery between the ages of 6 months and 1 year, as long as the child is in good health, weighs the correct weight, and the metacarpal bone is the right width. Is it painful to reconstruct the semi-metacarpal bone graft? As babies are relatively young, their expression of external emotions are mainly crying and laughing. When they feel uncomfortable, they will wail and cry. When they feel happy, they will laugh. Many parents in the clinic are worried that their babies will feel pain and cry constantly after the half-metacarpal bone graft reconstruction. In fact, according to the past cases of babies who have undergone this kind of surgery, the first and second days after the surgery will be a bit uncomfortable, but later on, it will be fine. Do I need to have a Gramoxone injection after surgery? Your baby will need to be immobilized with Gramoxone injections after the surgery. The duration of immobilization varies depending on the type of bunion dysplasia your baby has. Generally, Type IV bunions are removed after 3 months. Do I need to remove the stitches after surgery? Nowadays, we use cosmetic sutures in our surgeries, which do not need to be removed and can be absorbed at a later stage. In conclusion for parents of babies with floating bunions, no matter what type of surgery is done, careful consideration must be made before the surgery, after all, going under the knife is something that will affect your child for the rest of his/her life.