Bunion surgery

About bunion surgery

Bunions or hallux valgus ('hallux' means the big toe and 'valgus' means abnormal bending towards the other toes) are more common in women and often run in families. A bunion can cause discomfort, pain, swelling and redness in and around your big toe. If left untreated, it can make wearing shoes painful. Bunion surgery, or bunionectomy, is used to correct the abnormal bending of your big toe, and to reduce pain and pressure.

What are the alternatives?

Non-surgical treatments, such as bunion pads, orthotic insoles, night splints or alterations to your shoe may help to reduce pain, but they won't stop the bunions from getting worse over time. Medicines (eg paracetamol, ibuprofen) can also help to reduce pain and swelling. If non-surgical treatments don't help, your GP may refer you to a podiatrist or chiropodist (a health professional who specialises in conditions that affect the feet).

Preparing for bunion surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

Bunion surgery is usually done as a day-case operation, this means you will go home the same day.

You will usually be under general anaesthesia during the operation so you will be asleep. Alternatively, you may have the surgery under local anaesthesia. This completely blocks the pain in your foot and you will stay awake during the operation. You may be given a sedative with the local anaesthetic to help you relax.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, some anaesthetists (doctors specialising in pain management and giving anaesthetic medicines for surgical procedures) allow occasional sips of water until two hours before a general anaesthetic. It’s important to follow your anaesthetist’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear a compression stocking on the unaffected leg to help maintain circulation.

What happens during bunion surgery

Surgery to remove a bunion usually takes less than an hour, but the time can vary.

Your surgeon will make a cut on the inner side of your foot, over your big toe joint. The operation may be done through small cuts rather than one big cut. This is called keyhole (minimally invasive) surgery.

There are numerous different types of operations for bunions and the exact procedure you have depends on the type and size of your bunion, its severity, the shape of your foot and whether or not you have arthritis in the joint of your big toe.

Usually, your surgeon will remove some bone and may reposition bones, ligaments and tendons in your foot. He or she may use screws or wires to keep the bones in place. These are normally left in place, but if they become loose or cause irritation, then they may have to be removed in a second operation.

Metatarsal osteotomy is the most common form of bunion surgery. This form of bunion surgery is shown in the animation below.

How bunion surgery is carried out

Other types of surgery include:

  • Lapidus procedure. This is typically used if you have a large bunion or you also have arthritis in your toe. Your surgeon will cut the bony surfaces either side of the joint at the base of your big toe and realign the joint to straighten your toe.
  • Silvers procedure. This removes the bump of the bunion from the inside of your foot. It’s only used for mild bunions, as it doesn’t cure the underlying problem.
  • Basal wedge osteotomy. This involves removing a small wedge of bone from the base of your toe. It’s used for more serious bunions and you need to wear a cast for up to six weeks afterwards.
  • Keller arthroplasty. This procedure involves removing the bone at the base of your big toe and half of your big toe joint. It can be very effective in relieving pain but does result in shortening of the big toe. It’s usually only used in older people with arthritis.

If you need more information about the procedure you’re having, speak to your surgeon.

What to expect afterwards

You will need to rest until the effects of the general anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

Your foot will usually be heavily bandaged after the operation or you may have a splint or plaster cast. This is to protect your foot and help keep it correctly aligned. You will usually be given crutches and a special shoe to wear.

A physiotherapist (a health professional who specialises in movement and mobility) may visit you after your operation and give you some advice about how to move around safely and how to safely use crutches if you need them. If needed, your physiotherapist may arrange a further appointment to help your recovery.

You will usually be able to go home when you feel ready. Your nurse may give you a date for a follow-up appointment before you go home.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from bunion surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your GP or pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. You won't be able to drive while your foot is in the post-operative shoe.

If you’re in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

It usually takes four to eight weeks for the bones in your foot to heal. You will usually be able to walk immediately afterwards wearing the post-operative shoe, but may need crutches for the first few weeks. You will usually be required to wear the shoe for approximately six weeks. Keep the dressing or cast dry and always wear your protective over-shoe when you’re outside. Also, elevating the foot by resting with your foot up on a stool can help to reduce any swelling.

Your surgeon will give you advice about when you can go back to work, as this will depend on the type of operation you have had, and what stresses or pressures your feet will be under (eg walking around or standing). The average time people have off work is six weeks, but if your job involves a lot of standing or walking, then up to eight or even 12 weeks may be required.

Contact your GP if you get:

  • a high temperature
  • increasing pain, or pain that can't be controlled with painkillers
  • a discharge from the wound or dressing

What are the risks?

Bunion removal is commonly performed and generally safe. For eight to nine out of 10 people, it helps improve the alignment of the toe and relieve pain. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment, for example, feeling sick as a result of the general anaesthetic.

Your foot, especially your toe, will feel sore and have some swelling. This pain will gradually improve but it may take up to a year for the swelling to settle fully.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to bunion removal are uncommon but can include:

  • toe stiffness – the tendons in your big toe may be damaged, affecting how well your toe moves
  • toe numbness – the nerves in your toe may be injured
  • abnormal toe position – your big toe may heal out of line, bending outwards or upwards or be slightly shorter
  • slow healing – this can cause ongoing pain and swelling
  • wound infection – you may need antibiotics to treat an infection
  • pain – under the ball of your foot, caused by a change of weight distribution
  • reoccurrence – the bunion may come back or a corrected bunion may get worse.

What will happen if I don't have bunion surgery?

Answer

Surgery isn't usually recommended unless your bunion is causing a lot of pain and affecting your ability to walk. If this is the case, then your bunion will usually get bigger and hurt more, unless you have it corrected.

Explanation

Your GP will usually suggest treatments that don't involve surgery first. If they don't work, then he or she may suggest having surgery. If you decide not to have surgery, the bunion is likely to get larger and hurt more. The bunion may also affect your smaller toes so that they curve to the side. This means you will find it harder to walk and may end up needing to have a longer and more complex operation. Speak to your GP or surgeon if you have any concerns about bunion surgery.

Can I wear high-heeled shoes after having bunion surgery?

Answer

It's possible that you may be able to wear high-heeled shoes occasionally if your foot recovers well after bunion surgery.

Explanation

You shouldn't have bunion surgery for purely cosmetic reasons to make your feet look good or so you can wear high-heeled shoes.

Initially, you will need to wear sensible, low-heeled and wide fitting shoes for six months or more after having bunion surgery.

Wearing tight or ill-fitting shoes may increase your risk of getting a bunion again in the future. Slip-on shoes tend to be tighter on your feet, but leave less room for your toes, which puts them under pressure. High heels put more weight onto the ball of your feet, which also puts your toes under extra pressure.

It's important that you wear comfortable shoes and speak to your chiropodist or podiatrist (a health professional who specialises in conditions that affect the feet) about good foot care. Wider, deeper shoes are better for your feet, as are shoes with an adjustable strap or lace. Aim to choose shoes that have one centimetre between the end of your longest toe and the end of your shoe. If your foot rolls inwards when you’re walking (pronates), your chiropodist or podiatrist may suggest you wear insoles inside your shoes.

How long will it take until I can walk after bunion surgery?

Answer

On average, the initial recovery from bunion surgery takes about six weeks, depending on the type of operation you have had.

Explanation

The length of time it takes for you to recover from bunion surgery will depend on the type of operation you have had. You may have to wear a plaster cast or a protective shoe after some types of operation.

Depending on the type of operation, you may be able to walk on your foot immediately, or you may be asked to keep your weight off the affected foot for the first two to four days. If necessary, you can use crutches for the first few weeks.

It can take up to three months until you can walk well enough to get back to your usual activities, such as sports. However, it's important to remember that recovery times vary between people. One person may feel no pain and recover very quickly, whereas another may be in discomfort and take a long time to heal – it depends on your circumstances.

When you can return to work will depend on the type of operation you have had, and how much time you spend on your feet doing your job. The average time off work is six weeks. Your surgeon will give you advice about returning to work.

If you have any questions or concerns about bunions or surgery to correct them, talk to your GP or surgeon.