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Bunion surgery

If you have a bunion, you may know only too well how painful it can be. One can form if your big toe joint leans outwards and eventually a misshapen lump of bone and tissue develops. Although surgery isn’t always needed, it can be used to treat a bunion.

The treatment and care you receive may differ from what’s described here as it will be designed to meet your individual needs.

Bunion surgery aims to remove or realign the bone that sticks out on your big toe when you have a bunion. This will set your toe joint into a better position and reduce pain. There are a number of different operations that can treat a bunion (see The procedure below).

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Bunion removal surgery
Your surgeon will realign the bone that sticks out
Image showing a bunion in the right foot

Details

  • Preparation 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 have the operation and can go home the same day.

    You can have bunion surgery under general anaesthesia and be asleep during the operation, or you may have local anaesthesia. This will completely block the pain in your foot and you will stay awake during the operation. You can also have bunion surgery under spinal anaesthesia – this will numb the nerves from your waist to your toes. You may be given a sedative with local and spinal anaesthetic to help you relax.

    A general anaesthetic can make you sick so it's important that you don't eat or drink anything for six hours before your operation. Follow your anaesthetist or surgeon's advice. If you have any questions, just ask – nothing is too big or too small.

    You may need to wear compression stockings during bunion surgery to keep the blood flowing well through your legs.

    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. You might like to prepare some questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to inform yourself, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

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  • Alternatives What are the alternatives?

    There are a number of other treatments that don't involve having surgery. These include:

    • bunion pads that ease the pressure on the lump
    • using insoles in your shoes
    • wearing splints at night to hold your toes straight
    • making alterations to your shoes (maybe by stretching them)

    However, while these may help to reduce pain, they won't stop your bunion from getting worse over time.

    Medicines such as paracetamol and ibuprofen can also help to reduce pain and swelling.

    If these treatments don't help, your GP may refer you to a podiatrist (or chiropodist), or you may need to go as a private patient. These are health professionals who specialise in conditions that affect the feet.

  • The procedure What happens during bunion surgery?

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

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

    There are lots of different operations for treating bunions. The exact procedure you have will depend on a number of things including the size of your bunion and the shape of your foot. If you have arthritis in the joint of your big toe, this may also influence which procedure you have.

    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 everything in place. These are sometimes later removed but are usually left in place. If the screws or wires become loose or cause irritation, you may need to have them removed in a second operation.

    An operation called metatarsal osteotomy is a common type of bunion surgery. You can find out how this is done in our animation.

    Play video
      
    How bunion surgery is carried out

    We’ve put together some information about other types of surgery that you may be offered.

    • Lapidus procedure. You will usually have this type of surgery if you have a large bunion or have arthritis in your toe. Your surgeon will cut the bony surfaces on either side of the joint at the base of your big toe. He or she will then realign the joint to straighten your toe.
    • Silvers procedure. In this operation, your surgeon will remove 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 will 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 shorten your big toe. It’s usually only used in older people who have arthritis.

    For more information about which type of operation is best for you, speak to your surgeon.

  • Bunion treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including bunion treatment.

  • Aftercare 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 in a bandage after the operation and you may have a splint or plaster cast. This is to protect your foot and help keep it in the correct position. You will usually be given crutches and a special shoe to wear.

    A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) may visit you after your operation. They will give you some advice about how to move around without hurting yourself and, if you need them, how to use crutches safely. Your physiotherapist may arrange a further appointment if you need more help.

    You will usually be able to go home when you feel ready – generally about an hour or two after your operation. Your nurse may give you a date for a follow-up appointment before you leave. Make sure someone can take you home. And ask someone to stay with you while the anaesthetic wears off – this could take a day or so.

    Having a general anaesthetic may affect you in ways you don’t expect. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

  • Recovery 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 your medicine and if you have any questions, ask your pharmacist for advice. Elevate your foot in the first few weeks by resting it on a stool as this will help to reduce any swelling.

    It usually takes six to eight weeks for the bones in your foot to heal. You should be able to walk immediately afterwards (wearing a post-operative shoe that protects your foot) but may need crutches for the first few days. You may also need to wear a brace to support your foot for about six weeks. Keep the dressing and cast dry and always wear your protective shoe when you go outside. Put a plastic bag over your foot when you have a shower.

    When you can drive again will depend on the type of operation you have and how long your foot takes to heal. You will need to wait until you are back wearing normal footwear and feel comfortable. This may be up to eight weeks after your operation but check this with your surgeon. 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.

    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. It will also be influenced by what stresses or pressures your feet will be under when you work. The average time people have off work is six weeks. If your job involves a lot of standing or walking, you may need to take off more than this.

    Contact your GP if you get:

    • a high temperature
    • increasing pain, or pain that doesn't lessen when you take painkillers
    • redness around your dressing or if it feels warm
  • Risks What are the risks?

    As with every procedure, there are some risks associated with bunion surgery. We haven't included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how they apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the operation. Your foot, especially your toe, will feel sore and you will have some swelling. The pain will gradually improve but it may take up to six months for the swelling to settle fully.

    Complications

    Complications are when problems occur during or after the operation. Particular complications of bunion surgery can include:

    • a stiff toe – the tendons in your big toe may be damaged during the operation, which can affect how well your toe moves
    • a numb toe – the nerves in your toe may be injured
    • an abnormal toe position – your big toe may heal out of line and bend outwards or upwards, or be slightly shorter
    • slow healing – this can cause ongoing pain and swelling
    • an infection – you may need antibiotics to treat it
    • pain under the ball of your foot – this can happen if there is a change in the distribution of your weight
    • the bunion coming back – or a corrected bunion may get worse
  • FAQs FAQs

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

    Answer

    Surgery isn't usually recommended unless your bunion is very painful and affects your ability to walk. If this is the case, then your bunion will usually get worse and hurt more, unless you have it fixed.

    Explanation

    Your GP, podiatrist or chiropodist will usually suggest treatments that don't involve surgery first. These include:

    • pads to ease the pressure on your bunion
    • using insoles in your shoes
    • wearing splints at night to hold your toes straight
    • making alterations to your shoes (often by stretching them)

    These may help to reduce pain but they won't stop your bunion from getting worse over time. If non-surgical treatments don't work, you may need to have surgery.

    If you decide not to have an operation, the bunion is likely to get larger and hurt more. It 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

    It’s not a good idea to have bunion surgery for purely cosmetic reasons to make your feet look good or so you can wear high-heeled shoes. You will need to wear sensible, low-heeled, 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 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 to correct this.

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

    Answer

    It usually takes about six to eight weeks to recover from bunion surgery, depending on the type of operation you have.

    Explanation

    The time it takes 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.

    You may be able to walk on your foot immediately but it depends on the type of operation you have. You will probably need to keep your weight off the affected foot for the first few days but you can use crutches during this time.

    It can take up to three months until you can walk well enough to get back to your usual activities and playing sport. However, it's important to remember that recovery times are different for everyone. One person may feel no pain and recover very quickly, whereas another may be in discomfort and take a long time to heal. There’s no right or wrong – don’t rush to do too much before you’re ready.

    When you can return to work will depend on the type of operation you have had. It also depends on 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 when you can go back.

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

  • Resources Resources

    Further information

    Sources

    • Hallux valgus (bunion). British Orthopaedic Foot & Ankle Society. www.bofas.org.uk, accessed 31 October 2014
    • Bunion surgery. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published September 2012
    • Chevron osteotomy. American Orthopaedic Foot & Ankle Society. www.aofas.org, accessed 31 October 2014
    • Bunions/toe deformities. The College of Podiatry. www.scpod.org, accessed 31 October 2014
    • About podiatric surgery. The College of Podiatry. www.scpod.org, accessed 31 October 2014
    • Bunions. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2012
    • Bunion correction. The College of Podiatry. www.scpod.org, accessed 31 October 2014
    • Surgical correction of hallux valgus using minimal access techniques. National Institute for Health and Care Excellence (NICE), February 2010. www.nice.org.uk
    • Bunion. Medscape. www.emedicine.medscape.com, published 25 March 2014
    • Bunion (HAV) surgery. The College of Podiatry. www.scpod.org, accessed 31 October 2014
    • Hallux rigidus: Keller arthroplasty. The College of Podiatry. www.scpod.org, accessed 31 October 2014
    • Frequently asked questions about bunion surgery. Foot Health Facts. www.foothealthfacts.org, accessed 31 October 2014
    • Bunions. American Orthopaedic Foot & Ankle Society. www.aofas.org, accessed 31 October 2014
    • Commissioning guide: painful deformed great toe in adults. Royal College of Surgeons of England. www.rcseng.ac.uk, published November 2013
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