Browse through a rich range of information to find details of various treatments available for your condition. These include details on the treatment options, medications, physiotherapy and injections. Details are also provided on the range of surgical procedures and the rehabilitation following surgery.

You can also find out more about how to access private treatment when paying for yourself and the statutory quality criteria and success rates of our treatments.

 Hover over links below to view summary or click on the link to view full article:

Bunion Surgery

What is a bunion?
A bunion is a bony lump on the side of the foot at the base of the big toe. This may be associated with other problems, particular with the shape of the foot.
The operation your surgeon has suggested aims to improve the function of your foot and reduce your pain.

What causes a bunion?
Women are more susceptible to bunions than men, with some families being more prone than others. The most common cause of bunions is shoes that do not have enough room to fit the toes in their natural position. High heels push the toes into the front of the shoe where space is very restricted and are often the cause of bunions in women.

Bunions can be associated with arthritis of the joint at the base of the big toe but this is not always the case.
Bunion on the left foot

What are the benefits of surgery?
Your foot should fit more easily into a normal shoe as your big toe will be straighter.

Are there any alternatives to surgery?
Padding over the bunion or a spacer used between the big and second toes will ease any pain from the bunion rubbing. An extra wide pair of shoes may be sufficient to ease the pain caused by bunions. Alternately the Orthotics Department at your local hospital can advise regarding other options such as obtaining custom made shoes or stretching shoes. These shoes are often a successful treatment and save patients the risks of undergoing surgery even though they may not be particularly fashionable.

Surgery is an option if these measures do not work.

What will happen if I decide not to have the operation?
Referral to an Orthotist is an option. Orthotists are experienced in treating foot problems with insoles and shoe modifications.

Most bunions will get worse with time, and will not get better without surgery. You may be able to stop them getting worse by wearing sensible footwear. Your shoes may rub on the skin over the bunion and this can become inflamed and sore. This could cause the skin to become infected and cause an ulcer.

Aching in the foot is common but this is due to other related problems with how the foot works rather than the bunion itself.

What does the operation involve?
Your anaesthetist will discuss the various options available with you and will recommend the best form of anaesthesia for you. The operation usually takes 30-60 minutes.

Your surgeon will discuss the various surgical options available to you. These depend on the size of your bunion, other problems with how your foot works and any arthritis, and include:
• Removing the bunion.
• Releasing the tight ligaments and tightening stretched ligaments.
• Cutting and realigning the bones of your big toe.
• Stiffening a joint.
• Straightening one or more of your smaller toes.
Your surgeon may secure the toes in place with wires or tiny screws. At the end of the operation, stitches will be used to close the skin and a bandage or plaster cast applied to your foot.

What should I do about my medication?
You are advised to continue your normal medication unless you are told otherwise. If you are on Warfarin or Clopidogrel please let your surgeon know and follow his advice.
It is best to avoid anti-inflammatory painkillers as these may stop the bones healing properly.

What can I do to help make the operation a success?
• Lifestyle changes
The chances of you getting complications from surgery may be reduced by stopping smoking several weeks or more before an operation. This can also improve your long-term health. You have a higher chance of developing complications if you are overweight.
• Exercise
Regular exercise can improve how your lungs work, boost your immune system and reduce the risk of heart disease and other medical conditions. It can also help you to control your weight and improve your mood. Exercise will also improve your long-term health and aid your recovery.

What complications can happen?
The doctors and nurses responsible for your care have procedures in place to make your operation as safe as they can but complications can arise. Your Consultant will discuss these risks with you prior to surgery, some of which can be serious and can cause death. Please ask for clarification if you do not understand anything.

The potential complications fall mainly into three categories.
1 Complications of anaesthesia
2 General complications of any operation
3 Specific complications of this operation

1 Complications of anaesthesia
Your anaesthetist will discuss the possible complications of having an anaesthetic prior to surgery.

2 General complications of any operation
• Pain, which happens with every operation. The doctors and nurses will try to keep your pain to a minimum with medication. You may be given a local anaesthetic injection into your foot during the operation to help relieve any pain you may feel following surgery.
• Bleeding during or after surgery. There is normally little bleeding as a tourniquet (a tight strap) is placed around your leg during the operation.
• Infection in the wound. This usually settles with antibiotics but occasionally the wound may need to be drained. Infection can damage a ligament repair and result in the big toe becoming deformed again.
• Unsightly scarring of the skin, although bunion surgery wounds usually heal to a neat scar.
• Blood clots in the legs (deep-vein thrombosis). These can occasionally move through the bloodstream to the lungs (pulmonary embolus), making it difficult for you to breathe. You may be given treatment to reduce the risk of blood clots.
• Difficulty passing urine. You may need a catheter (tube) in your bladder for a day or two following surgery.

3 Specific complications of this operation
Damage to nerves around the big-toe joint. This may result in a small area of numb skin, or a tender swelling on the nerve called a neuroma.
Problems with bone healing. This may occur if the operation includes cutting the bone to realign the toe (osteotomy). The bone needs to heal in the same way as a fracture but sometimes the position of the bone can slip before it heals or healing can take longer than the usual six weeks. Further surgery would be required to correct these problems.
Loss of movement in the big toe. This can be caused by arthritis or scarring from the surgery and often improves with time, but there may be some permanent stiffness.
Severe pain, stiffness and loss of use of the foot (Complex Regional Pain Syndrome). This is a rare condition and the cause is not known. If this occurs, you may need further treatment in the form of painkillers and physiotherapy. It could take months or years to get better.
Pain in the ball of the foot when standing or walking (metatarsalgia). This is caused by your foot not taking weight evenly and you may require an insole in your shoe.
Recurrent deformity. This can occur if the big toe gets out of position again, or if arthritis causes more damage to your joints. If you are young or you have very mobile joints the risk of a recurrent deformity is higher and you may require more surgery in the future.

How soon will I recover?
• In hospital – You will recover initially in the recovery area following surgery and then be transferred to the day case ward. You will have a plaster cast or thick padded bandage on your foot and you will be advised to keep your foot raised to reduce swelling. A member of the healthcare team will check the blood circulation in your foot and monitor any bleeding or swelling. You will be told how much weight you can put on your foot. Your physiotherapist will help you to walk safely, possibly with the aid of crutches or a walking frame.

You should be able to go home later on the same day. A responsible adult should take you home in a car or taxi, and stay with you for at least 24 hours. You will need support for a few days.
• At home
To ensure that the swelling settles you will need to spend most of the first week with your foot raised. After that, you should be a little more mobile.

• Returning to normal activities
It may be necessary to have your dressings changed to make sure the skin is healing and to remove any stitches. Any wires in your toes can be removed by your surgeon in the clinic after a few weeks. X-rays may be required to check the bones have healed. It can take approximately six weeks, sometimes longer, before the swelling will have reduced sufficiently for you to wear a normal soft shoe. Massaging moisturizing cream into any scars and gently moving your toes to keep them supple can begin once the bones have healed.

Your surgeon, physiotherapist and occupational therapist will tell you when you can return to normal activities. Regular exercise should help you to return to normal activities as soon as possible (ask your surgeon prior to starting exercises). You are advised not to drive until you are confident you are able to control your vehicle and always check with your surgeon and insurance company beforehand.

• The future
The swelling can takes up to six months to diminish completely. You should wear comfortable shoes that have enough space for your toes and are advised against wearing high heeled shoes or shoes with pointed toes as this may cause more toe problems in the future.

Bunion surgery to straighten your big toe, may improve the cosmetic appearance and make the wearing of shoes more comfortable, ease the pressure and pain. This surgery is usually safe and successful but on occasion complications can arise and return to sports and full activities may take a little time.

© OrthopaedicsOpinionOnline 2011
 Full text pdf

Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.