Bunion surgery

Surgery Overview

Bunion surgery generally involves an incision in the top or side of the big toe joint and the removal or realignment of soft tissue and bone to relieve pain and restore normal alignment to the joint. If the joint is severely deformed, it may be stabilized with tiny wires, stitches, screws, or plates. There are no guarantees that a bunion surgery will fully relieve your pain.

• A regional anesthetic that affects only the foot is commonly used for bunion surgery. A sedative may also be used during the procedure.
• The procedure usually takes an hour or more, depending on the type of surgery.
• Bunion repairs are usually done on an outpatient basis.

There are over 100 surgeries for bunions. Research does not indicate which type of surgery is best—surgery needs to be specific to your condition. More than one procedure may be done at the same time.

The general types of bunion surgery are:

• Removal of part of the metatarsal head (the part of the foot that is bulging out). This procedure is called exostectomy or bunionectomy.
• Realignment of the soft tissues (ligaments) around the big toe joint.
• Removal of a small wedge of bone from the foot (metatarsal osteotomy) or from the toe (phalangeal osteotomy).
• Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped (resection arthroplasty).
• Fusion (arthrodesis) of the big toe joint.
• Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure).
• Implant insertion of all or part of an artificial joint.

What To Expect After Surgery

The usual recovery period after bunion surgery is 6 weeks to 6 months, depending on the amount of soft tissue and bone affected. Complete healing may take as long as 1 year.

• The foot must be kept covered while showering or bathing to keep the stitches dry.
• Stitches are removed after 7 to 21 days.
• Pins that stick out of the foot are removed in 3 to 4 weeks.
• Walking casts, splints, special shoes, or wooden shoes are sometimes used depending on the procedure. Regular shoes can usually be worn in about 4 to 5 weeks, but some procedures may require wearing special shoes up to 8 to 12 weeks after surgery. Many activities can be resumed in about 6 to 8 weeks.

Why It Is Done

You may want to consider surgery when:

• Other treatment has not relieved your bunion pain.
• You have difficulty walking or doing normal daily activities.

For more information on making this decision, see:

Should I have surgery for bunions?

How Well It Works

After surgery, your ability to walk and do other activities is likely to improve. The big toe joint is generally less painful and, as a result, moves better. After the incision has healed and the swelling has gone down, the toe may look more normal than before.

Research does not indicate which type of surgery is best. A review of bunion surgeries indicates that 25% to 33% of people who have surgery for bunions are disappointed in the result, despite an improvement in pain and the degree of deformity.¹

Risks

Risks of surgery include:

• Infection in the soft tissue or bone of the foot.
• Side effects from anesthetic medications.
• Recurrence of the bunion.
• An outward or upward bend in the big toe.
• Decreased feeling or sensation, numbness or tingling, or burning in the toe from damage to nerves.
• Damage to the tendons that pull the big toe up or down.
• A shorter big toe, if bone is removed.
• Restricted movement or stiffness of the big toe joint (may be an expected outcome of some types of surgery).
• Persistent pain and swelling.
• Degenerative joint disease (arthritis) or avascular necrosis (disruption of the blood supply to the bone) after surgery.
• Development of a callus on the bottom of the foot.

What To Think About

Consider the following when deciding about bunion surgery:

• Bunions may return after surgery, especially if you continue to wear narrow or high-heeled shoes.
• The type of surgery used depends on the severity of the bunion and the surgeon's experience. Look for a surgeon who does many different types of bunion surgery on a regular basis. Each bunion is different, and surgery needs to be tailored to each case.
• Your expectations may influence your satisfaction with the surgery. For example, although surgery may improve your foot's appearance, those who make appearance their primary reason for surgery are generally disappointed in the results. Discuss your expectations with your health professional.
• Surgery may reduce the flexibility of the big toe joint, which may be a concern for active people who need a full range of motion in the big toe.
• You will have to stay off your foot for a while after surgery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Colleen Cronin	Last Updated March 20, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
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