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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. This is done to relieve pain and restore normal alignment to the joint. Small wires, screws, or plates may be used to hold the bones in place. 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 show 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.

Types of bunion surgery

  • 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
  • Making small cuts in the bones (osteotomy) and moving the bones into a more normal position
  • 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.

  • When you are showering or bathing, the foot must be kept covered to keep the stitches dry.
  • Stitches are removed after 7 to 21 days.
  • If your doctor used pins that stick out of the foot to hold your toe in place, they are usually removed in about 4 to 6 weeks.
  • After surgery, you will need to wear a cast or a special type of shoe to protect your toe and to keep it in the right position for at least 3 to 6 weeks. After some types of surgeries, a cast or special shoe is used for a few months. Many activities can be resumed in about 6 to 8 weeks.
  • After some procedures, no weight can be put on the foot for 6 to 8 weeks. Then there are a few more weeks of partial weight-bearing with the foot in a special shoe or boot to keep the bones and soft tissues steady as they heal.

Why It Is Done

You may want to consider surgery when:

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

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.

Risks

Risks of surgery include:

  • Infection in the soft tissue or bone of the foot.
  • Side effects from anesthetic medicines or other medicines used to control pain and swelling.
  • 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

Think about 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 doctor.
  • 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.

Credits

Current as of:
March 2, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Anne C. Poinier MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Gavin W.G. Chalmers DPM - Podiatry and Podiatric Surgery