There are several different causes of bunions. They are partly genetic, often running in families and can be made worse with certain footwear choices. There are things that can be done to ease the discomfort of a bunion, such as wearing wider and flatter shoes but surgery is the only way to correct the underlying bony deformity that causes them.
Also known as a hallux valgus correction, bunion surgery involves correcting both the deformed bone and the lax tissues around the big toe. Having surgery to treat bunions early in the year will increase your chances of being pain free and able to wear your favourite strappy sandals by the summertime.
Here, King Edward VII’s Hospital consultant orthopaedic surgeon, Mr Lee Parker, talks about bunion surgery and how best to recover from it.
What is a bunion?
The bone of the big toe gradually moves, creating what’s known as a hallux valgus. This results in a bony prominence called a bunion. When the skin rubs against the bunion, it causes pain and inflammation called bursitis.
Wearing wider fitting or softer shoes can help to relieve the discomfort of bunions, but there may come a time when this no longer helps. If this is the case for you, speaking to an orthopaedic foot and ankle specialist is advisable.
What happens during bunion surgery?
Bunions are caused by a combination of a bone deformity in the foot and laxity, or looseness, in the soft tissues surrounding the joints that help to maintain the internal structure of the foot. Because of this, most often a bunionectomy, that involves simply shaving the bone, isn’t enough to remedy the problem.
Instead, precise surgical cuts, called osteotomies, on the bones of the big toe are required to straighten-out the deformity. These cuts are then secured with small surgical screws, buried into the bone to allow the bone to heal in the correct position.
At the same time, the lax soft tissues are reinforced with surgical stitches to support the alignment of the big toe.
Bunion correction surgery is usually carried out while you’re asleep under a general anaesthetic. However, if you’re unsuitable for a general anaesthetic due to health reasons, you may be suitable for bunion surgery whilst awake, with your foot numbed by a local anaesthetic.
Either way, when your surgery is completed, your surgical team will apply heavy bandaging around your foot. This should remain in place for two weeks. You will be provided with a surgical shoe that can be worn over the top of the bandaging. This will allow you to walk on your heel for short distances, such as around your home, using crutches for support if necessary.
How will I manage my pain after surgery?
During surgery, your surgeon or anaesthetist will inject a local anaesthetic into the area surrounding the nerves in your ankle or around your wound. This will help to numb the area and minimise pain in the days following surgery.
When the numbness wears off, you’ll be advised to take painkillers on a regular basis to help you manage your pain. Depending on your medical history, this will usually be a combination of paracetamol and codeine or an anti-inflammatory drug such as ibuprofen.
How much pain will I feel after surgery and how long will it last?
You can expect to feel some level of pain in the days after bunion surgery. Each person experiences this differently but it’s normal to have minor low level pain, commonly caused by swelling within the foot.
Elevating your foot for 55 minutes in each hour and taking regular painkillers for two weeks after surgery will help to keep pain at a minimum. Using extra pillows and cushions in bed and while resting on the sofa will help to keep your foot elevated.
After two weeks, your pain should lessen and your need to take painkillers will reduce.
Is there anything else I can do to minimise pain during my recovery?
Your foot will be supported by heavy bandaging during the two weeks following surgery. This protects the foot and will help to reduce the swelling and the pain associated with swelling so it should be kept on.
Two weeks after surgery, you will need to attend hospital to have your dressings removed. Once your dressings are removed, you will notice that your foot swells when you’re up and about. For this reason, it’s recommended that you continue to rest and elevate your foot as often as possible.
Gently applying an ice pack or bag of frozen peas wrapped in a towel to your foot will also help to reduce swelling and pain.
How should I keep my wound clean?
Whilst your foot is covered with heavy bandaging in the first two weeks following surgery, you must keep your foot and the bandages dry. You can have a bath, whilst keeping your affected foot out of the water, or you can shower using a waterproof LimbO Bag covering your foot.
When you visit the hospital two weeks after surgery to have your dressings removed, your specialist nurse will give you full instructions on looking after your wound. They will also trim or remove any excess stitches.
You should keep the wound covered, and you’ll be given enough spare dressings to keep it clean and covered for the next 7-10 days.
It isn’t necessary to clean and redress the wound each day, but you should aim to allow air to get to the wound for a short period every few days. Should you need to clean your wound during this time, do so with clean hands using a clean face cloth, soap and water. It’s important not to disturb any scabbing on the wound, and instead allow it to flake off naturally on its own.
If you’re concerned about scarring, you can massage the skin surrounding the wound with Bio-Oil once the wound has scabbed over.
What should I wear on my feet whilst I recover?
Your wound should remain bandaged for two weeks, and the surgical shoe given to you after surgery can be used to protect your bandaging during this time.
After six weeks, your surgeon will advise you to return to normal footwear. However, your foot will still need support and it will still swell when you’re upright.
For this reason, a shoe with a soft upper and a supportive insole is ideal. Sketcher shoes offer a suitable range of options.
Are there any exercises I should be doing to aid my recovery?
After your bandages have been removed, your surgeon will show you how to gently move your big toe to help prevent it becoming stiff. The muscles of your forefoot may also become weak, and you’ll be given exercises to help strengthen these muscles.
For the first two weeks, you should keep your foot elevated for 55 minutes in each hour, and you should only walk a few metres at a time, wearing your surgical shoe when weight bearing.
After your two week check-up, and your bandages have been removed, you’ll be able to spend more time walking in your surgical shoe and moving your toes and ankle.
Stiffness and muscle wasting can be a problem following bunion surgery so moving the hip, knee and ankle of your operated leg is important. As is gently and regularly moving your toes to move the blood around and prevent DVT.
Once you’ve had your six week follow up appointment, you’ll have a clearer idea of what other exercise you can begin. For the next 3-6 months, repetitive load bearing may cause your foot to swell, but gentle swimming, cycling, yoga and pilates can be started 8 weeks after surgery.
What is the recovery like following bunion surgery?
In the majority of cases, most surgeons will allow you to walk short distances using a surgical shoe on the same day as surgery, once you’ve recovered from the anaesthesia. Your surgical shoe will help to protect your big toe by preventing it from pressing against the ground whilst you walk.
You will be helped onto your feet by your nursing team and a physiotherapist, who will assess your needs for additional walking aids such as crutches.
You will need to wear your surgical shoe for six weeks following surgery. During this time, the cuts to your bone and the repair to your soft tissue will be healing. After six weeks, your foot should be sufficiently healed to walk without your surgical shoe.
Your medical team will book you in for a six week check-up up to assess your healing. You should bring a wide fitting, supportive trainer with you to this appointment so that your nurse or doctor can assess your walking.
The aim of bunion surgery is to correct the deformity and relieve pain, but there is also an aesthetic element to the surgery. Your surgeon will aim to create a natural looking, pain free, functional foot.
When will I get back to normal life?
If you have a job that involves mostly sitting, such as desk-work, you should be fine to return to work after 3-4 weeks. It’s important to allow yourself adequate time to heal and recover from the anaesthesia, even if you’re able to work from home, so you should allow a week before returning to work if this is the case.
You should allow 6-8 weeks off work if you have a manual job or you need to be on your feet all day.
If you drive an automatic car and your left foot is your operated foot, you can begin to drive short distances after two weeks. You should refrain from driving any car for six weeks if your right foot is your operated foot.
Most importantly, if you’re still taking strong painkillers or your mobility is restricted such that you cannot safely get into and out of a car in an emergency at any point following surgery you should refrain from driving.
Returning to running, contact sports and racquet sports is possible after four to six months from bunion surgery. You may find that your foot still swells or feels uncomfortable from time to time, but this will settle. Wearing insoles inside your trainers or sports shoes can be helpful in preventing overloading the big toe.
In terms of wearing strappy sandals and short heels, it should be possible to wear these kinds of shoes from around three months following surgery.
When should I speak to my doctor?
Medical problems such as infection in the wound or your foot following bunion surgery can take a couple of weeks to emerge. By then, you would’ve been seen back in the hospital to have your dressings removed. If any infection is present, your surgeon will take the appropriate action.
If you notice that your wound begins to discharge fluid or it gapes open or if the surrounding skin becomes red and warm, you should contact the clinic or consultant as these could be signs of an infection.
Some complications can arise sooner, such as deep vein thrombosis (DVT). Any kind of lower limb surgery carries with it a small risk of developing DVT, but it’s rare after bunion surgery.
Signs of DVT include swelling, warmth and pain in the calf. Contact the hospital if you’re concerned.
How likely is it that I’ll need further surgery?
Reasons for further bunion surgery vary. Surgery to remove a prominent screw or to correct non-healing bone cuts is rare, affecting only 2-3% of cases.
However surgery to correct a recurrent deformity of the bone after initial bunion surgery is more common, affecting 10-15% of people who have bunion correction surgery.
Whether or not you need further surgery will depend on how well you recovered, the type of surgery you had and the experience level of your surgeon.
If you’re concerned about your bunions returning, speak to your surgeon who can arrange a consultation to assess your needs.
● If you think you might have bunions, speak to your GP who can refer you to a foot specialist. If you don’t have a GP, you can make an appointment with one of our same day private GPs.
● The King Edward VII’s Hospital Orthopaedic Surgery Department is a world leader in orthopaedics, including the management and treatment of bunions.
● Mr Lee Parker is a consultant orthopaedic foot and ankle surgeon at King Edward VII’s Hospital and London Orthopaedic Clinic.