Bunions can cause intense pain and may increase the risk of other foot problems. Research estimates that up to 23 percent of adults between the ages of 18 and 65 and 35 percent of people over 65 have bunions.
Surgery aims to:
- relieve pressure and pain in the foot
- repair the toe joint
- restore proper foot alignment
This article describes what to expect before, during, and after the procedure. It also includes alternative treatments to bunion removal.
Types of bunion surgery
A doctor will assess the bunion before recommending a type of surgery.
A doctor will select the type of surgery, depending on a person's symptoms, the shape and size of their bunion, and other factors.
Types of bunion repair involve:
Repairing tendons and ligaments
If tight or loose soft tissues are causing the bunion to form, a surgeon may loosen tight tendons and ligaments or tighten loose ones.
This procedure is usually in addition to others.
The surgeon cuts into the bone and places pins, screws, or plates into the openings. These devices help to keep the toe straight and reduce misalignment.
It may sometimes be necessary to remove a small portion of bone.
People typically have an exostectomy in conjunction with other types of surgery, such as soft tissue removal and an osteotomy. Exostectomy involves removing the bony bump from the big toe.
The bunion will often return if a doctor performs an exostectomy on its own because this surgery does not correct the underlying cause.
The doctor will remove areas of arthritic joints before using plates, screws, or wires to hold the surfaces together. People with arthritis or severe bunions often undergo this type of surgery.
The surgeon removes areas of damage from the joint to provide more space between the bones, during this type of bunion removal.
A resection arthroplasty can reduce power in the big toe. It is, therefore, typically for older adults, people with arthritis that an arthrodesis may not treat, and people who have unsuccessfully had other forms of bunion surgery.
Some types of bunion surgery involve removing bone and tissue.
Image credit: BruceBlaus, 2016
Surgical screws and pins can help prevent misalignment of the toe.
Image credit: DrNealBlitz, Collage of Clinical Images, 2012
A surgeon can usually remove stitches after 2 weeks.
Before the procedure
Before surgery, a doctor may request the following tests:
- an electrocardiogram, to check heart health
- an X-ray of the lungs
- urine and blood tests, to detect illness or infection
People should aim to be in good health before undergoing a bunion removal, or any other type of surgery. To maintain good health before surgery, people should:
- eat a healthful diet in the weeks before the procedure
- exercise regularly, to encourage faster recovery
- quit smoking at least 4 weeks beforehand, to reduce risk of infection
A doctor can advise patients about any medications they are taking. It may be necessary to stop taking some types of medication, such as aspirin or warfarin, before having surgery.
The doctor will also explain how long to fast (avoid food or liquids) before surgery. This typically depends on the type of anesthesia a person will have, and the length of time the operation will take.
During the procedure
A doctor will administer anesthesia, either local or general, before they begin. A general anesthetic means the person is unconscious for the procedure. Most people, however, have a local anesthetic, which numbs them below the ankle.
Once the anesthetic has taken effect, the surgeon will perform the surgery. Individuals who are preparing for bunion surgery should ask their doctor for specific details on the type of surgery they will have.
Afterward, the surgeon will then apply a bandage to the foot. Patients will go to the recovery room where staff will monitor them carefully. Until the anesthesia wears off, the team will observe the following :
- blood pressure
- heart rate
- other vital signs
Most people can go home a few hours after their surgery. They will need to organize transport home before going to the hospital, as people should not drive themselves after general anesthesia.
Recovery after the procedure
A person may require a surgical boot after bunion removal surgery.
A doctor will provide instructions on recovery, and it is important to follow these steps carefully to speed up healing and avoid complications.
People may need to:
- rest and elevate their foot and leg to keep it from moving
- take pain medications for discomfort and antibiotics to prevent infection
- use ice packs on the foot and toe to bring down swelling
- wear a surgical boot for several weeks
- use crutches or a knee walker for a few weeks
- keep their wound and stitches dry by using a plastic bag over the foot when showering
- wear shoes with wide toe boxes to reduce pain and prevent recurrence
- avoid wearing high heels for at least 6 months after surgery
- see a physical therapist for rehabilitation exercises and techniques
People can begin to place weight back on their foot over time, according to their doctor's instructions. They may be able to drive after 1 to 2 weeks.
A doctor will typically remove the stitches after 2 weeks, but people may have to continue to wear dressings or a foot brace for 6 to 12 weeks. It can be up to a year before a person makes a full recovery and their foot returns to its regular size.
During this time, individuals may have several follow-up appointments with their doctor, as well as one or more X-rays of the foot to check if the surgery was successful.
It is essential that individuals wear supportive and appropriate footwear to prevent bunion recurrence and avoid complications.
Some people may never be able to wear high heels or shoes with tight toe boxes again. A 2016 study in the Journals of Gerontology suggests that wearing constrictive footwear between the ages of 20 and 39 years old may be a risk factor for the development of bunions.
When to contact a doctor during recovery
During the recovery period, people should contact a doctor if any of the following occur:
- the wound dressing comes loose, gets wet, or falls off
- blood or drainage fluid soaks through the dressing
- medications cause adverse reactions
- symptoms of infection appear, including fever, chills, shortness of breath, and warmth or more pain around the wound
Alternatives to bunion surgery
Doctors will usually only recommend surgery when the condition is severe or when other treatments do not work.
People who are unable to undergo bunion removal, or those who do not wish to do so, may find relief from the following:
- wearing supportive shoes with a wide toe box
- avoiding high-heeled shoes
- using bunion pads or shoe inserts, which are available over the counter, to reduce pressure on the toe
- taping or splinting the toe into its correct position
- wearing a toe spacer between the big toe and the one beside it
- applying ice to inflamed feet
- taking pain-relieving medicines recommended by a doctor
- getting cortisone injections into the foot to bring down pain and swelling
- seeing a physical therapist for ultrasound therapy, exercises, and other treatments
According to the American Academy of Orthopedic Surgeons, most people who have bunion surgery will notice an improvement in their symptoms, including a reduction in pain and better alignment of the big toe.
Some research from 2012 suggests that proper surgical treatment offers a good or very good outlook for 85 percent of people and a satisfactory outcome in another 10 percent of those who have the procedure.