What is bunion surgery?

Bunion surgery is done to reduce the pain and correct the deformity caused by a bunion. A bunion (hallux valgus) is a deformity of the bone or tissue around the joint at the base of the big toe or at the base of the little toe. The one at the small toe is called a "bunionette" or "tailor's bunion." Bunions often form when the joint is stressed for a long time. Most bunions form in women, mainly because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis. This often affects the big toe joint.

Your healthcare provider may first advise wearing comfortable, well-fitting footwear. This means shoes that conform to the shape of your foot and don't put pressure on any areas. They may also suggest using splints and orthotics. These are special shoe inserts shaped to your feet. These can reposition the big toe and provide padding. For bunions caused by arthritis, medicines may help reduce pain and swelling.

If these treatments don’t help, your healthcare provider may advise surgery. This often solves the problem. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic. It is not meant to improve how the foot looks.

The type of surgery done depends on factors, such as:

• The severity of the bunion

• Your age

• Your general health

• Your activity level

• The condition of the bones and connective tissue

Other factors for the choice of a procedure include:

• Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone. They may realign the muscles, tendons, and ligaments around the joint.

• Moderate bunion. The surgeon may cut the bone and shift it to its correct position. This depends on the severity and location of the deformity. The tendons and ligaments around the area may also need to be repositioned.

• Severe bunion. Surgery may be done to remove the enlarged portion of the bone, cut and realign the bone, and correct the position of the tendons and ligaments.

• Arthritic bunion or big toe joint. With arthritis, the joint may be damaged beyond repair. In this case, it may need to be fused. This lets the bones heal together. It stops movement and pain. In some cases, joint replacement implants may be used to rebuild the big toe joint.

Why might I need bunion surgery?

You may need bunion surgery if you have any of the below:

• Severe foot pain even when walking or wearing flat, comfortable shoes

• Chronic big toe inflammation and swelling not helped with rest or medicines

• Toe deformity

• Bending of the big toe toward the small toe

• Inability to bend and straighten the big toe

Your healthcare provider may have other reasons to advise bunion surgery.

What are the risks of bunion surgery?

All surgery has risks. Risks of this kind of surgery include:

• Stiffness

• Numbness

• Swelling

• Delayed healing

• Infection

Other complications may include:

• The bunion comes back

• Nerve damage

• Continued pain

• The big toe extends away from the other toes (called overcorrection)

There may be other risks. This depends on your health condition. Discuss any concerns with your healthcare provider before the procedure.

How do I get ready for bunion surgery?

• Your healthcare provider will explain the procedure to you. Ask any questions that you have about the procedure.

• You will be asked to sign a consent form. This gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• Your healthcare provider will ask about your health history. They will give you a complete physical exam. This is to make sure that you are in good health before having the procedure. You may have blood tests or other tests.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines. This includes latex, tape, and anesthetic agents (local and general).

• Tell your healthcare provider about all medicines, vitamins, and herbal supplements that you are taking. This includes prescribed and over-the-counter medicines.

• Tell your healthcare provider if you have a history of bleeding disorders. Tell them if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

• If you are pregnant or think you could be, tell your healthcare provider.

• Follow any directions you are given for not eating or drinking before the procedure.

• You may get a sedative before the procedure. This is to help you relax. Because it may make you drowsy, you will need to plan to have someone to drive you home.

• Based on your medical condition, your healthcare provider may ask for other specific preparation.

What happens during bunion surgery?

Bunion surgery may be done on an outpatient basis. This means you go home the same day. In rare cases, you may stay overnight in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices.

Most bunion surgery is done under ankle block anesthesia. This means your foot is numb, but you are awake. In some cases, general or spinal anesthesia is used.

Bunion surgery often follows this process:

1. You will be asked to remove clothing and will be given a medical gown to wear.

2. An IV (intravenous) line may be started in your arm or hand.

3. The skin over the bunion will be cleansed with an antiseptic solution.

4. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging feeling. If general anesthesia is used, you will be put to sleep using IV medicine.

5. The surgeon will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based on the severity of the bunion.

6. The surgeon will close the opening with stitches and apply a sterile bandage or dressing.

What happens after bunion surgery?

After your surgery, you will be taken to the recovery room. Your recovery process will vary depending on the type of anesthesia you had. The blood flow and feeling in the foot will be kept track of. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to a hospital room or discharged to your home.

Your healthcare provider will give you specific instructions for caring for your foot at home during the first few weeks after surgery. You may be discharged from the hospital wearing a special surgical shoe or cast to protect your foot.

Once you are at home, you will need to rest. Keep your foot raised (elevated) as much as possible for the first few days after surgery and apply ice as recommended by your healthcare provider. This is to help reduce pain and swelling. Never apply ice directly to your skin. Wrap the ice in a thin towel to prevent skin injury.

Depending on the type of surgery you had, you may be advised to limit walking and limit the amount of and weight you put on your foot. You may be advised to use an assistive device, such as crutches, a cane, a walker or a knee walker after surgery.

It's important to keep the dressing clean and dry. Follow your healthcare provider's instructions on showering. You may be advised to cover the dressing with a plastic bag or plastic wrap and tape it with plastic tape when showering. Or take a sponge bath. The stitches will be removed during a follow-up visit. This is generally scheduled for 2 weeks after surgery.

Take a pain reliever for soreness as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only approved medicines. Your healthcare provider may also prescribe antibiotics. This is to help prevent infection after your surgery.

Tell your healthcare provider if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Chills

• Redness, swelling, bleeding, or other fluid leaking from the incision site

• Pain around the incision site that gets worse

• Swelling in lower leg of the affected foot

Your healthcare provider will advise you about safe activities after surgery. Your foot may need ongoing support from dressings or a brace for 6 to 8 weeks or longer after surgery. Driving may be restricted for a period of time after surgery until your bones are healed. Especially if the surgery was performed on your right foot.

Exercises or physical therapy may be advised to help your foot recover its strength and range of motion after surgery. Don't wear high heels until approved by your healthcare provider. They may recommend that you never return to wearing high-heeled shoes. 

Your healthcare provider may give you additional or alternate instructions after the procedure.