Bunion surgery

What is it?

Bunion surgery corrects the position of the big toe by cutting and realigning the bones (an osteotomy) and fixing them with small screws or plates. The soft tissues around the joint are rebalanced too. For suitable patients, minimally invasive (keyhole) bunion surgery is done through very small incisions. In more severe bunions, or where the joint is arthritic or unstable, joining a joint (a fusion) can give a more lasting correction. Bunion surgery is done to relieve pain and improve function, not for cosmetic reasons.

Who might it help?

• A painful bunion that limits walking or the shoes you can wear
• Symptoms that have not settled with wider footwear, padding or insoles
• Problems with the neighbouring toes caused by the bunion, such as a hammer toe

What does it involve?

• It's usually a day-case operation under a general or regional anaesthetic.
• The type of correction is chosen to suit the size of your bunion and the shape of your foot.
• Other toe problems can often be treated at the same time.

Before your operation

• You'll have a pre-assessment check, usually a week or two before surgery, including blood tests if needed
• Stop smoking, ideally at least six weeks before, as it slows bone and wound healing
• Arrange help at home for the first couple of weeks, and someone to take you home
• Prepare your home: clear walkways, and put everyday things within easy reach
• If you'll use crutches or a knee scooter, practise beforehand

On the day

• You'll be asked not to eat or drink for a few hours beforehand
• The anaesthetist will discuss the anaesthetic with you, often a general anaesthetic with a nerve block to keep the foot numb for several hours afterwards
• Mr Jeyaseelan will see you before the operation to answer any questions and mark the leg
• Before you go home, you'll be shown how to use crutches and given pain relief and written instructions

Recovery

You'll usually walk in a special post-operative shoe for around six weeks, keeping the foot raised as much as possible in the first two weeks. Most people return to wider, comfortable shoes after six to eight weeks, and swelling can take six to twelve months to settle fully.

These times are typical only. You'll be given a personal recovery plan.

Getting back to normal

Driving

You can usually drive once you're out of a boot and can do an emergency stop safely. After right-foot surgery this is often six to eight weeks or more. Check with your insurer.

Work

Desk-based work is often possible after two to six weeks if you can keep the foot raised. Jobs that involve standing or walking take longer.

Sport

Low-impact exercise, such as cycling and swimming, usually comes first. Running and contact sport come later, once strength and movement have returned.

Flying

Long-haul flights are usually avoided for at least six weeks after foot and ankle surgery because of the risk of blood clots. Ask before booking travel.

Possible risks

As with any operation, there are risks. They include:

• Infection or wound problems
• Stiffness of the big toe
• Numbness from nerve irritation
• The bunion returning, or the toe being under- or over-corrected
• Pain under the ball of the foot
• Slow bone healing
• Blood clots in the leg or lungs

Alternatives

Non-surgical options include wider, softer shoes, bunion pads or toe spacers, insoles and pain relief. These don't straighten the toe but can ease symptoms.

Conditions this may treat