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Bunion surgery

A bunion is a lump of bone on the knuckle of your big toe. It can become inflamed and make walking difficult. Bunion surgery involves removing the part of the bone that is sticking out and setting the toe joint into a better position.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

  • About bunion surgery
  • Diagnosis
  • What are the alternatives?
  • Preparing for your operation
  • About the operation
  • What to expect afterwards
  • Recovering from bunion surgery
  • What are the risks?
  • Further information
  • Sources
  • Related topics

About bunion surgery

A bunion or "hallux valgus" (where hallux means the big toe and valgus means abnormal bending towards the other toes) are more common in women and run in families. Other factors that may increase your risk of having a bunion are osteoarthritis (inflammation of the joints) and wearing tight or ill-fitting shoes over many years.

A bunion can cause discomfort, pain, swelling and redness in and around the big toe. If left untreated, it can make walking difficult.

Diagnosis

Your GP will usually diagnose a bunion by simply examining your foot and asking you about how and when the bunion developed. An X-ray may be taken to confirm the diagnosis.

What are the alternatives?

Foot exercises to help strengthen the muscles in your toes and wearing insoles in your shoes to take the pressure off the bunion can sometimes help to minimise discomfort. Medicines can also help with pain and swelling. If non-surgical treatments don't work, you may be referred to an orthopaedic surgeon (a surgeon specialising in bone surgery).

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

Bunion surgery is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. Alternatively you may prefer to have the surgery under local anaesthesia. This completely blocks the pain in your foot and you will stay awake during the operation. A sedative may be given with the local anaesthetic to help you relax.

Your surgeon will advise which type of anaesthesia is most suitable for you.

If you are having general anaesthesia you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours beforehand. However, some anaesthetists allow occasional sips of water until two hours before a general anaesthetic.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to wear a compression stocking on the unaffected leg to help prevent blood clots forming in the veins in your leg.

About the operation

The operation usually takes about an hour and a half.

Your surgeon will make a cut on the inside of your foot over your big toe joint.

The exact procedure will vary depending on the type and size of the bunion being treated. Often your surgeon will shave off the bone that is sticking out. He or she may then cut and reposition the foot bone (the metatarsal), setting it in a better position. Your surgeon may also reposition the ligaments and tendons in your foot. Screws or tiny wires may be used to keep the bones in place whilst they heal.

The skin is closed with stitches and your foot is bandaged or placed in a plaster cast.

What to expect afterwards

You will need to rest until the effects of the general anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

Your foot may be in a plaster cast or heavily bandaged. This is done to protect your foot. You will usually be given crutches and a special shoe to wear over the cast.

A physiotherapist (a health professional who specialises in movement and mobility) may visit you after your operation and give you some advice about how to move around safely. Your physiotherapist may see you again at a later date after your cast or dressing is removed.

You will usually be able to go home when you feel ready. Your nurse will give you a date for a follow-up appointment before you go home.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from bunion surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. You won't be able to drive while your foot is in a cast.

It usually takes about six weeks for the bones to heal and you must not put your weight fully on the foot during this time, although you will probably be able to walk around on your heel. You may need to use crutches for the first few weeks. Keep the dressing or cast dry and always wear your protective over-shoe when you are outside.

You should rest and raise your foot on a stool whenever you can to help reduce any swelling.

Your surgeon will give you advice about when you can return to work, as this will depend on the type of operation you have and how much time you spend on your feet at work.

Please contact your GP if you develop any of the following symptoms:

  • a high temperature
  • increasing pain, or pain that can't be controlled with painkillers
  • cracks in your cast or if the wound bleeds through the dressing

What are the risks?

Bunion removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

Your foot and especially the toe will feel sore and have some swelling. This pain will gradually improve but it may take up to six months for the swelling to settle.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to bunion removal are uncommon but can include:

  • toe stiffness - the tendons in your big toe may be damaged and this can affect how well your toe moves
  • toe numbness - the nerves in the toe may be injured and you may find your toe is numb in places
  • abnormal toe position - your big toe may heal out of line, bending outwards or upwards
  • shorter toe - your big toe may be slightly shorter than before if any bone is removed
  • persistent pain and swelling - sometimes it can take up to a year for the pain and swelling to settle
  • wound infection - you may need antibiotics to treat an infection and it may delay your recovery
  • callus - you may develop a hardened area of skin on the bottom of your foot
  • re-occurrence - the bunion may re-occur

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

British Orthopaedic Foot & Ankle Society

www.bofas.org.uk

Sources

  • Ferrari J. Bunions. Clinical Evidence. www.clinicalevidence.bmj.com, accessed 17 March 2008
  • The great toe. Oxford Handbook of Clinical Surgery. McLatchie GR, Leaper DJ (eds). Oxford University Press, 2002:647
  • Ferrari J, Higgins JPT, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Systematic Reviews 1999, Issue 4. www.cochrane.org, accessed 18 March 2008
  • Holden D, Siff S, Butler J, Cain T. Shortening of the first metatarsal as a complication of metatarsal osteotomies. J Bone Join Surg Am 1984;66:582-587

Related topics

Bunions

Caring for surgical wounds

General anaesthesia

Local anaesthesia and sedation