What is bunion surgery?

Bunion surgery (bunionectomy) repairs an area of enlarged bone or tissue near your big toe. The enlarged area is called a bunion. It forms on the joint where your big toe joins your foot. The surgery may also help straighten your big toe.

Your doctor will make one or more small cuts near your toe joint. These cuts are called incisions. The doctor will remove small pieces of bone and may straighten your toe. This is done by cutting the bone and setting it in a new position. Your toe may be held in place with pins, screws, wires, or staples. These may stay in your toe. Or they may be removed after a few weeks. The surgery will leave scars that fade with time.

The surgery may make walking easier. It may reduce stiffness, pain, or swelling in your toe joint. It may also improve the way your toe looks.

Your doctor will give you medicine to help you relax and to numb your foot before the surgery starts. Or you may get medicine that makes you sleep during the surgery.

You will probably go home on the day of your surgery. If your surgery is more complex, you may need to spend the night in the hospital.

How soon you can put weight on your toe depends on how complex your surgery is. It may take 6 weeks or longer before swelling goes down and you have healed enough to return to your normal routine. You may have some swelling and pain for as long as 6 months to a year.

There are more than 100 surgeries for bunions. Research doesn't show which type of surgery is best. Your surgery needs to be specific to your condition. More than one procedure may be done at the same time. Surgeries include:

• Removal of part of the metatarsal head. (It's the part of the foot that is bulging out.) This procedure is called exostectomy or bunionectomy.
• Realignment of the soft tissues (ligaments) around the big toe joint.
• Making small cuts in the bones (osteotomy) and moving the bones into a more normal position.
• Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped (resection arthroplasty).
• Fusion (arthrodesis) of the big toe joint.
• Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure).
• Implant insertion of all or part of an artificial joint.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Follow your doctor's instructions about how much weight you can put on your foot and when you can go back to your usual activities.
• Ask your doctor when you can drive again.
• You may shower, unless your doctor tells you not to. Keep the bandage dry. If the bandage has been removed, you can wash the area with warm water and soap. Pat the area dry.
• You will probably need to take several weeks off from work. How much time you need to take off depends on the type of work you do and the extent of your surgery.
• You may need to avoid heavy lifting for 3 to 8 weeks or longer, depending on the type of surgery you had.
• You may need to do regular rehabilitation (rehab) exercises to strengthen your foot and improve movement. Start out slowly, and follow your doctor's instructions.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• You will leave the hospital with bandages holding your toe in the correct position. Your doctor will probably remove the bandages after several days. Or your doctor may have you remove your bandages at home. Do not touch the surgery area. Keep it dry.
• Do not soak your foot until your doctor says it is okay.

Ice and elevation

• Put ice or a cold pack on your foot for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice and your skin.
• Prop up your foot and leg on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

After surgery, your ability to walk and do other activities is likely to improve. The big toe joint is generally less painful and, as a result, moves better. After the incision has healed and the swelling has gone down, the toe may look more normal than before.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Risks of surgery include:

• Infection in the soft tissue or bone of the foot.
• Side effects from anesthetic medicines or other medicines used to control pain and swelling.
• Recurrence of the bunion.
• An outward or upward bend in the big toe.
• Decreased feeling or sensation, numbness or tingling, or burning in the toe from damage to nerves.
• Damage to the tendons that pull the big toe up or down.
• A shorter big toe, if bone is removed.
• Restricted movement or stiffness of the big toe joint (may be an expected outcome of some types of surgery).
• Persistent pain and swelling.
• Degenerative joint disease (arthritis) or avascular necrosis after surgery.
• Development of a callus on the bottom of the foot.

The usual recovery period after bunion surgery is 6 weeks to 6 months. How long it takes depends on the amount of soft tissue and bone affected. Complete healing may take as long as 1 year.

• When you take a shower or bath, the foot must be kept covered to keep the stitches dry.
• Stitches are removed after 7 to 21 days.
• If your doctor used pins that stick out of the foot to hold your toe in place, they are usually removed in about 4 to 6 weeks.
• For at least 3 to 6 weeks after surgery, you will need to wear a cast or a special type of shoe. It will protect your toe and keep it in the right position. After some types of surgeries, a cast or a special shoe is used for a few months. Many activities can be resumed in about 6 to 8 weeks.
• After some procedures, no weight can be put on the foot for 6 to 8 weeks. Then there are a few more weeks of partial weight-bearing with the foot in a special shoe or boot to keep the bones and soft tissues steady as they heal.

You had bunion surgery to repair an area of enlarged bone or tissue (bunion) from the joint where your big toe joins your foot. This can help straighten your big toe.

You will have pain and swelling that slowly improves in the 6 weeks after surgery. You may have some minor pain and swelling that lasts as long as 6 months to a year.

You won't be able to put weight on your foot at first. You will need to wear a cast or a special type of shoe to protect your toe and to keep it in the right position for at least 3 to 6 weeks. After some types of surgeries, a cast or special shoe is used for a few months. Your doctor will remove your stitches or sutures about 2 weeks after the surgery. If you have removable pins holding your toe in place, they are usually removed in about 4 to 6 weeks.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Wear clothing that is easy to put on and take off. You may have a large bandage on your foot.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will usually take about 1 to 1½ hours. If you are having both feet done at the same time, it may take 2 to 3 hours.

You may want to consider surgery when:

• Nonsurgical treatment has not relieved your bunion pain.
• You have trouble walking or doing normal daily activities.