Bunion surgery

Bunion surgery most often involves an incision in the top or side of the big toe joint and the removal or realignment of soft tissue and bone. This is done to relieve pain and restore normal alignment to the joint. Small wires, screws, or plates may be used to hold the bones in place. There are no guarantees that a bunion surgery will fully relieve your pain.

• A regional anesthetic that affects only the foot is commonly used for bunion surgery. A sedative may also be used during the procedure.
• The procedure usually takes an hour or more, depending on the type of surgery.
• Bunion repairs usually don't require an overnight stay in the hospital.

There are more than 100 surgeries for bunions. Research doesn't show what is best. The surgery you get needs to be specific to your bunion. More than one procedure may be done at the same time.

You may want to consider surgery when:

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

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.

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.

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.