Bunion surgery

What is bunion surgery, and how does it work?

In a bunion (hallux valgus), the big toe moves towards the other toes and a lump forms on the inner side of the foot¹. Surgery aims to correct the position of the big toe and to ease pain from the joint or from shoes rubbing².

Most operations combine releasing and rebalancing the soft tissue around the toe with cutting the bone (an osteotomy) and moving it into a better position¹². More than 100 different operations have been described². Simply shaving off the lump (a bunionectomy) isn't a successful operation on its own, because the bunion is likely to come back³.

What is bunion surgery used for, and how well does it work?

It's used for a painful bunion that hasn't eased with a change of shoes or other non-surgical care, and that noticeably affects how your foot works⁴. Looks alone aren't a reason to operate⁵.

For people in that situation, surgery can help. More people feel improved a year after surgery than after using a shoe insert or simply waiting, with fewer painful days, fewer shoe problems and better foot function⁶. Surgery also lowers pain and improves quality of life, with the biggest gains in pain⁷.

In growing children with a bunion, a procedure that guides bone growth has improved results, though the toe often stays mildly to moderately angled and more research is needed in children⁸⁹.

Is bunion surgery right for me?

It tends to suit otherwise healthy people with a painful bunion that hasn't improved after about 3 months of non-surgical care, and who accept being off their feet for several weeks afterwards¹⁰. A bunion that doesn't hurt is a poor reason to operate, because pain can last weeks or even months afterwards⁴.

Poor circulation (arterial occlusive disease) is the main reason not to operate⁴. Smoking raises the risk of bones not healing and of major complications, so you'd need to stop before surgery and stay stopped until your bones have healed³⁵. Diabetes and rheumatoid arthritis may make failure to heal more likely¹. Diabetes isn't a barrier by itself, but the operation needs to be chosen with care⁴.

What happens before, during and after surgery?

Your surgeon chooses the operation based on your bunion, your pain and what you need from your foot afterwards². Milder bunions usually need a cut near the toe end of the bone, moderate ones a cut along the shaft (a scarf osteotomy), and severe ones a cut near the base or a joint fusion¹¹. It helps to ask which operation is planned and why it suits your bunion.

Afterwards, rest with your foot raised for the first few days². Your toe is usually held straight with a bandage, and you wear a flat-soled healing shoe for around 6 weeks⁴. Moving your ankle and wiggling your toes often is encouraged early on¹².

If you have a desk job and can keep your foot raised, you may be back at work from about two weeks. Physically demanding work or sport can take three months or more³. Timings vary between operations (especially fusion) and between surgeons, so follow your surgeon's plan.

What are the risks?

Complications are uncommon and most settle without lasting problems, though they're probably under-reported²¹³. General risks include infection, scarring, swelling, numbness and blood clots¹.

Stiffness in the big toe is common, and reduced feeling in the operated toes can last indefinitely¹². The bunion can come back, or the toe can be over-corrected so it drifts away from the other toes, and either may need more surgery¹²³. How often this happens isn't clear yet.

When the big toe joint is fused, the main risk is the bones failing to join. This is more likely if you smoke or have diabetes or rheumatoid arthritis¹.

What are the other options?

Surgery is generally kept for when non-surgical care hasn't worked¹⁰. The first steps are footwear changes, pain relief and shoe inserts (orthoses)¹⁰. Roomier, more comfortable shoes are often tried first¹. A pharmacist can advise on pain relief.

Shoe inserts can ease symptoms, but only for a short time⁶. Surgery can ease pain more, but it brings the risks above⁶. Which operation is best depends on your bunion, your symptoms and your lifestyle, so it's worth talking it through with your podiatrist or GP².