What is bunion surgery?
Bunion surgery is done to reduce the pain and correct the deformity caused by a bunion. A bunion (hallux valgus) is a deformity of the bone or tissue around the joint at the base of the big toe or at the base of the little toe. The one at the small toe is called a "bunionette" or "tailor's bunion." Bunions often form when the joint is stressed over a prolonged period. Most bunions form in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis. This often affects the big toe joint.
Before surgery is an option, your healthcare provider may first advise wearing comfortable, well-fitting footwear. This means shoes that conform to the shape of your foot and don't put pressure on any areas. He or she may also suggest using splints and orthotics. These are special shoe inserts shaped to your feet. These can reposition the big toe and provide padding. For bunions caused by arthritis, medicines may help reduce pain and swelling.
If these treatments don’t help, your healthcare provider may advise surgery. This often solves the problem. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic. It is not meant to improve the appearance of the foot.
The type of surgery done depends on factors such as:
- The severity of the bunion
- Your age
- Your general health
- Your activity level
- The condition of the bones and connective tissue
Other factors for the choice of a procedure include:
- Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone. He or she will realign the muscles, tendons, and ligaments around the joint.
- Moderate bunion. The surgeon may cut the bone and shift it to its proper position. This depends on the severity and location of the deformity. The tendons and ligaments around the area may also need to be repositioned.
- Severe bunion. Surgery may be done to remove the enlarged portion of the bone, cut and realign the bone, and correct the position of the tendons and ligaments.
- Arthritic bunion or big toe joint.With arthritis, the joint may be damaged beyond repair. In this case, it may need to be fused. This lets the bones heal together. It stops movement and pain. In some cases, joint replacement implants may be used to rebuild the big toe joint.
Why might I need bunion surgery?
You may need bunion surgery if you have any of the below:
- Severe foot pain even when walking or wearing flat, comfortable shoes
- Chronic big toe inflammation and swelling not helped with rest or medicines
- Toe deformity
- Bending of the big toe toward the small toe
- Inability to bend and straighten the big toe
Your healthcare provider may have other reasons to advise bunion surgery.
What are the risks of bunion surgery?
All surgery has risks. Risks of this kind of surgery include:
- Delayed healing
Other complications may include:
- Return of the bunion
- Nerve damage
- Continued pain
- Overcorrection, in which the big toe extends away from the other toes
There may be other risks. This depends on your health condition. Discuss any concerns with your healthcare provider before the procedure.
How do I get ready for bunion surgery?
- Your healthcare provider will explain the procedure to you. Ask any questions that you have about the procedure.
- You will be asked to sign a consent form. This gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- Your healthcare provider will ask about your medical history. He or she will give you a complete physical exam. This is to make sure that you are in good health before having the procedure. You may have blood tests or other tests.
- Tell your healthcare provider if you are sensitive to or are allergic to any medicines. This includes latex, tape, and anesthetic agents (local and general).
- Tell your healthcare provider about all medicines, vitamins, and herbal supplements that you are taking. This includes prescribed and over-the-counter medicines.
- Tell your healthcare provider if you have a history of bleeding disorders. Tell him or her if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
- If you are pregnant or think you could be, tell your healthcare provider.
- You may be asked to not eat for 8 hours before the procedure.
- You may get a sedative before the procedure. This is to help you relax. Because it may make you drowsy, you will need to plan for someone to drive you home.
- Based on your medical condition, your healthcare provider may request other specific preparation.
What happens during bunion surgery?
Bunion surgery may be done on an outpatient basis. In rare cases, you may stay overnight in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices.
Most bunion surgery is done under ankle block anesthesia. This means your foot is numb, but you are awake. In some cases, general or spinal anesthesia is used.
Bunion surgery often follows this process:
- You will be asked to remove clothing and will be given a medical gown to wear.
- An IV (intravenous) line may be started in your arm or hand.
- The skin over the bunion will be cleansed with an antiseptic solution.
- If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging feeling. If general anesthesia is used, you will be put to sleep using IV medicine.
- The surgeon will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based upon the severity of the bunion.
- The surgeon will close the opening with stitches and apply a sterile bandage or dressing.
What happens after bunion surgery?
After your surgery, you will be taken to the recovery room. Your recovery process will vary depending on the type of anesthesia you had. The blood flow and feeling in the foot will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to a hospital room or discharged to your home.
Your healthcare provider will give you specific instructions for caring for your foot at home during the first few weeks after surgery. You may be discharged from the hospital wearing a special surgical shoe or cast to protect your foot.
Once you are at home, you will need to rest. Keep your foot elevated on 1 or 2 pillows. This is to help reduce pain and swelling. Your healthcare provider may also advise that you apply ice and limit walking. You may be advised to use a cane or walker following surgery.
It's important to keep the dressing clean and dry. Cover the dressing with a plastic bag or plastic wrap and tape it with plastic tape when showering. Or, take a sponge bath. The stitches will be removed during a follow-up visit. This is generally scheduled for 2 weeks after surgery.
Take a pain reliever for soreness as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only approved medicines. Your healthcare provider may also prescribe antibiotics. This is to help prevent infection after your surgery.
Tell your healthcare provider if you have any of these:
- Fever of 100.4°F (38°C) or higher, or chills as directed by your healthcare provider
- Redness, swelling, bleeding, or other fluid leaking from the incision site
- Pain around the incision site that gets worse
- Swelling in lower leg of the affected foot
Your healthcare provider will advise you about safe activities after surgery. Your foot may need ongoing support from dressings or a brace for 6 to 8 weeks after surgery. You may need to not drive for a week or more after surgery.
Exercises or physical therapy may be advised to help your foot recover its strength and range of motion after surgery. Don't wear high heels for at least 6 months after surgery.
Your healthcare provider may give you additional or alternate instructions after the procedure.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure