Surgery Overview

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.

Types of bunion surgery

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.

What To Expect

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.

Why It Is Done

You may want to consider surgery when:

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

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How Well It Works

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.

Risks

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.