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The medical term for a bunion is hallux valgus. It is characterized by a bump on the side of the big toe joint, indicating changes in the bone structure of the joint.
The big toe gradually sways toward the second toe instead of pointing straight. The bump then becomes increasingly noticeable.
The big toe joint supports a large amount of your body weight when walking. Because of this, bunions can cause extreme pain if left untreated. (1)
Nonsurgical treatment of a bunion includes:
- Changes in shoe gear
- Injection therapy
- Shoe inserts or orthotics
- Modifications of physical activities or sports
Bunion surgery may be beneficial to relieve pain and repair the big toe joint if conservative measures have not helped.
The goals of surgery are to remove the bony lump on the side of the big toe joint, restore the structure of the joint, and relieve pain.
Because bunions worsen over time, they do not go away. Not all bunions are the same. Some bunions occur quicker than others. (2)
Treatment of Bunions
Once your surgeon has evaluated your bunion, a treatment plan can be developed that is fit to your expectations. A treatment plan first involves a nonsurgical approach. Sometimes keeping an eye on the bunion is all that is needed.
In other cases, however, some type of treatment is needed, such as the use of wide-width shoes, padding, and shoe inserts or injection therapy, as stated previously.
The goal of early treatment includes easing the pain of the bunion and preventing the bunion from getting worse. A simple bunionectomy is indicated for minor deformities, wherein only the bony lump on the side of the big toe joint is removed.
Severe bunions may need an extensive procedure. Realigning the structure of the big toe joint may be necessary by cutting the bone and adjusting the framework of the joint. With severe bunions, there may be a possibility of using hardware, such as screws, plates, staples, and wires, inside the foot.
Bunion surgery, like any surgery, cannot be expected to be without risk. Education about what the surgery and recovery period entails is of major importance.
To reduce risks and complications, your surgeon may order tests before your surgery, which may include foot x-rays, blood tests, and circulation tests. Your surgeon will also ask you about your current and past medical history and surgical history. (3)
Risks and Complications of Bunion Surgery
The following risks and complications are possible with bunion surgery:
- Reaction to local anesthesia
- Hematoma or a collection of blood at the surgery site
- Reoccurrence of the bunion
- Scarring or thickening of the skin incision
- Swelling for an extended period
- Delayed healing of incision or bone cut
- Blood clot (deep vein thrombosis)
- Excessive bleeding
- Shortening of the big toe
- Thickened skin growth on the bottom of the foot (callus formation)
- Stiffness of the big toe joint
- Arthritis after surgery
Conservative management should be exhausted before bunion surgery. When nonsurgical treatment has not relieved pain, surgery may be necessary to address a painful bunion. It important for you to know how to prepare for bunion surgery.
The success of your surgery will depend greatly on how well you follow your surgeon’s instructions at home after surgery. Complications can occur after bunion surgery if recovery is not as expected.These complications include but are not limited to:
- Delayed healing of the incision site
- Nerve problems/numbness
- Loosening of hardware (screws, staples, wires) that have been put in your foot to hold the bone in place
- Bone infection
- Not healing of the bone
- Big toe healing in an incorrect position
- Skin infection
- Loss of blood flow to bone or tissue
- Bunion reoccurrence
- Loss of big toe
Reversing a bunion is not possible with conservative management. Nonsurgical treatment, however, can help relieve pain and prevent the bunion from worsening.
How to Prepare for Bunion Surgery
Consider the following when preparing for bunion surgery:
- Request time off from work: Schedule time off for the bunion surgery and your recovery period. Discuss your recovery timeline with your surgeon in order to plan for your time off.
- Recruit a driver: You will not be able to drive home after your bunion surgery due to the anesthesia used for your procedure. You definitely will not be able to drive if surgery was performed on your right foot.Schedule a friend or family member to take you to and from the surgery. You will also need a driver during your recovery period.
- Follow instructions given to you by your surgeon: You will not be able to eat before the surgery for a certain amount of time. This is imperative because anesthesia administration could be affected if your body is digesting food. Your surgeon will instruct you about your diet.
- Wear comfortable, loose-fitting clothing to the hospital or surgery center: This preparation makes putting your clothes back on after bunion surgery less complicated and less painful.
Almost all bunion surgery is performed as an outpatient procedure. You will probably be asked to arrive at the hospital or surgical center 1 or 2 hours before the surgery.
After arrival, you will be evaluated by an operating room nurse and someone from the anesthesia team. The anesthesiologist will be with you throughout the bunion surgery to administer medications, if necessary. The whole operating room team will make sure you are comfortable.
How is the Bunion Surgery Performed
Most bunion surgeries are performed under local anesthesia with conscious sedation or twilight sleep. You are not fully put to sleep. After you are sedated, the bunion site is numbed locally with an injection.
Depending upon the type of bunionectomy performed, your surgeon will make an incision along the side of your big toe joint or on top of the joint. In some cases, more than one incision is needed.
With a simple bunionectomy, just the bony bump on the side of the foot will be removed. In more severe bunion cases, a cut in one or more bones will be required. Bones will be held together with hardware, such as screws, plates, staples, or wires.
X-rays will be performed throughout your surgery and following your surgery. The length of your surgery will depend on the extent of your surgical procedure.
Following surgery, you will be transferred to the recovery room where you will be monitored until you are cleared to go home, which could be in an hour or two. (4)
You will be discharged from the hospital or surgery center with bandages on your foot, holding your toe in a straight position. Keeping your toe in this position is important during the healing process. It is important to follow your surgeon’s directions about your bandages.
How Long Does It Take to Recover from Bunion Surgery?
The success of your bunion surgery will depend on how well you follow your surgeon’s instructions after surgery. You will see your surgeon regularly for many months to make sure that your surgery site heals properly.
Recovery time period after bunion surgery could last from 6 weeks to 6 months. It depends on the severity of your bunion. Complete healing may take up to 1 year.
Keep your foot elevated as much as possible for a couple of days after surgery. Apply ice as recommended by your surgeon to help relieve pain and swelling.
The pain will be controlled by medications prescribed by your surgeon. In addition to pain medication, your surgeon may prescribe antibiotics to prevent infection.
Stitch removal is usually performed in 14 to 21 days. If your surgeon used pins that stick out of the foot, the pins might be removed in about 4-6 weeks.
Many activities can be resumed in about 6-8 weeks. After surgery, certain exercises will help strengthen your foot and increase the motion of your big toe joint. Your surgeon or physical therapist will educate you on these exercises.
It will take several months for your bones to heal completely. Your surgeon will educate you on shoes when you are ready to transition to them.
Fashionable shoes should be avoided until your surgeon allows it. Also, note that your surgeon may advise you to never return to wearing high heels.
After some procedures, you will not be able to walk on your foot for 6-8 weeks. Discuss your ability to walk with your surgeon.
There may be a few weeks in which you are only allowed to put some weight and pressure on your foot in a special surgical shoe or boot with the assistance of crutches or a cane. The surgical shoe or boot will help keep the bones and soft tissues of the big toe joint still as they heal straight.
Depending upon the type of bunion surgery you had, your bunion correction can be lost by walking on your foot too early or without proper support. Some bunion procedures allow you to walk on your foot right after the surgery with the use of a surgical shoe to protect the bunionectomy site.
Strict instructions about your ability to walk on your foot will be given to you by your surgeon. The amount of pain experienced after bunion surgery differs with each individual. Most patients feel uncomfortable for a time period of 3-5 days. Pain can be controlled with prescribed medications.
Your surgeon will instruct you to rest, ice, and elevate your foot. Icing and elevation decrease swelling, which in turn can minimize pain. If you follow your surgeon’s instructions, you can help minimize pain and swelling after your bunion surgery.
There is always a possibility of bunions growing back after surgery. A variety of factors play a role. An inadequate choice of surgical procedure may be a cause of a bunion growing back after surgery. Incorrect tight-fitting shoes can cause a bunion deformity to return.
Follow your foot doctor’s recommendations for the proper shoe gear for you. Sometimes, bunions grow back when the instructions after surgery given to you by your surgeon were not followed properly.
For example, it is very important to follow your surgeon’s directions about bandage care after surgery. Keeping your big toe in the correct position after surgery is essential for the success of healing.
Do not disrupt the bandage without talking to your foot doctor. Interfering with proper healing could cause the bunion to grow back.
Complications of Leaving Bunions Untreated
If bunions are left untreated, more serious foot pain can occur. Also, the bunion may be more difficult to correct. An untreated bunion can lead to worsening discomfort, severe pain, difficulty walking, curling of the toes, osteoarthritis, and swelling and redness from rubbing with other toes and shoes that are too tight.
Hammertoes can develop in which the middle toes may become deformed, curled, bent, or crossed over. As the bunion deformity worsens, it may be more difficult to surgically manage the bunion later.
Painful bunions can be managed by wearing shoes that fit properly and not allowing tight pressure on the toes. Some shoes can be modified by using a shoe stretcher to prevent tight pressure on your toes. Lacing your shoes to keep the toe box wide can also help relieve the pain on your toes.
Protective over-the-counter padding can cushion the painful bunion. Test the padding for a short period of time first. Sometimes the size of the padding can worsen the pressure on the bump and increase the pain.
The use of shoe inserts or orthotics can control and stabilize the big toe joint to prevent pain and swelling.
Toe spacers can be worn between the first and second toes to prevent your big toe from abutting your second toe. Sometimes a toe splint that places your big toe straight may help relieve the pain. Both nonsteroidal anti-inflammatory medicine and icing can help relieve pain and swelling.
Injection therapy can reduce pain and swelling as well. It is important to note that injection therapy could be of temporary relief only.
Physical therapy can be useful by providing strengthening and range-of-motion exercises to the big toe joint. Physical therapy also offers a variety of pain-relieving modalities, such as ultrasound and cryotherapy.
When to See a Doctor
During your recovery period at home, contact your doctor if:
- Your dressing loosens.
- Your bandage comes off.
- Your bandage gets wet.
- You notice an odor from your surgical site.
- Your toe becomes pale or blue.
- You notice the pin, if used during surgery, loosening and backing out of your toe.
- Your dressing is moistened with excessive amounts of blood or drainage.
- You experience side effects from medicine after surgery.
- You experience persistent fever.
- You have chills.
- You develop warmth or redness around the bandage.
- Your pain increases.
- You develop significant swelling in the calf.
- You experience calf pain.
- You develop shortness of breath.
Bunion surgery can relieve foot pain. It can improve the alignment and motion of your big toe. There are several types of bunion surgeries. The type of bunion surgery performed depends on the severity of your bunion.
Every bunion surgery is custom for each individual. The length of your recovery will depend on the type of bunion surgery and how well you follow your surgeon’s instructions after surgery.
There is a possibility that a bunion can reoccur after surgery, especially if you wear a narrow shoe gear or high heels. Instructions given to you by your foot doctor after surgery must be followed for proper healing.
Discuss your expectations and goals with your foot surgeon before surgery. Address all questions and concerns about the surgery and recovery period with your foot doctor. Being educated about the whole surgical process and preparing for surgery early will allow you to experience a smooth surgical experience and get you one step closer to relief from foot pain.