Bunion surgery

If you have bunions, or wish to avoid them, the simplest approach is to make sure you wear more suitable footwear. This will decrease the likelihood of developing bunions and help prevent them getting worse too quickly if you already have them.

Proper shoes will not cure bunions however, and over time they are still likely to continue to get worse eventually. Even with looser footwear the bunion can be expected to wear against the inside of the shoe, potentially leading to inflammation or infection-related ulcers.

For a more permanent solution to the pain and discomfort of bunions, surgery is a common option.

Bunion surgery at The Edinburgh Clinic will usually take around 30-60 minutes, though this will vary with every patient.

Before coming for surgery, our anaesthetist will discuss options with you regarding pain prevention and reduction during and after your operation. During the surgery itself, antibiotics may also be used to help minimise the chances of an infection.

The specific surgery you receive will depend on an evaluation by your surgeon, but common approaches include removing the bunion entirely, adjusting ligaments to make them looser or tighter as required, reshaping and realigning the bones in your big toe (known as an Osteotomy), stiffening joints and straightening one or more of your toes.

To finish the procedure, your surgeon may use wires or small screws to fix the toes in place. Your skin will then be closed and stitched before the area is covered with a bandage or foot cast.

Any surgery carries some degree of risk and bunion surgery is no different. Some of the possible complications of surgery are listed below:

• Post-surgical pain. This will be dealt with through appropriate medication as advised by your medical team.
• Bleeding. While there may be some bleeding during surgery itself, though this is minimised through standard steps such as a tourniquet, the risk of bleeding afterwards is low.
• Infection. As well as their use during surgery, antibiotics can be used to minimise the risk of post-surgical infection. We also advise that the area is kept completely dry for two days after surgery and kept dry in general after that. Infection could result in the redevelopment of deformity in the toe, so any signs such as pus, redness or high temperature must be reported as soon as possible.
• Scarring. While a small scar is likely to be visible, this is unlikely to be problematic and should heal to a minimal mark.
• Blood clot in the leg (also known as DVT, Deep Vein Thrombosis). To help reduce the risk, you will be encouraged to stay mobile after the operation, and may also be advised to have injections or wear special clothing. If you feel you may have a DVT, let your healthcare team know immediately.
• Blood clot in the lung (pulmonary embolus). If you feel short of breath, feel chest or upper back pain or cough up blood it is essential that you immediately let your healthcare team know while in hospital, or call an ambulance to visit your nearest Emergency department.
• Difficulty in passing urine. It may be necessary for you to use a catheter tube in your bladder in the days following your surgery.

While most of the above risks are applicable to any surgery, some specific potential complications of bunion surgery can include:

• Damage to nerves near the wound. This can lead to numb areas of skin, which should heal, but can sometimes be permanent.
• Bone-healing issues. If the bones of your toe are cut or reshaped during surgery, there is the potential for problems with the healing process such as the newly reset bone shifting before healing is complete. A further operation may be required if this happens.
• Stiffness and loss of movement in the big toe. Though this should improve over time, some stiffness can be permanent.
• Complex regional pain syndrome. In some cases you may experience severe pain, stiffness and the loss of use of your foot. This condition is unexplained, and may require painkillers and physiotherapy over a period of months or years. Taking 1mg of vitamin C for 6 weeks after the operation way help reduce the risk.
• Pain in the ball of the foot. This can occur when standing or walking, and may require that you wear an insole in your shoes.
• The return of the deformity. This can occur should the big toe become misaligned again, or if arthritis causes damage to the joints. Younger people are more at risk. Further surgery may be required.

You should inform your doctor about any medication you use, including herbal or complementary medicines, and anti-inflammatory painkillers.

Since nicotine is a known inhibitor of bone healing, giving up smoking in advance of surgery is advised to help make the operation a success, alongside the other known health benefits of quitting.

Complications are more likely if you are overweight, so maintaining a healthy weight through proper diet and exercise is advised. It is a good idea to ask your healthcare professionals for advice before starting a programme of exercise.

To help reduce the chance of infection, having a bath or shower on the day of (or day before) the surgery is advised. Staying warm in the time before the operation can also help.

After your surgery you will remain in hospital for a short time to have suitable protection applied to your foot and to allow the team to check your circulation and identify any bleeding or swelling. You will also be given advice on how best to put weight on your foot and given assistance in walking with crutches or a walking frame.

You will be able to return home on the same day.  If you do return home it is important that a responsible adult remains with you for 24 hours afterwards in case of emergency.

It is important that you follow the advice of your healthcare team to avoid complications such as blood clots. This includes taking medication and wearing special clothing as advised.

For the first week after surgery you should rest with your leg raised to help reduce swelling. The wound should be kept dry and your dressings should be checked for signs of infection and to monitor healing.

Your surgeon will remove your stitches and any supporting wires or screws a few weeks after the operation. It may take up to 6 weeks before you can return to wearing regular shoes.

Your healthcare team will advise you on caring for your foot including treatment for scarring, and returning to exercise. You should also check with your doctor and insurance provider before driving again.

The swelling from your operation should be fully reduced within 6 months. Wearing comfortable and suitable shoes will help with this process and help avoid a recurrence of the issue.

If you decide that you do not wish to have surgery on your bunions, there are still some measures you can take to improve your foot’s condition.

As mentioned above, wearing better, less tight-fitting shoes, can help slow the development of bunions. We can also discuss with you your options when it comes to special medical shoes which can help to reduce pain.

The pain of bunions can also be relieved in part through placing padding over the bunion and between the big toe and second toe to help them straighten.

While these measures should make it easier to live with bunions, it’s important to note that bunions will not improve with time unless they are properly treated through surgical intervention.