Bunions

About bunions

A bunion is a condition where your big toe is angled towards your second toe.

Causes

There is no proven cause. Bunions may be inherited, or due to muscle imbalance. Some kinds of footwear can make bunions worse.

Symptoms

Sometimes bunions do not cause any trouble, but symptoms can include:

• pain, swelling and redness around the bunion
• difficulty in walking, due to discomfort
• widening of your foot, making it difficult to find shoes that fit
• pain under the ball of your foot, or under your small toes.

Treatment

Non-surgical options

• You can try to wear flat, wide shoes that fit you correctly. Do not wear high-heeled, pointed, or tight shoes.
• You can use a bunion pad over the bunion, or a toe spacer. You can buy these from any pharmacy, and they will protect the bunion from the pressure of your shoes.
• You can take your usual painkillers (for example paracetamol or ibuprofen). 

Surgical options

We only consider surgery if non-surgical options do not relieve the pain caused by your bunion. Bunion surgery is not a cosmetic procedure.

We perform surgery to straighten the big toe and reduce the bump over the bunion. It involves cutting the bone, straightening it and fixing it in a new position.

There are different types of bunion surgery and we will discuss the best option with you. 

Scarf osteotomy

This is the most common type of bunion surgery.

• We make a cut (incision) in the first long bone of your foot (metatarsal) which leads to your big toe. We reposition the bone to make it straighter.
• We fix it in place with two small screws which are buried in the bone. They rarely need to be removed.
• We close the wound with stitches which are usually dissolvable.
• Most patients do not need a plaster cast.
• You will have to wear a bulky dressing, and we will give you a special shoe to wear afterwards.

Akin osteotomy

Sometimes a patient needs us to perform an akin osteotomy at the same time as a scarf osteotomy.

• In this type of surgery, we remove a wedge of bone from the base of your big toe. This straightens the big toe and prevents it from crossing under or over your second toe.
• We realign the big toe and fix it in place using a staple or screw.
• We close the wound with stitches which are usually dissolvable.
• Most patients do not need a plaster cast.
• You will have to wear a bulky dressing, and we will give you a special shoe to wear afterwards.

After surgery

You can expect the following after surgery.

Most patients are discharged on the same day.

Wound care/dressings

We will discharge you from hospital with your foot and ankle covered in a bulky bandage. Keep this in place until your next outpatient appointment. This is usually 2 weeks after surgery, at a clinic led by Clinical Nurse Specialists (CNS).

We will discharge you with a special shoe to wear, which will help you to walk. We usually advise patients to wear the special shoe (and some type of dressing) for 6 weeks after surgery.

Depending on the type of surgery we performed, this shoe may be a heel weight-bearing sandal or a flat-foot sandal. 

Keeping your foot raised

During the next 2 weeks after surgery, continue to raise your foot above hip level for as long as you can during each day and night.

Washing

You must keep the bulky bandage clean and dry until we remove it at your outpatient appointment (2 weeks after your surgery).

You may find it easier to take a bath, or use a chair in the shower, to avoid slipping or losing your balance.

Use a waterproof cover or bandage protector over your foot, to prevent the bandage getting wet. You can buy LimbO waterproof dressings on Amazon and direct from Limbo.

Pain

We will discharge you home with a supply of painkillers. We recommend you take these regularly, during the week after your surgery.

You are likely to experience pain in your foot for the first few weeks after surgery.

During the first 6 months, you may tend to walk on the outer border of your foot. This will avoid you putting weight through your big toe. However, it may cause some discomfort under the ball of your other toes.

Your pain and swelling will improve as your bone heals.

Exercise

A physiotherapist will assess your walking before we discharge you home. They will send you home with crutches if you need them.

They will offer advice on how to move your foot and ankle, to prevent stiffness of your big toe during your recovery.

It is a good idea to move around and walk as much as possible, as long as this feels comfortable.

We will advise on physiotherapy or guided exercises after your post-operative clinical review (2 to 6 weeks after your surgery).

Bleeding

Wounds often bleed after surgery, and it is usual to see small spots of blood through the bandage. If you experience additional bleeding, get in touch with us (see Contacts, below). We will invite you back for a wound assessment.

If you experience additional bleeding in the evening or weekend, go to your nearest Emergency Department (A&E).

Scarring

It is usual for surgery to leave a scar, and this can sometimes feel sensitive. We recommend you massage your scar with E45 cream or Bio Oil. You can buy these online or from a pharmacy. Start doing this 3 weeks after your surgery.

Stiffness

You may develop some stiffness in your big toe. Most patients do not find this a problem, although it may affect high-performance athletes or dancers.

Risks and side effects

Common (more than 5 in 100)

Discomfort

This can include pain, irritation or stiffness. It can last for days or weeks and can be treated with painkillers.

Numbness and tingling

This can occur around the wound because of minor nerve damage. It usually settles, but can become permanent.

Repeat of the deformity 

Further surgery may be required.

Less common (fewer than 5 in 100)

Over-correction or under-correction

This is when we do not achieve a normal toe position. It can cause discomfort and you may not like the way your foot looks. We may recommend some stretching exercises, using a splint, or further surgery.

Rare (fewer than 1 in 100)

Infection

This will need treatment with antibiotics, and can require further surgery.

Blood clots 

Deep vein thrombosis (DVT) or a pulmonary embolism (PE). We give every patient a blood clot risk assessment before surgery. If needed, we recommend preventative injections.

Everyday activities

Returning to work

If you have a job where you sit for much of the time, you may be able to go back to work 3 weeks after surgery. You can do this if your swelling has gone down enough to allow you to easily raise your affected foot.

If you have a physically demanding job, you may have to wait up to 4 months before going back to work. 

Most patients go back to work at around 8 weeks. 

Driving

Let your insurance company know that you have had foot surgery. They will check if your insurance is still valid.

If you had surgery on your left foot and you drive an automatic car, you can start driving at around 3 weeks after surgery.

If this does not apply, you may be able to drive from 6 to 8 weeks.

Do not start driving again until you are fully comfortable making an emergency stop.

Sports

You can return to sporting activities such as swimming and cycling, from 2 to 4 months after your operation.

Most patients take 6 months before they return to sports that involve running and jumping.

Follow-up

You can expect these follow-up appointments.

2 weeks after surgery

At this appointment, we will remove your bulky bandage and check how your wound is healing. We will give you advice on caring for your wound, show you how to do some simple exercises, and use a splint (if needed).

6 to 8 weeks after surgery

At this appointment, we usually take an X-ray to check how your bone is correcting its position and healing. If you are making good progress, we will discharge you fully.

Most patients experience some foot swelling and discomfort for up to 6 months after surgery.

Contact your GP if you experience any problems after we discharge you.

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