Bunion surgery

Publication date Sep 21, 2007

This information tells you about an operation to get rid of bunions. It explains how the operation is done, how it can help you, what the risks are and what to expect afterwards.

The benefits and risks described here are based on research studies and might be different in your hospital or clinic. You may want to talk about this with the podiatrists and surgeons treating you.

What is a bunion operation?

If you have a bony bump at the base of your big toe, you probably have a bunion.

During a bunion operation your surgeon takes out the bony bump and puts your big toe back into a straight line. After the operation the joint on the inside of your foot won't stick out any more.

Most people have few problems after bunion surgery. But the operation has risks. Your big toe may not be perfectly straight and you may have some pain. It can take up to a year to get better.

Your doctor will only usually recommend surgery if your bunion is painful or beginning to push your other toes out of line.

What is a bunion?

A bunion is a bony bump at the base of your big toe. Bunions are far more common in women than in men.[1] About half of all women get them.[2]

A bunion happens when the two main bones in your big toe joint move are no longer in line with each other.[3] This makes your toe joint stick out. The bony bump is the bunion.[3]

Sometimes a sac of fluid forms over the bump. It's like a blister. Doctors call this sac a bursa.[4] [5] The sac can get inflamed when your bunion rubs on your shoes. If this happens, you also have bursitis.

Doctors call bunions hallux valgus. Hallux means big toe. Valgus means bent outwards. A bunion is simply a joint that is out of line. It isn't a growth on the side of your toe, as some people think.

Bunions can hurt a lot. You may notice the area around the bunion is swollen and red. And you may find it hard to walk. Your big toe may start to roll on its side and cross over your second toe. And your big toe can push your second toe toward your third toe and so on. Your toes may even lie on top of each other in bad cases.[4] [5]

Some people get a small bunion, called a bunionette, on their little toe. This is also known as a tailor's bunion.[6]

Doctors don't really know why some people get bunions. The shape of your foot and how you walk probably have something to do with it.[1] Wearing shoes that are too tight can make the problem worse.[7]

When do I need an operation?

An operation is the only way to get rid of your bunion, but surgery has risks. Your doctor will usually recommend that you try simple treatments first. For example, wearing insoles in your shoes can take the pressure off your bunion and make it hurt less. And medications can also help with pain and swelling.

You and your doctor may think about surgery if:[1]

Your bunion hurts a lot
You can't fit your foot into normal shoes
You can't walk easily or do your usual activities.

But you shouldn't have bunion surgery just to make your foot look better or so you can wear more fashionable shoes. Surgery helps eight out of 10 people.[8] But there's no guarantee that your toe will be perfectly straight and free of pain afterwards.

An operation for bunions can be done by an orthopaedic surgeon or by a podiatric surgeon. Podiatrists are not medical doctors. But they do have special training in foot and ankle problems, including bunions.

Your specialist will take your medical history and give you a physical examination. You may have an X-ray of your big toe joint so that your doctor or podiatrist can see how far your toe bone has moved.[9] You stand up while this X-ray is taken. It shows the angles between the bones in your feet.

The angle between your big toe and the main long bone of your foot is called the hallux abductus angle. If this angle is more than 15 degrees, it's a sign of bunions.
The angle between your main foot bone and the foot bone next to it is called the intermetatarsal angle. If this angle is more than nine degrees, it is also a sign of bunions.

Different types of operation

There are more than 100 ways to do a bunion operation. There are different ways to take out bone, mend the shape of your joint and make the tissues around your joint tighter or looser.

The type of surgery you need depends on how bad your bunion is, how far your bones have moved and what your doctor suggests. There isn't any evidence that one type of operation works better than another. Talk to your doctor about how he or she plans to get rid of your bunion.

The most common type of operation is osteotomy. During this operation the bones in your toe joint are cut and put back into line with each other. Your doctor may:

Take out a small piece of bone from your main foot bone and move it back into line
Take out a small piece of bone from the base of your big toe to straighten this toe, as well as taking out a piece from your main foot bone
Take out more bone to get your bones to line up better
Cut the main bone in your foot further down the bone and away from your toe
Operate on the tendons and ligaments around your big toe joint. This can make them tighter or looser. It's done through a separate cut, usually between your big toe and second toe.

A less common type of bunion surgery is arthroplasty. This is usually used if you have bad bunions and are older. Another type is called arthrodesis. This is sometimes used if you have arthritis.

Doctors call surgery just to get rid of your bony bump exostectomy. In this operation, doctors just shave off the part of the bone that's sticking out (the bunion). They don't put the bones in your toe joint back into line with each other. This is the least serious type of bunion surgery.[1]

Your foot may look better afterwards and your shoes may fit better. But this surgery doesn't mend your toe joint. That means your bones can keep moving and cause another bunion. Doctors don't use this operation very often.

What happens during surgery?

Most bunion operations are done in a day. You don't usually need to stay in hospital overnight. Bunions on both of your feet can sometimes be operated on at the same time if the type of operation you have allows you to walk afterwards.

You'll probably only need a local anaesthetic. This will numb your foot so you won't be able to feel anything. But you'll still be awake. A screen will prevent you from seeing the operation. Some patients have a general anaesthetic, especially if their operation is more complicated and will take longer. You'll be asleep for the operation if you have a general anaesthetic.

The operation takes from 25 minutes to up to an hour. Here's what happens during the most common type of bunion operation, known as an osteotomy:

Your surgeon puts a tight strap (called a tourniquet) around the ankle to squeeze blood away from your foot.
He or she then makes a cut in your skin on the side of your foot at the big toe joint.
Then they cut through the tissue to your bone and joint.
The next step is to shave off the bony bump of your bunion.
Your surgeon may will also cut some tendons and small bones (known as sesamoids) and put them back under the long foot bone (the metatarsal). These tendons often tighten and the bones shift out of position when you have a bunion.
He or she will then cut and remove some of the long foot bone (the metatarsal)..
The toe is then put back in the correct position
It is fixed in place to the main foot bone with screws, pins wires or a plate.[10] [11] The pins, screws or plate may be left in your foot, may dissolve over time or may be taken out in a second operation.
Sometimes the bone in the base of your big toes is also fixed in place.
The surgeon will then close the cut with stitches. He or she will use stitches that dissolve to stitch the tissues under your skin. But you may have ones that need to be removed to close your skin.

You'll probably be able to go home an hour after your operation if you have a local anaesthetic or after two or three hours if you have a general anaesthetic. You'll usually be given crutches and a special shoe to protect your foot. For some kinds of bunion surgery, you might need a plaster cast covering your foot and up to your knee. The cast stops you putting weight on the foot. You won't be able to walk on it for up to six weeks. But for most operations there's no evidence that it's better to have a plaster cast than a soft cloth bandage to protect your foot after surgery.[1] [12] [13]

We don't know for sure when you should start to put weight on your foot or walk after bunion surgery. Some research shows that toe joints take the same time to heal if you rest your foot in a plaster cast for at least a month afterwards or if you start putting weight on your foot soon after surgery.[1] [14]

How can this surgery help me?

After surgery your big toe should be straighter and your toe joint should stick out less. Research shows that:[1] [8] [15]

Your toe may hurt less
You may feel happier about how your foot looks
You may be able to move your toe up and down more comfortably
You may be able to walk more easily.

It's hard to say how much better your symptoms will be because there haven't been many good studies on this. One small study followed people for up to three years after their bunion surgery:[1] [15]

About three-quarters of the people said they were completely happy with the results.
Seven in 10 people didn't have pain any more.
Nine in 10 people could walk more easily.

But your big toe may not be perfectly straight and you still have some pain. And you may not be able to wear all types of shoe. So be sure to talk to your doctor about what you should expect. Studies show that up to a quarter of people are not happy with the results of some operations for bunions:[16] [17]

Up to 20 in 100 people still have pain after surgery
Up to 15 in 100 people still need special shoes.
Up to 3 in 100 people have problems walking easily.
Some people aren't happy with how their foot looks because their toe is not completely straight.

What are the risks?

Bunion surgery has risks. These depend on the type of bunion operation you have.

Osteotomy (the most common type of operation)

At least 6 in 100 people have problems from a type of osteotomy operation known as chevron osteotomy.[8] These include:

An infection in the wound
Small breaks in the bones that were operated on (doctors call these stress fractures)
Not having any feeling around the big toe and joint from damage to your nerves.

There's also a chance that your toe joint won't bend as much after surgery. This may be a problem if you are very active.

Other research found that as many as 2 in 5 people have problems.[16] The problems included:

Swelling around the toe joint
A toe that points slightly outward rather than straight ahead.
Very slow healing of your joint
Another bunion
Corns and calluses (these are thick patches of skin that can hurt)
A shorter toe than before surgery
Stiffness in the toe
Pain in the ball of the foot.

You may also still have problems wearing all types of shoes. We don't know if this operation is harmful in the long term. The research has followed people for only a few years after surgery.

You may be more likely to get problems if you have diabetes or your circulation isn't so good. In these conditions, you might not have as much blood flowing to your feet. And your feet need blood to heal properly.

Arthroplasty

You may have more problems after an arthroplasty than after other kinds of bunion surgery.[15] [18] But we can't say for sure how likely it is that you will get problems because there hasn't been much good research on this.

We do know that your big toe may not work very well after a Keller's arthroplasty.[1] You may not be able to move it properly. And it may be shorter than it was before. Also, more than half the people who have this type of operation can't put the soft part of their toe down on the ground when they walk.[18] (Doctors call this a cock-up deformity.) This problem is more common after an arthroplasty than after an arthrodesis. About a quarter of the people who have arthroplasty are not happy with the results.[1]

Arthrodesis

One study found that about half the people who had this operation got problems afterwards. These included pain and hard skin, infections and loss of feeling in the foot for some time. In some people the bones didn't join properly, although this didn't always cause problems. About 1 in 50 people needed another operation.[19]

What will happen if I choose not to have surgery?

The bones in your toe joint won't move back on their own. And bunions usually get worse if you don't treat them. But it's hard to say how bad your bunion will get and how quickly because there isn't a lot of research on this.

One study found that after a year, the symptoms of bunions got better for:[8]

Eight in 10 people who had surgery for bunions
Less than half of people who used insoles in their shoes
A quarter of people who didn't have any treatment.

The people in the study said that their foot hurt less and they could walk more easily than they could a year before.

If you don't treat bunions, they usually get bigger and hurt more. You can try treatments that don't involve surgery first. But they may not work as well as surgery. The only way to get rid of your bunion is to have an operation to make the bones in your big toe joint line up again. If you wait too long, your smaller toes can get out of line too. Then you could end up needing a bigger operation that might not work so well.

What other treatments are there?

Only surgery can get rid of your bunion. But there are some things you can try to stop your bunions getting worse and make them hurt less.[20]

Wear roomy, comfortable shoes that have lots of space for your toes. Don't wear shoes that are too tight, too narrow or too pointed.
Wear shoes that have laces or buckles that you fasten. Shoes that fasten up give your foot more support than slip-on shoes.
Wear flat shoes or shoes with a low heel. High heels force your toes into the front of your shoes and crowd them. This can make your bunions worse.
Put a pad on your bunion. Covering your bunion with a pad may protect it from pressure and rubbing, so it won't hurt as much.
Ask your doctor about taking painkillers. These include non-steroidal anti-inflammatory drugs (NSAIDs for short), such as ibuprofen. NSAIDs might help with your pain and swelling. But some of these drugs have side effects. To learn more see Warnings about side effects of NSAIDs in our section on arthritis.
Ask about insoles you put in your shoes. The way you walk can put extra stress on your big toe joint. Shoe insoles may stop the stress and the pain for a short while.[8]
Ask your doctor about splints you wear at night. You can wear these to hold your toes straight while you sleep. But we don't know whether splints worn at night can stop your bunions getting worse. There is no good research to tell us.[1]
Ask about exercises. Your doctor can suggest exercises to make the muscles in your big toe stronger. For example, you can try putting your feet side by side and moving your big toes towards each other three or four times a day.

What can I expect after the operation?

First few days

You must usually rest completely for four days.
You'll feel a lot of pain, but painkillers will help.
You shouldn't get your foot wet.

One week later

You'll need to go for a check-up and a clean dressing.
You can start to do more with the help of crutches. But if you feel pain you are doing too much.

Two weeks later

You'll need to go for another check-up and to have your stitches removed (unless they are on the sole of your foot. These are taken out after three weeks).
You don't need a bandage anymore and you can get your foot wet. You probably won't need crutches.
Your surgeon will probably show you some exercises to strengthen and improve the movement of your toe.

Two to six weeks later

Your foot starts to return to normal, but it will still be quite swollen especially at the end of the day.
You can wear shoes again.
You can go back to work if you aren't expected to be on your feet a lot.
You can drive provided you can do an emergency stop. But you must check with your insurance company before you drive again.
You can start to get back to your normal activities, but you should avoid any sport.

Two to three months later

Your foot should be less swollen and feel normal again.
You can try sport after three months, depending on how well you've recovered.

Six months later

You'll have a final check-up three to six months after surgery.
You should only have a slight swelling.
You should be getting the full benefit of the surgery.

A year later

Your foot should have healed. You probably won't see any more improvements in your foot or your symptoms.

References

Ferrari J, Higgins JPT, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. In: The Cochrane Library, Issue 2, 2005. Wiley, Chichester, UK.
Kilmartin TE, Barrington RL, Wallace WA. A controlled prospective trial of a foot orthosis for juvenile hallux valgus. Journal of Bone and Joint Surgery: British Volume. 1994; 76: 210-214.
Coughlin M. Hallux valgus. Journal of Bone and Joint Surgery. 1996; 78: 932-966.
British Chiropody and Podiatry Association. Bunions. Available at http://www.premierfootcare.com/factsheets/bunions.pdf (accessed on 14 September 2006).
American Podiatric Medical Association. Foot health: bunions. Available at http://www.apma.org (accessed on 14 September 2006).
Caselli MA, George DA. Foot deformities: biomechanical and pathomechanical changes associated with aging, part I. Clinics in Podiatric Medicine and Surgery. 2003; 20: 487-509.
Ferrari J, Hopkinson DA, Linney AD. Size and Shape Differences between male and female foot bones. Journal of the American Podiatric Association. 2004; 94: 434-452.
Torkki M, Malmivaara A, Seitsalo S, et al. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. Journal of the American Medical Association. 2001; 285: 2474-2480.
LaPorta G, Melillo T, Olinsky D. X-ray evaluation of hallux abducto valgus deformity. Journal of the American Podiatric Medical Association. 1974; 64: 544-566.
Prior TD, Grace DL, MacLean JB, et al. Correction of hallux abductovalgus by Mitchell's osteotomy: comparing standard fixation methods with absorbable polydioxanone pins. Foot. 1997; 7: 121-125.
Calder JD, Hollingdale JP, Pearse MF. Screw versus suture fixation of Mitchell's osteotomy: a prospective, randomised study. Journal of Bone and Joint Surgery - British Volume. 1999; 81: 621-624.
Meek RMD, Anderson EG. Plaster slipper versus crepe bandage after Wilson's osteotomy for hallux valgus. Foot. 1999; 9: 138-141.
Meek RMD, Anderson EG. Plaster slipper versus crepe bandage after first metatarsophalangeal joint fusion. Foot and Ankle Surgery. 1998; 4: 213-217.
Lampe HI, Fontijne P, van Linge B. Weight bearing after arthrodesis of the first metatarsophalangeal joint: a randomized study of 61 cases. Acta Orthopaedica Scandinavica. 1991; 62: 544-545.
Turnbull T, Grange W. A comparison of Keller's arthroplasty and distal metatarsal osteotomy in the treatment of adult hallux valgus. Journal of Bone and Joint Surgery - British Volume. 1986; 68: 132-137.
Klosok JK, Pring DJ, Jessop JH, et al. Chevron or Wilson metatarsal osteotomy for hallux valgus: a prospective randomised trial. Journal of Bone and Joint Surgery: British Volume. 1993; 75: 825-829.
Resch S, Stenstrom A, Jonsson K, et al. Results after chevron osteotomy and proximal osteotomy for hallux valgus: a prospective, randomised study. Foot. 1993; 3: 99-104.
O'Doherty DP, Lowrie IG, Magnussen PA, et al. The management of the painful first metatarsophalangeal joint in the older patient. Arthrodesis or Keller's arthroplasty?. Journal of Bone and Joint Surgery: British Volume. 1990; 72: 839-842.
Faber FW, Mulder PG, Verhaar JA. Role of first ray hypermobility in the outcome of the Hohmann and Lapidus procedure: a prospective, randomized trial involving one hundred and one feet. Journal of Bone and Joint Surgery: American Volume. 2004; 86: 486-495.
Donley BG, Tisdel CL, Sferra JJ, et al. Diagnosing and treating hallux valgus: a conservative approach for a common problem. Cleveland Clinic Journal of Medicine. 1997; 64: 469-474.

Glossary

inflammation: Inflammation is when your skin or some other part of your body becomes red, swollen, hot and sore. Inflammation happens because your body is trying to protect you from germs, from something that's in your body and could harm you (like a splinter) or from things that cause allergies (these things are called allergens). Inflammation is one of the ways in which your body heals an infection or an injury.
X-ray: X-rays are pictures taken of the inside of the body. They are made by passing small amounts of radiation through the body and onto film. Larger amounts of radiation are used to treat some kinds of cancer.
tendons: Tendons are the tough, rope-like connections between muscles and bones.
ligament: A ligament is a strong piece of tissue that connects one bone to another. For example, ligaments in your ankle connect the bones of your leg to the bones of your heel.
arthritis: Arthritis is when your joints become inflamed, making them stiff and painful. There are different kinds of arthritis. Osteoarthritis is the most common type. It happens when the cartilage at the end of your bones becomes damaged and then starts to grow abnormally. Rheumatoid arthritis happens because your immune system attacks the lining of your joints.
infection: You get an infection when an , such as a or , gets into a part of your body where it shouldn't be. These organisms are so tiny that you can't see them without a microscope. An infection in your nose and airways causes the common cold. An infection in your skin can cause rashes such as athlete's foot.
diabetes: Diabetes is a condition that causes too much sugar (glucose) to circulate in the blood. It happens when the body stops making a called (type 1 diabetes) or when insulin stops working (type 2 diabetes).

This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.

Bunion surgery