Bunion surgery

There are various types of surgery for bunions. Most of them involve tightening the joint capsule and changing the length of the tendons so they pull on the big toe in the right direction. This corrects the position of the big toe. After that, the first metatarsal bone (the foot bone leading up to the big toe) is cut – and sometimes the proximal phalanx (the bone at the base of the big toe) is cut too. The cut bones are then re-positioned and fixed in place with wire or screws, so that the toe is straight again.

Further measures might be needed for more severe bunions. For instance, the joint at the base of the big toe – or the joint at the base of the first metatarsal bone – can be fixed in place during the surgery. If hammer toes or claw toes have already developed, these deformities can also be corrected during the operation.

People with less severe bunions can now have minimally invasive (keyhole) surgery instead. Then only small cuts need to be made.

The foot is usually stabilized using metal plates, screws, wires or special bandages. Bunion surgery lasts about 30 to 100 minutes. It is usually done in a hospital under general anesthesia and then you stay there for a few days. But it can also be done as a day procedure (without staying overnight in the hospital) if you have help at home.

In the first few weeks after the procedure, it's important to keep the operated joint in the foot stable. This is done using bandages, and sometimes a splint too. You also wear a special shoe that takes pressure off the front of the foot. You can carefully put weight on the foot again immediately after the operation. But in the first week you should only walk a little bit and regularly put your foot up in order to prevent swelling. If there’s a lot of swelling, lymphatic drainage massages are offered in places like physical therapy practices. How much you’re allowed to use your foot will depend on the type of operation that was done and how painful it is.

The type of treatment you have after surgery will depend on what was done during surgery. Once the wound has healed enough, you can start doing exercises to move the toes. After surgery, it takes about 4 to 6 weeks for the bones to become stable enough for you to make full use of the foot again. If screws or other implants were used during surgery to increase stability, they are removed again after a few months. Some implants break down on their own after a while, so they don't need to be removed.

You can’t move around much in the first few weeks after the operation. Because of this, some people need help at home – for instance, with household chores or shopping. One option is to organize nursing care at home during that time.

The surgical options, and whether surgery is considered at all, will depend on the answers to the following questions:

• How bad are the symptoms?
• How severe is the deformity?
• Do you have osteoarthritis in the foot too?
• What kinds of sports, work-related and everyday activities would you like to be possible?
• What negative effects can the procedure have?
• Do you have other medical conditions like vascular (blood vessel) disease, diabetes, nerve disorders or rheumatoid arthritis?

Different doctors often specialize in different types of surgical procedures. For that reason, different hospitals also often recommend different types of surgery. Sometimes it’s only possible for doctors to decide exactly what to do once they have already started the operation and looked inside the foot.

Surgery straightens out the toes and the midfoot, bringing the bones back into the correct position. The symptoms often improve as a result. Many people can use their foot a lot better after surgery, and find it easier to walk. But some are disappointed with the outcome of the surgery – for instance, because their foot still hurts or because they can move their foot even less than before. Bunion surgery usually causes the joint at the base of the big toe to stiffen. This means that it becomes harder to do things like rolling the foot in a smooth heel-to-toe movement when walking.

Several studies have compared the different types of surgery with each other. Their results suggest that the commonly used surgical techniques are similarly effective. There is not enough research to say whether minimally invasive (keyhole) surgery has any advantages over open surgery. But a few studies suggest that minimally invasive surgery is a bit faster and associated with less pain in the two weeks after the procedure. There is no proof that it leads to a better overall outcome or fewer complications.

Bunions may form again after surgery. To prevent this from happening, people are advised not to wear tight shoes.

Like any type of surgery, bunion operations can lead to inflammations, infections and damage to nerves or blood vessels. If the wound becomes infected, further surgery might be needed. Nerve damage can cause part of the toe to become permanently numb. Other, rare complications include osteoarthritis of the metatarsal bone and the death of bone tissue (necrosis).

Because you can’t move your leg much for a few days after the operation, the risk of thrombosis is greater during this time too. To prevent this complication, anticoagulant (anti-clotting) injections can be prescribed. The foot may still hurt in the first few days and weeks after surgery. But the pain usually goes away on its own. Until then, it can help to take painkillers such as acetaminophen (paracetamol) or NSAIDs. In the first year after surgery, the foot is also more prone to swelling.

Feet are generally quite prone to wound-healing problems. This is because their blood supply isn’t as good as in other parts of the body, and you regularly put your weight on them when walking. If someone already has blood circulation problems due to other medical conditions (such as peripheral artery disease or diabetic foot), foot surgery can lead to wound-healing problems or the development of a chronic wound. For this reason, doctors sometimes advise people with these conditions not to have bunion surgery.

Smoking also increases the risk of wound-healing and bone-healing problems because it affects the oxygen supply to the tissue. This risk can be reduced by quitting smoking for at least a few weeks before and after surgery.