Claire Dawson
Bunion surgery, or bunionectomy, is a procedure to remove a bunion, a deformity of the bone or tissue around the joint at the base of the big toe, or occasionally, the little toe. The surgery is carried out in hospitals or surgical centres and is usually performed as an outpatient procedure, meaning patients can go home on the same day. However, in rare cases, an overnight stay in the hospital may be required. The surgery typically lasts an hour or more, and the patient is given a local anesthetic and a sedative. The surgeon uses one of four techniques to cut, realign, and possibly remove portions of bone, ligaments, and tendons. The recovery process can be lengthy, often taking up to six months, and patients may need to use assistive devices like crutches or scooters during this time.
| Characteristics | Values |
|---|---|
| Surgery Type | Bunionectomy, Lapiplasty, PECA, Lapidus |
| Surgery Time | 1 hour or more |
| Anesthesia | Local, ankle block, general, spinal |
| Hospital Stay | Outpatient, same-day, rare overnight |
| Recovery | 2–6 months, up to 1 year for swelling |
| Pain | Minimal pain, managed with medication |
| Walking | Possible with assistive devices, special shoes |
| Weight-Bearing | Depends on procedure, may need crutches |
| Dressings | Bandages, brace, cast, boot |
| Recurrence | Possible, may require revision surgery |
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What You'll Learn
Bunionectomy types
Bunionectomy, or bunion surgery, is a procedure to remove a bunion—a deformity of the bone or tissue around the joint at the base of the big toe or the little toe. Bunions are bony growths that develop on the inside edge of the big toe joint when something pushes the big toe out of alignment for a long time.
There are four main types of bunion surgery:
- Osteotomy: This is one of the most common types of bunion surgery. The surgeon makes small incisions in the foot and toe bones and inserts screws or pins to realign the big toe joint. A Chevron Osteotomy is a specific type of osteotomy where a "V-shaped cut" is made behind the big toe joint, allowing the surgeon to shift the first metatarsal bone towards the second.
- Arthrodesis (joint fusion) : This procedure is performed if arthritis in the foot and toe caused the bunion or in cases of severe bunions.
- Exostectomy: This procedure involves shaving off the bunion without performing any bone realignment. It is a less invasive option for patients with mild bunions or those who cannot undergo more invasive surgeries.
- Lapidus procedure: This type of surgery involves fusing the first metatarsal bone to the medial cuneiform bone. It is recommended for patients with hypermobility in the first metatarsal joint or severe bunions.
Other types of bunion surgery include the Lapiplasty 3D bunion correction, which is considered the "gold standard" of bunion surgery, and minimally invasive bunionectomy, which offers quick recovery, immediate weight-bearing, and reduced scarring.
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Recovery time
Bunion surgery is performed to reduce pain and correct the deformity caused by a bunion, a painful bony growth that develops at the base of the big toe. The recovery time for bunion surgery varies depending on the type of surgery performed and the individual's health condition.
Immediately after surgery, patients are taken to a recovery room where their blood flow, breathing, and heart rate are monitored. Once stable, patients are discharged to their homes or moved to a hospital room.
During the first week after surgery, patients are advised to focus on rest, elevation, and pain management. Keeping the foot elevated for at least 55 minutes each hour can help minimise swelling. Patients should also take prescribed pain medication to manage pain effectively.
In the second week, wound care becomes a priority. It is important to keep the surgical area clean and dry while continuing to elevate the foot and use ice packs to reduce swelling. Pain management strategies, including medication and cold therapy, are still crucial during this time.
The recovery process can vary from a few weeks to several months, with some sources stating that it may take up to six months for a full recovery. During this time, patients may experience swelling, pain, and discomfort. It is important to follow the surgeon's instructions for caring for the foot, including specific directions about dressing care and weight-bearing restrictions. Failure to adhere to these instructions can undo the effects of the surgery and lead to complications.
Minimally invasive bunion surgery is an option that allows patients to recover faster and get back on their feet more quickly. This type of surgery does not require fasting, crutches, or absences from work, and patients can often return to their desks by noon after a morning procedure. However, regardless of the type of surgery, a well-planned recovery is crucial for effective healing and regaining strength and mobility.
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Pre-operative tests
Bunion surgery is performed in hospitals to remove bunions and realign toes. Before the surgery, your doctor will ask you to undergo several pre-operative tests to ensure that your body is ready for surgery. Here are some of the pre-operative tests that you may need to undergo:
Physical Examination
Your doctor may ask you to visit your family doctor or a specialist for a complete physical examination. They will assess your overall health and identify any potential issues that could interfere with your surgery. This examination helps ensure that you are in good health and ready for the procedure.
Blood Tests
Your doctor may request blood tests as part of the pre-operative assessment. These tests can provide valuable information about your health status and help identify any potential concerns, such as anaemia or other conditions that may impact your surgery and recovery.
Electrocardiogram (EKG)
An electrocardiogram, also known as an ECG or EKG, is a test that records the electrical activity of your heart. This test is often recommended before surgery to evaluate your heart's health and ensure it can withstand the stresses of the procedure.
Imaging Tests
Your doctor may order imaging tests, such as X-rays, MRI scans, or CT scans, to visualise the bunion and assess the extent of the deformity. These tests help your doctor plan the surgery and make decisions about the specific surgical approach. For example, weight-bearing foot X-rays are often used to clearly see the deformity and determine the best location for any necessary osteotomies.
Urine Sample
You may also be asked to provide a urine sample as part of the pre-operative testing. Urinalysis can provide information about your kidney function, hydration status, and overall health. It can also help identify any potential infections or other issues that may impact your surgery.
It is important to follow your doctor's instructions and undergo the recommended pre-operative tests. These tests help ensure your safety during surgery and aid in developing an effective treatment plan.
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Risks and complications
Bunion surgery (bunionectomy) is a procedure to remove a bunion, a deformity of the bone or tissue around the joint at the base of the big toe or the little toe. The surgery is performed to reduce pain and correct the deformity. It is important to be aware of the risks and potential complications associated with bunion surgery, which can include:
- Infection: Infections can be severe and lead to serious complications such as amputation of the affected toe, chronic pain, and disability.
- Blood clots: Blood clots in the lower leg can form and move to the lungs, causing a pulmonary embolism.
- Nerve damage: Nerve damage can result in long-term numbness, tingling, or pain in the toe or surrounding areas.
- Recurrence: Bunions may recur due to improper healing, failure to address underlying causes, or inadequate post-surgical care.
- Scarring: Scarring may cause discomfort or cosmetic concerns.
- Limited movement and stiffness: The big toe may lose flexibility, limiting motion and making activities such as walking or running challenging and painful.
- Permanent changes to foot structure: Certain procedures, such as the Lapidus bunionectomy, can cause permanent changes to the foot structure, including shortening of the first metatarsal bone.
- Prolonged recovery: Bunion surgery typically requires a long recovery period, often taking up to six months or even longer.
- Activity restrictions: Patients may need to restrict the types of shoes they wear and avoid certain activities for an extended period or even permanently.
- Pain: While bunion surgery aims to reduce pain, it is common to experience pain during the early stages of recovery, and some individuals may experience chronic pain years after the surgery.
It is important to discuss any concerns with a healthcare provider and understand the specific risks and potential complications of the procedure before deciding to undergo bunion surgery.
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Post-operative care
Bunion surgery, or bunionectomy, is performed to remove a bunion and realign the toe. It is a generally safe procedure, but like all surgeries, it carries some risks. Most patients need a few months to recover, and the recovery process may vary depending on the type of bunionectomy performed. Here are some detailed instructions for post-operative care after bunion surgery:
- Elevation and Icing: Elevating the foot above the heart level and applying ice are recommended to reduce pain and swelling. It is essential to follow the doctor's advice on icing, and never apply ice directly to the skin. This practice should be maintained for at least the first three days after surgery.
- Weight-bearing: It is crucial to follow the surgeon's instructions regarding weight-bearing. Some bunionectomies require avoiding weight-bearing for an extended period to ensure proper bone healing. Crutches or a knee roller/scooter may be necessary for a few weeks. Putting weight on the foot too early can undo the correction and impact bone healing.
- Footwear: A protective shoe, boot, or cast may be provided by the surgeon to protect the foot and maintain the corrected position of the toe. It is vital to wear the recommended footwear consistently to support the healing process.
- Pain Management: Pain is expected after bunion surgery, and your surgeon will suggest ways to manage it. Prescription pain medication, over-the-counter NSAIDs, acetaminophen, or a combination of these medications may be recommended. It is important to follow the instructions for taking pain medication to ensure safe and effective use.
- Dressing Care: Keeping the dressing dry and intact is essential for wound healing. Notify your healthcare provider if the dressing loosens, falls off, or gets wet, as this may increase the risk of infection.
- Signs of Infection: Be vigilant for signs of infection at the surgery site, including leaking, odour, discolouration, swelling, or warmth. A fever higher than 101 degrees Fahrenheit (39 degrees Celsius) may also indicate an infection. Contact your healthcare provider if you experience any of these symptoms.
- Follow-up Care: Regular follow-up appointments with your doctor are essential for several months and occasionally up to a year. These appointments ensure that your foot is healing properly and provide an opportunity to address any concerns or complications.
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Frequently asked questions
Bunion surgery, or bunionectomy, is a surgical treatment to remove a bunion from the joint where the big toe meets the foot.
Yes, bunion surgery is performed in hospitals. It is usually done as an outpatient procedure, meaning patients go home to recover on the same day as the surgery. However, in rare cases, an overnight hospital stay may be required.
The surgeon will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based on the severity of the bunion. The surgeon will then close the opening with stitches and apply a sterile bandage or dressing.
Recovery from bunion surgery typically takes a few months, but it can take up to six months for a full recovery. During the first few weeks, patients will need to keep their foot elevated and limit their activity to reduce swelling and allow the wounds to heal.
