Bunion removal and treatment

Bunion removal is a straightforward surgery that corrects the alignment of your big toe and helps relieve the pain and discomfort a bunion causes. There are two types of surgery available: traditional open surgery and minimally invasive bunion surgery, which involves small incisions to realign the bone.

Bunion surgery aims to reduce pain, improve mobility, and help you wear shoes more comfortably. Typically, you’ll have the procedure as a day case under general anaesthetic or a regional nerve block.

Signs of needing a bunion removal 

Not everyone with a bunion needs surgery. You may want your bunion removed if you experience: 

• Changes to your foot’s shape eg your big toe leaning into the second toe
• Pain or deformities in your smaller toes because of pressure from the bunion
• Significant pain and discomfort, especially when walking or wearing shoes
• Swelling, redness, or tenderness around the big toe joint
• Trouble finding well-fitting shoes 

Is bunion removal right for you? 

If lifestyle changes such as wearing wider shoes, using toe spacers, and taking painkillers haven’t helped, and your bunion is causing difficulties in your daily life, then you may want to consider bunion removal. Your consultant will assess the severity of your symptoms, your overall health, and the structure of your foot to determine the best approach. Surgery is not usually recommended for purely cosmetic reasons. 

Bunion surgery may not be suitable if you have severe bunions or certain medical conditions that increase the risks of surgery eg poor circulation, osteoporosis, or rheumatoid arthritis. 

Alternative treatments to bunion removal 

There are several alternatives to surgery that you can try to relieve pain or discomfort caused by your bunion: 

• Bunion pads
• Ice packs
• Night splints
• Orthotics
• Painkillers
• Shoe inserts
• Toe spacers

There are 2 types of bunion removal surgery and your consultant will discuss the best option for your needs: 

• Open technique
• MICA (minimally invasive chevron akin procedure)

The open technique involves making an incision in your foot to expose the bunion and has a longer recovery time than MICA. The incision is usually on the top or side of the big toe and allows your surgeon to access the bunion easily. 

MICA, or minimally invasive bunion surgery, is a type of keyhole surgery. Your surgeon will make small incisions, usually around 3–5mm long, and pass special instruments into these incisions to cut and realign the bone. They may insert tiny screws to hold the bones in place while they heal. This is usually reserved for less severe bunions.

After your surgeon has corrected the alignment, your foot will be bandaged and placed in a stiff-soled post-operative shoe. If other toes are affected, you may also need a wire or screw to support healing.

How to prepare for bunion removal surgery

Make sure you attend all your pre-operative appointments, where you’ll be able to ask any questions you have. You’ll need to complete a preadmission form before your surgery to provide a detailed assessment of your medical and social history. We’ll ask about any medications you take, your allergies, your weight, and whether you smoke.

If you’re having regional anaesthetic, you can eat and drink as normal before surgery. However, if you’re having general anaesthetic you’ll be asked to fast (ie not to eat or drink anything other than water) for at least 6 hours before your surgery. You may be asked to stop drinking clear liquids up to 2 hours before your surgery.

Who will be involved? 

Your surgery will be performed by an orthopaedic surgeon or podiatric surgeon. Your care team will also include an anaesthetist, nurses, and you may see a physiotherapist to assess your mobility before you can leave the hospital.

How long the procedure takes

This depends on the type of procedure you’re having, but generally surgery takes less than 90 minutes.

Anaesthetic choices

You will discuss this with your care team before your surgery. The options are:

• General anaesthesia, where you are asleep throughout the procedure
• Regional anaesthesia, which includes nerve blocks that numb your foot so you won’t feel any pain

Pain during surgery and straight after surgery

You won’t be able to feel any pain during your surgery. After the procedure, your foot will likely feel numb for several hours because of the long-acting regional anaesthetic. You’ll be given painkillers to take home and advised on how and when to take them. 

What happens straight after surgery 

You’ll  be taken to the recovery room where nurses will monitor your blood pressure, heart rate, and oxygen levels as the anaesthetic wears off. Once you’re comfortable, you’ll return to the ward. You’ll likely feel nauseous for up to 24 hours, but this usually goes away by itself. 

Your hospital stay 

You’ll typically only stay in the hospital until your anaesthetic wears off, and in most cases you can go home the same day as your procedure. 

Before you’re discharged you need to: 

• Eat and drink something
• Pass urine normally
• Walk safely with your post-op sandal
• Understand how to care for your wound at home

Most people can walk carefully the day after surgery, but it can take up to 6 months to recover fully.

In the first few days after the procedure, you may experience some symptoms, but these usually improve within 1-2 weeks. These include:

• A slightly raised temperature as your body heals
• Mild to moderate pain that can be managed with painkillers
• Numbness from the local anaesthetic
• Swelling and bruising around the foot and ankle

For the first 24 hours, you’ll be encouraged to walk short distances while wearing a stiff-soled sandal. You should keep your foot elevated above groin level as much as possible to aid healing.

You’ll be given crutches to take home with you, and a physiotherapist will teach you how to use them. You’ll be able to walk carefully, putting your weight through your heel for support.

Wound care

You should keep the dressing on for 3–5 days unless it becomes wet or dirty. After 48 hours, you can take the outer dressing off, but most people prefer to keep it on the wound to prevent it from rubbing against your shoe. 

Any steri-strips or surgical glue used during the procedure will likely come off on their own or when you wash. Bruising and some redness around the wound are normal and usually improve over 2–3 weeks.

Pain management

You can take painkillers to manage your pain, but follow your care team’s instructions so you don’t feel drowsy.

Footwear

Your care team will advise you to wear stiff-soled sandals at first, and will let you know when you can wear trainers or soft shoes again. You’ll likely have to wear wider, supportive footwear thereafter to reduce the chances of your bunion recurring. You may be advised to avoid wearing high heeled or narrow shoes.

Diet

Some painkillers can cause constipation, so make sure you follow a high fibre diet after your surgery. You may need to cut down or stop drinking alcohol depending on which painkillers you’re taking. 

Smoking

Smoking slows down healing and increases your chances of developing an infection, so this is a good opportunity to quit smoking.

Driving

If you’ve had general anaesthesia you can’t drive for at least 24 hours and will need someone to take you home from hospital. 

You will be able to return to driving when you can safely perform an emergency stop, although note that some painkillers can impair your reaction times and you may be advised to stop driving while taking them.

Time off work

The amount of time you need to take off work depends on your job.

• Desk-based roles — you should be able to return to work within 1–2 weeks, but will need to keep your foot elevated
• Active or standing jobs — you may need 4–6 weeks off
• Physically demanding roles — depending on how fast you recover, you may need between 6–12 weeks off

Aiding your recovery

You will need someone to take you home after surgery, and may need some help around the house for a couple of days. 

Make sure you rest and elevate your foot for at least 2 weeks, taking pain relief as required. You’ll need to wear your post-operative shoe to stand or walk. You will not be able to take part in high-impact exercise (like running) for around 12 weeks.

Attend your follow-up appointments and let us know if you have any concerns.

All surgeries carry some risk of complications, although these are rare. Your consultant will discuss these with you before your procedure.

Bleeding

Blood can collect under the skin near the incision site. This usually happens if there is a lot of bruising around the wound, and may need to be drained by a clinician.

Bruising and swelling

This is common and should resolve in the weeks following your surgery.

Deep vein thrombosis (DVT)

This is a blood clot in your leg veins, and can be serious. Symptoms include throbbing pain in the calf or thigh, swelling, warm, red, or darkened skin, and swollen, painful veins that feel hard to the touch.
Numbness

You may experience numbness around the incision site due to minor nerve injury.

Wound infection

This is a rare complication of bunion surgery. Seek help if the area around your wound becomes red, hot, swollen, painful or you notice any unusual discharge.

Risks specific to bunion surgery

• Recurrence — occasionally, your big toe may return to its original position
• Non-union or malunion — the bone may not heal as expected and may need more surgery
• Overcorrection — surgery may straighten the toe too much, which can cause your shoe to rub
• Pain, including complex regional pain syndrome (CRPS) — some people continue to experience pain under the ball of the foot, even after surgery; this can develop into CRPS where the nerves around the joint become hypersensitive
• Prominent metalwork — you may be able to feel the screws or plates through your skin; this usually isn’t serious, but can cause discomfort
• Stiffness — stiffness around the big toe is fairly common, and exercises can help improve your mobility

Anaesthetic risks

After waking from general anaesthesia, it’s common to feel nauseous or to vomit. You may also experience:

• Blurred vision
• Dizziness
• Headaches
• Memory loss of the time when the anaesthesia is still wearing off

Very rarely, you may have severe reactions such as an allergic response, nerve injury or heart complications.

When to contact a doctor

Seek urgent care if you have any of the following symptoms as they could indicate an infection or blood clot:

• High fever or chills
• Increasing pain, redness, swelling, bleeding, or discharge at or around the wound
• Unexplained cough, shortness of breath, or chest pain
• Unexplained swelling in your calf