What to Expect from Bunion Surgery

Bunions, medically known as hallux valgus, are bony protrusions that develop at the base of the big toe, causing the toe to angle inward toward the other toes. This deformity often results from genetic factors, improper footwear, or conditions like arthritis, leading to pain, swelling, and difficulty walking. When conservative treatments such as orthotics, wider shoes, or pain medications fail to provide relief, bunion surgery—also called bunionectomy—becomes a viable option. The primary goals of the procedure are to alleviate pain, correct the toe alignment, and restore foot function. Surgery is typically recommended for moderate to severe cases where the bunion interferes with daily activities. With advancements in techniques, including minimally invasive options, outcomes have improved, offering faster recovery for many patients. However, expectations vary based on the bunion's severity, the surgical method, and individual health factors. Understanding the process from preparation to long-term recovery can help patients approach the procedure with realistic anticipation.

Preparation for bunion surgery begins weeks in advance to ensure optimal outcomes. Patients undergo a thorough medical evaluation, including blood tests, X-rays of the foot, and possibly an electrocardiogram or chest X-ray to assess overall health and identify any risks, such as heart or lung conditions. It's crucial to inform the surgeon about all medications, supplements, and allergies, as blood thinners or certain drugs may need to be discontinued. Smoking cessation is advised, as it impairs healing. On the day of surgery, patients must fast for at least eight hours, though approved medications can be taken with a sip of water. Arranging transportation home is essential, as anesthesia impairs driving. Additionally, preparing the home environment—such as stocking up on easy-to-prepare meals and setting up a comfortable resting area with elevation tools—can ease the initial recovery phase.

The surgery itself is usually performed on an outpatient basis, lasting one to two hours depending on complexity. Anesthesia options include local (numbing the foot), regional (from the waist down), or general, with most patients awake but sedated. There are several types of bunionectomy. Osteotomy, the most common, involves cutting and realigning the metatarsal bone with screws or pins to straighten the toe. For severe cases or those with arthritis, arthrodesis fuses the joint to eliminate pain, while exostectomy shaves off the bony bump but is rarely used alone. Minimally invasive techniques, gaining popularity, use small incisions and a burr tool instead of large cuts, minimizing tissue disruption. During the procedure, the surgeon removes the bunion, repositions bones, and adjusts ligaments or tendons as needed. The foot is then bandaged, and patients are monitored in recovery before discharge the same day.

Immediately after surgery, patients experience numbness from anesthesia, which wears off within hours, revealing initial pain and swelling managed with medications like ibuprofen or stronger opioids if needed. A surgical shoe, boot, or cast protects the foot, and elevation is key to reduce swelling—aim for 55 minutes per hour in the first two weeks. Weight-bearing varies: traditional surgeries may require non-weight-bearing with crutches for several days to weeks, while minimally invasive options often allow immediate walking with support. Keeping the dressing dry is critical; showers may involve plastic wrapping. Follow-up appointments start within days to check the incision and remove stitches around two weeks post-op.

Recovery unfolds over several phases, typically spanning three to six months for basic function and up to a year for complete healing. In the first week, rest is paramount: elevate the foot, apply ice (wrapped to avoid direct contact), and limit activity to essentials, using assistive devices like walkers or knee scooters. Pain peaks early but subsides with medication. By weeks two to six, stitches are out, and patients transition to a protective boot; physical therapy may begin to restore mobility and strength through gentle exercises. Swelling decreases gradually, but minor discomfort can persist for six months. Around six to twelve weeks, bones heal sufficiently for normal shoes and light activities, though driving (especially right-footed) is restricted until cleared. For minimally invasive procedures, recovery is faster—often returning to sneakers in six weeks—with less pain and better motion. Full return to sports or high-impact activities takes three months or more. Adherence to instructions, like avoiding tight shoes, prevents setbacks.

As with any surgery, risks exist, though they are generally low. Common complications include infection, nerve damage causing numbness, blood clots, delayed bone healing, or joint stiffness. Bunion recurrence affects about 20% of patients long-term, often due to returning to ill-fitting footwear. Overcorrection, where the toe angles outward, is rare but may require revision. Patients with conditions like diabetes or poor circulation face higher risks. Monitoring for signs like fever, excessive redness, or worsening pain and promptly contacting the surgeon can mitigate issues.

Long-term, most patients report significant pain relief, improved toe alignment, and enhanced quality of life, enabling comfortable shoe wear and activity. Outcomes are best when bunion surgery addresses underlying causes and patients commit to preventive measures, such as wide-toed shoes and orthotics. While cosmetic improvement occurs, the focus is functional; residual swelling may linger for a year, but satisfaction rates are high with proper expectations.

In conclusion, bunion surgery offers effective relief for persistent foot issues, but success hinges on preparation, compliance, and realistic recovery goals. Consulting a specialist ensures personalized guidance.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.