A bunion or hallux abducto valgus is a deformity of the first toe. It is characterised by a “bump” at the first metatarsal head and is a malalignment of your big toe joint. Surgery may be advised if non-surgical treatment options do not relieve the discomfort/problems of the bunion bone. Conservative treatment measures include appropriate footwear, modifications to footwear (such as padding), and custom orthotics. A distal chevron osteotomy is an appropriate procedure for mild to moderate deformities; severe deformities require other procedures.
Bunion toe surgery involves an incision over the bunion bone. The first toe joint is opened and the bony lump is then removed. The first metatarsal bone is cut, repositioned and fixed with a screw or wire. The soft tissues of the joint are tightened to straighten the toe.
Bunion foot surgery is usually performed as a day case, provided that you are medically fit, and have someone who can collect you and look after you after the operation. If you have medical problems such as diabetes, asthma or high blood pressure, you may have to stay overnight after surgery.
Usually the surgery is performed under a general anaesthetic. Alternatively, an injection into the back, leg or around the ankle can be performed to make the foot numb while you remain awake. Localanaesthetic is injected into the foot while you are asleep to reduce postoperative pain. You will also be provided with pain relieving medication after the surgery.
Your foot will be dressed and bandaged after surgery and fitted into a special post-operative shoe. This allows you to walk immediately after surgery, although you must limit the time on your feet. You will be required to wear this shoe day and night for approximately four to six weeks following bunion surgery.
Returning to work depends on what you do and how you get to work. If you have an office job that allows you to elevate your foot for the majority of the day you could perhaps return to work after one week. On the other hand, if you have a heavy manual job you may be off work for up to three months. If you need to drive to work, this can also affect when you can go back. It also depends on which foot is being operated on.
Once you are back into comfortable shoes, you may be able to start driving again. You must be comfortable and not too stiff before trying to drive. It is best to start by driving short distances. Remember, if you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. As a guide, an automatic car can be driven approximately 3 weeks after surgery and a manual car approximately 6 weeks after surgery.
When you are wearing normal footwear you can start gently exercising your foot and walking further every day. When you are comfortable doing this you can start gentle running and stretching. Impact sports can follow as comfort dictates. Everyone is different in how quickly they can resume exercise again: be guided by your own body’s reactions and the advice of your surgeon. The majority of people can resume most of their previous activities within 2-3 months of bunion surgery.
Bunion surgery is very effective in the vast majority of patients. Research shows that 96% of people who have had bunion corrections are satisfied with their results. Although it is unlikely, there are complications that can arise following surgery. These can include infection, stiffness of the joint, nerve injury and wound healing difficulties. Recurrence of the deformity is uncommon.