Bunion surgery (bunionectomy) at Highgate Hospital

The bony growth on the joint sometimes causes your big toe to turn in towards your second toe.

Symptoms include pain, swelling of your big toe and, as the bunion sticks out, it can often rub on the inside of your shoe.

The cause is not always known - there may be a deformity of the joint, called hallux valgus (hallux means big toe, valgus means bent outwards). Or it can be as simple as ill fitting footwear not allowing enough width to fit the toes in their natural position.

Sometimes bunions are associated with arthritis in the joint at the base of your big toe. Left untreated bunions can continue to grow and become more painful.

Treatment can help ease the pain. You can wear good supporting footwear - narrow, pointed shoes are best avoided. Painkillers can help, as can comfortable insoles and padding over the bunion. However, surgery is most effective if symptoms are not easing. The operation to remove bunions is called a bunionectomy.

What happens during a bunionectomy operation?

Bunion surgery can be performed under local or general anaesthetic. The operation usually takes between half an hour to an hour.

There are several types of bunionectomies. Some involve removal and realignment of the bones in your foot. Mild bunion problems can sometimes be resolved using soft tissue release or tightening. For some very severe cases bones of the big toe are fused or the bunion is cut out along with some of the bone at the base of the toe. Be sure and discuss which type of operation you will have with your surgeon.

With any type of bunionectomy, your surgeon will make one or more incisions (cuts) near your big toe. They will use instruments to trim the bones and remove the bunion. Wire, screws or plates may also be used to hold the new joint in place.

After bunion surgery

Depending on what procedure is used you should be able to go home the same day of the surgery. In some cases an overnight stay is required. Discuss your length of stay with your surgeon.

You may need to wear a plaster cast or dressing. You will be given a surgical shoe so you can walk on your heel. You will need crutches to move around.

In the first few weeks following your operation, your foot and ankle will be sore and swollen. You will need to spend most of your time with your leg raised so that the swelling settles.

You will not be able to wear normal footwear for at least three to four months after surgery. When you do transition to normal shoes it is recommended they are wide-fitting and have low heels. Avoid any narrow, high-heeled shoes that might put pressure on the surgical area.

What are the complications of bunion surgery?

Any surgical procedure may result in complications. These could include:

General complications:

• Pain
• Bleeding
• Infection of the surgical site (wound)
• Scarring
• Blood clots (DVT - deep vein thrombosis)
  

Specific complications in bunionectomy may include:

• Nerve damage -  This can lead to numb areas of skin, which should heal, but can sometimes be permanent.
• Continued swelling and pain.
• Problems with bone healing -  If the bones of your toe are cut or reshaped during surgery, there is the potential for problems with the healing process such as the newly reset bone shifting before healing is complete. A further operation may be required if this happens.
• Loss of movement in big toe - Though this should improve over time, some stiffness can be permanent.
• Pain in the ball of the foot - This can occur when standing or walking, and may require that you wear an insole in your shoes.
• Bunion coming back - This can occur should the big toe become misaligned again, or if arthritis causes damage to the joints. 
• Complex regional pain syndrome - a condition that causes long-term (chronic) burning pain in one of the limbs.