Bunion surgery insights: Types, recovery, and post-operative considerations

In his latest online article, Mr Billy Jowett gives us his insights into bunions. He talks about, the three primary types of surgery and all you need to know about recovery.

Can I get rid of a bunion without surgery?

Surgery is necessary to eliminate a bunion, as non-surgical methods like using specific splints to slightly align the toe won't eliminate the bony protrusion at the inner base of the big toe, which is essentially what a bunion is.

What surgeries are available?

There have been over 50 various surgical approaches for addressing bunions throughout the years. This suggests that we haven't yet identified the perfect surgical method. However, I've narrowed down my approach to three primary operations.

The initial one is called the "scarf" technique, sometimes coupled with osteotomy, which involves cutting and repositioning bones, particularly at the base and within the big toe. Alongside this, the connective tissues on the side leading to the second toe are released, addressing the tendency to pull the big toe towards the second toe during a bunion.

The second option involves fusing a joint in the middle of the foot, known as the Lapidus procedure. By fusing these bones, the protrusion at the inner base of the big toe causing the bunion can be rectified.

The third choice is the first metatarsophalangeal (MTP) joint fusion, which stabilises the base of the big toe. This is employed when there's a pronounced deformity, as greater deformity increases the likelihood of post-operative angulation. Unlike the other operations, fusing the big toe maintains its alignment permanently, though some joint movement is sacrificed. This deficiency can be partially compensated by upward movement in the joint itself. Occasionally, there's a combination of bunion and big toe arthritis, and the first MTP fusion serves to address both issues by eradicating the arthritis and correcting the angulation.

Another infrequently used option is minimally invasive bunion surgery, often referred to as "keyhole" surgery, although it differs from keyhole procedures in other fields. It entails making small incisions and utilising X-rays for guidance. Despite its trendiness in the past, the advantages of this method aren't significant compared to its complexities. 

Generally, these three major surgical options cover the entire spectrum of bunion cases I encounter, ranging from mild to severe.

What is the recovery time for bunion surgery?

Regrettably, there's a notable duration involved as the bones require approximately six weeks to fully unite. Following the scarf and aching osteotomies, as well as the big toe fusion, patients typically wear a post-operative shoe with a sturdy sole for this six-week period. With the Lapidus procedure, which entails fusing bones in the middle of the foot, this time frame tends to be a bit longer. Occasionally, patients might need to wear a plaster for a brief period immediately following this operation.

Unfortunately, post-bunion surgery swelling tends to persist for roughly three months, aligning with the wise advice of one of my mentors: "Three months good, six months better, twelve months best." This timeframe seems to be a reasonable assessment. Normally, patients can begin walking without the post-operative shoe after six weeks, allowing them to resume driving around the same time. However, engaging in sports or physical activities tends to require approximately three months before it can be safely resumed.

How can I reduce swelling after bunion surgery?

During the initial weeks following the operation, I recommend individuals to manage swelling by consistently elevating their foot above hip level whenever feasible. I typically suggest around 45 minutes each hour. After transitioning out of the post-operative shoe, attempting to fit your foot into a reasonably regular shoe can help alleviate swelling to some extent. Additionally, as your activity level rises, the body's fluid circulation improves, facilitating the efficient return of fluid to the heart. This enhanced fluid movement also contributes to the reduction of swelling.

Should I wear compression socks after bunion surgery?

I generally don't recommend the use of compression socks to patients, although it is an available choice that they can consider.

Can I wear heels after bunion surgery?

After bunion surgery, there's usually no issue with wearing heels, except when a first metatarsophalangeal (MTP) fusion is done. In such cases, wearing a small heel is generally fine. However, procedures like the scarf and akin osteotomies or the Lapidus procedure don't restrict movement at the base of the big toe, so wearing heels after bunion surgery is usually not a problem.

Mr Billy Jowett is a distinguished orthopaedic surgeon with over 15 years’ experience. You can schedule an appointment with Mr Jowett on his Top Doctors profile.