Bunions: What to expect from treatment and recovery

Bunions, which are bony bumps at the joint of the big toe, can cause pain and stiffness, making walking or exercising uncomfortable. In this expert guide, renowned consultant orthopaedic surgeon Mr Shafic Al-Nammari, who is specialist in foot and ankle surgery, sheds light on the principal approaches to treatment of bunions and what to expect from recovery.

How can bunions be treated without surgery?

As well as surgery, there are many other treatment options for bunions. Despite the very high success rates of surgical procedures and improved recovery times, all types of operations carry risks and therefore we always advise trialling a range of conservative (non-surgical) approaches to treatment in the first instance.

There are many types of conservative treatment available for bunions, some being more suitable for some patients than others. Depending on the severity of the bunion, its cause and any other conditions which are present in the patient, such as Achilles contractures, the most appropriate treatment can be determined.

A simple measure that all patients with bunions can undertake is to wear flat shoes, which are wide, soft and comfortable, particularly for lengthy periods of time spent standing or walking. Fortunately, for many people this measure is all that is required to diminish discomfort caused by bunions.

People with flat feet or those who over pronate (put excess weight on the inside edge of the feet) tend to put more pressure on the bunion while walking. These patients will likely benefit from a shoe orthotic which is a type of insert placed within the shoe or some form of arch support.

On the other hand, patients who have a tight calf muscle or Achilles tendon, which is found in the heel, can be treated with physiotherapy to stretch the area. This is helpful in reducing pain and restoring normal function, as patients with these issues tend to overload the forefoot while walking.

Additionally, there are a wide variety of pads, spacers and splints to support the area as well as specially modified surgical shoes which can be tailor-made for the patient. As they are at an elevated risk of complications in surgery, patients suffering from multiple medical issues or who are less active often find conservative treatments such as these to be the best solution.

What is involved in bunion surgery?

The aim of bunion surgery is to reduce pain and discomfort and to improve function, through correcting the deformity at the toe joint and narrowing the foot as well as the improving the foot’s structure and function, which is known as biomechanics.

More than two hundred types of surgery can be used to correct bunions and I offer a full range of treatments in my own practice and have also published on an innovative technique used to treat severe bunions.

In order to determine the most appropriate procedure for each patient, there are many factors to be considered including the nature and severity of the bunion itself. The majority of surgical procedures to correct bunions involve:

• releasing tissues which are overly tight
• strengthening tissues which have become slack
• cutting through the bones of the toe to allow them to be returned to their original position (osteotomy)

Metal implants, usually a type of low profile screw, are used to hold the cut bones in place.

Generally, bunion surgery is a relatively simple procedure which only takes around forty-five minutes to complete and can be performed as a day-case with local anaesthetic if preferred. It is also possible to walk immediately after surgery using a special surgical show. Another benefit is that there is no need for a cast after the procedure or for you to be off your feet for a long period while recovery takes place thanks to modern surgical techniques.

What is the recovery process like following bunion surgery?

The recovery process following bunion surgery is relatively smooth. You can return to work after just two weeks if you have a job that mostly involves sitting down, provided that you will be able to maintain your foot in an elevated position (to waist height). Otherwise, you will need to take four weeks off work to recover fully, or after six weeks if your job involves more walking or standing. For patients who have manual jobs or who need to be fully mobile at work, eight or more weeks may be required to make a full recovery, depending on swelling and comfort.

When a patient can return to driving following surgery depends upon which type of car they have (automatic or manual) and on which foot the procedure was performed. For instance, a patient who has undergone surgery on the left foot who has an automatic car may drive as soon as two weeks following the operation as there is no need to operate a clutch with the affected foot. On the other hand, for manual driving or right sided surgery, six weeks are likely needed to recover before returning to driving. Your doctor and car insurer can advise you on when it is safe to do so in your specific case.

If you are considering bunion surgery and wish to discuss your options with Mr Al-Nammari, don’t hesitate to visit his Top Doctors profile and schedule a consultation.