What is a bunion?

A bunion is a bony lump on the side of your foot at the base of your big toe.

Bunions tend to run in families. They are more likely if you have stretchy ligaments (hypermobility).

Wearing shoes increases the risk of getting bunions, especially if they have high heels, pointed toes or badly designed soles. Some people with bunions have arthritis in the big toe joint, but many people have no other joint problems.

What are the benefits of surgery?

Your big toe should be straighter, so your foot should fit more comfortably in a normal shoe.

Are there any alternatives to surgery?

Putting padding over the bunion or a spacer between your big toe and second toe can help give you relief from the pain caused by the bunion rubbing.

Using wide-fitting shoes from a good-quality shoe shop may be enough. If not, the orthotics (surgical appliances) department at the hospital will be able to give you advice about special shoes.

What will happen if I decide not to have the operation?

Your surgeon can ask an orthotist to see you. They are experienced in treating foot problems using insoles and shoe modifications.

Bunions do not get better without surgery. Most bunions slowly get worse with time. Wearing sensible footwear will usually prevent them from getting rapidly worse. The skin over the bunion can become inflamed where it rubs on the inside of your shoe. Sometimes your skin can get infected and cause an ulcer. Aching in other parts of your foot is common but this is caused by other related problems with how your foot works rather than the bunion itself.

What does the operation involve?

Various anaesthetic techniques are possible.

The operation usually takes 30 minutes to an hour.

Your surgeon will discuss with you which of the following procedures the operation is likely to involve.

• Removing the bunion.
• Releasing the tight ligaments and tightening stretched ligaments.
• Cutting and realigning the bones of your big toe.
• Stiffening a joint (arthrodesis).
• Straightening one or more of your other toes.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. Nicotine is known to prevent bones from healing.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and even cause death.

General complications of any operation

• bleeding
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• blood clot in your leg
• blood clot in your lung
• difficulty passing urine
• chest infection

Specific complications of this operation

• damage to nerves
• problems with bone healing
• loss of movement in your big toe
• severe pain, stiffness and loss of use of your foot
• pain in the ball of your foot
• over-correction of your big toe
• the deformity coming back

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home the same day or the day after.

Spend most of the time during the first week with your leg raised so that the swelling settles.

It can take 6 weeks or longer before the swelling has gone down enough for you to wear a normal soft shoe.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

The swelling often takes up to 6 months to go down completely.

Summary

If you have a bunion that is causing pressure and pain, surgery should straighten your big toe and make your foot fit more comfortably into a normal shoe.

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