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Forefoot Surgery SURGERY

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Bunions can be painful, causing the need for repair. This article presents a thorough treatment guide for bunions. Covering a variety of topics, from the identification and causes of bunions to the surgical procedures and their recovery timelines, this guide offers a deep-dive into the world of bunion surgery. 

It also answers important questions regarding post-surgery lifestyle, prevention of bunion recurrence, costs, and the potential consequences of untreated bunions.  

pain in bunion

What Is a Bunion?

A bunion is a bony prominence that presents on the inside of the first metatarsal head, situated at the base of the big toe. 

As the space between the first and second metatarsal gradually expands over time, the inner portion of the first metatarsal head protrudes, giving rise to this bony prominence. 

This causes the big toe to press against its adjacent second toe, leading to discomfort.

Bunions are primarily hereditary, but can occur from prolonged wear of improperly fitting footwear. Bunions have the potential to cause significant pain, preventing the ability to walk or wear shoes comfortably. 

Although there are non-invasive treatments available to alleviate bunion-associated discomfort, surgical intervention may become a necessity for severe, painful bunions to fix the deformity.

Who Needs Bunion Surgery?

Bunion surgery is recommended for individuals who are experiencing significant discomfort, pain, or mobility issues due to their bunions. 

The indications for bunion surgery are listed below.

  • Persistent or severe pain that interferes with daily activities, despite non-surgical treatments such as wearing comfortable shoes, using padding and orthotics, and taking pain relievers.
  • Chronic inflammation or swelling that doesn’t improve with rest or medications.
  • Toe deformity, with the big toe drifting towards the other toes, causing issues such as difficulty in walking or standing, and problems fitting into shoes.
  • Inability to bend or straighten the big toe.
  • Failure of non-surgical treatments to relieve symptoms.

Surgical intervention is generally considered the last resort when conservative treatments fail. 

What Happens During Bunion Removal Surgery?

Bunion surgery is a quick procedure that doesn’t require a hospital stay. It will take 1-2 hours for your surgeon to complete.

Bunion surgery  involves IV sedation, a type of anesthesia that makes you relaxed and sleepy. Your doctor will inject a local anesthetic into your foot to numb the surgical site. 

Occasionally, depending on the complexity of the surgery or your overall health, general or spinal anesthesia might be used, which induces full unconsciousness or numbs your body from the waist down.

Listed below are the sequence of events during bunion surgery.

  • Preparation for the surgery: You will be required to wear a surgical gown, replacing your regular clothing. There might be a need to insert an intravenous (IV) line in your arm or hand.
  • Anesthesia Administration: The foot undergoing the operation will be cleaned using an antiseptic solution. In case local anesthesia is the chosen method, the injection might cause a fleeting sensation of stinging pain. If general anesthesia is required, you will be administered medication that will induce sleep.
  • Operative Procedure: Based on the bunion’s severity, the surgeon will make a cut and reposition, or remove portions of the bone, ligaments, and tendons in the affected foot.
  • Wound Closure: The surgeon will close the incision with sutures or staples. They will cover the incision site with a bulky, sterile bandage to reduce the risk of bleeding and infection.  
bunion surgery

How Are Bunions Treated?

There are several different types of bunion surgery. The type of surgery that is right for you will depend on the severity of your bunion and your overall health.  

Exostectomy Procedure

An exostectomy procedure is generally recommended for mild cases of bunions. This surgical procedure aims at removing the bony prominence that causes the bunion, providing relief from the pain and discomfort associated with it. 

During this surgery, the surgeon makes a small incision over the bunion and shaves off the bony prominence. However, exostectomy alone may not always prevent the recurrence of the bunion, as it does not address the underlying structural problem.

Osteotomy Procedure 

Osteotomy is a more comprehensive procedure often considered for moderate to severe bunion deformities. In this surgery, the surgeon cuts the first metatarsal bone and the bone in the great toe to correct the alignment. 

This may involve removing wedges from the bones or moving the bones into a more anatomically correct position. Once the bones are correctly aligned, they are secured with hardware such as screws, plates, or staples to allow the bone to heal in the correct position. 

Sometimes, a fusion at the midfoot (known as Lapidus procedure) may be needed to provide additional stability and correction.

Arthrodesis Procedure

Arthrodesis, or first metatarsophalangeal joint fusion, is indicated for severe bunions accompanied by significant arthritis in the big toe joint. In this procedure, the surgeon removes the arthritic joint surfaces and then uses screws, plates, or a rod to fixate the bones together, allowing them to fuse into one solid bone. 

This eliminates the painful motion from the arthritic joint but also limits the joint’s mobility.

Each of these surgical procedures can take between 30 minutes to 2 hours, depending on the complexity of the case.

 After the surgery, the surgeon closes the incision using sutures or staples, and a post-operative dressing is applied to protect the surgical site and aid in healing

What Is the Recovery Like After Surgery?

The recovery journey after bunion surgery is a gradual process and depends on the procedure that you have done. 

3 Weeks After a Bunion Operation

If you’ve undergone a simple exostectomy procedure, the initial three weeks post-surgery are crucial. 

During this period, your doctor will advise you to bear partial weight on your operated foot. To help with this, a postoperative shoe will be provided which should be worn for approximately 3-4 weeks. 

Stitches would be removed around the two-week mark.

6 Weeks After a Bunion Operation

If your surgery involves an osteotomy or arthrodesis procedure, the recovery timeline will be extended. You will need to remain non-weight-bearing to the surgical foot for about 6-8 weeks post-surgery in a cast or cast boot. 

During this period, your doctor will regularly monitor your progress with office visits and post-operative radiographs. This is an important step to ensure the bone cuts or fusion sites are healing appropriately. 

A knee scooter or crutches can be used during this period to help you stay off of your foot. You can purchase these from Amazon. 

Once you cross the 6-8 week mark and the surgical site is adequately healed, your doctor will allow you to transition into wearing athletic shoes as tolerated.

Rehab After Removal of a Bunion

Rehabilitation following a bunion removal surgery requires physical therapy. Physical therapy will enhance strength, alleviate pain, and reduce swelling. It will also help to prevent stiffness at the surgical site. 

Physical therapy will need to be completed 3 times a week for 1 month.

How Should You Prepare for an Invasive Bunion Foot Surgery?

Proper preparation is important for invasive bunion surgery and it involves several steps. These steps are listed below.

  • Medical Assessment: Prior to surgery, you will need a thorough medical check-up with your family doctor to ensure you are healthy for the procedure. Your doctor will order blood tests, heart tests or any other tests your doctor deems necessary.
  • Medications: Discuss your current medications with your surgeon, including any over-the-counter drugs, vitamins, and supplements. Certain medications like blood thinners may need to be stopped a week before surgery.
  • Anesthesia Evaluation: You will need to meet with an anesthesiologist prior to surgery to discuss anesthesia options and any potential risks.
  • Footwear: After surgery, you will need special footwear such as a surgical shoe or boot. It’s a good idea to get this before your surgery.
  • Home Preparation: Arrange your home for the recovery period. You will need to move your bed to a lower floor if you have stairs. Set up a recovery area with necessary items within easy reach. You should consider getting a shower chair since standing for long periods will be difficult.
  • Fasting: You will need to fast (not eat or drink) for 8 hours before the scheduled surgery.
  • Transportation: Arrange for someone to drive you to and from the hospital on the day of your surgery. 

Can You Drive After Bunion Surgery?

It’s important to avoid driving for at least six weeks following bunion surgery if the procedure involves your right foot. If the surgery is on your left foot, you may be able to drive as soon as one week after surgery. 

It’s important to wait for clearance from your surgeon before resuming your driving activities. It’s strongly advised not to drive with a cast or boot on your foot.

Driving a vehicle while under the influence of narcotic pain relievers should be strictly avoided. These medications can induce dizziness and light-headedness, thereby elevating the risk of an accident. 

Your safety and the safety of others on the road should always come first. 

How Soon Can You Return to Work After Bunion Surgery?

The timeline for returning to work after bunion surgery is dependent upon the nature of your job. For people in sedentary roles, where the foot can be comfortably elevated during working hours, a return to work within 2 weeks is feasible. 

However, it’s important to ensure that you’re not under the influence of narcotic medications while working.

However, if your job entails significant amounts of walking or standing, a more prolonged leave of absence – typically between 6 to 8 weeks – will be necessary to ensure full recovery and the ability to walk comfortably. 

Can You Feel the Screw After Bunion Surgery?

Most people cannot feel the hardware after bunion surgery because the screws are inside the bone. 

In some people, however, hardware from bunion surgery can be felt and cause discomfort. 

Once your osteotomy or arthrodesis site heals, your doctor may suggest removing the hardware several months later. 

Does Shoe Size Change After Bunion (great toe) Surgery?

Your shoe size will change after bunion surgery. Your foot will be more narrow after surgery. 

During the first year after bunion surgery, your foot will be more swollen. 

Once the swelling goes down, you should go to a shoe store and get your feet measured for length and width before picking appropriate shoes.

Shoe size length and width can be measured using a Brannock device. 

Check out this video by SanLuis Podiatry on how to measure your feet using a Brannock device:

How Much Does It Cost to Fix a Bunion?

The cost of bunion surgery can vary anywhere from $3,000-$12,000 depending on the procedure performed. However, in many cases, insurance may cover most of the cost if not all of it. It’s best to call your insurance company to see if the surgery would be covered. 

What Happens if Bunions Go Untreated?

In most cases, bunions do become larger over the years. However, in many people, bunions do not cause pain. You can live with a bunion deformity. 

Simple shoe gear modifications and orthotics can slow down the progression of bunions. Talk to your foot doctor about custom orthotics and shoe gear recommendations.

How Can You Prevent a Bunion From Coming Back After Surgery?

Preventing the recurrence of a bunion after surgery is dependent on maintaining proper foot health and habits. 

1) Proper Footwear: Wear shoes that are comfortable and supportive with a wide toe box. Avoid high heels and shoes with narrow, pointy toes as they can put pressure on the big toe joint, increasing the chance of bunion recurrence.

2) Orthotics: Custom-made orthotic devices can help control foot function and prevent the progression of deformities. 

    3) Foot Exercises: Strengthening foot muscles can help keep your foot and toe alignment in the correct position. This would include exercises to improve your balance and flexibility. 

    4) Healthy Weight: Maintaining a healthy weight can reduce unnecessary pressure on your great toe joint and reduce the chance of bunion recurrence.


    This guide has served as a comprehensive exploration into the world of bunion foot surgery, providing knowledge for patients dealing with this condition. With a detailed description of what a bunion is, the necessity for the surgical procedures, and the aftermath of a bunion procedure, we aimed to address popular topics revolving around this ailment. 

    The crucial part for every patient is to understand that each case is unique, requiring a tailored approach for the best healthcare outcome. Thorough preparation, following post-operative guidelines, and understanding the intricacies of the procedure are key to ensuring a smooth journey through bunion repair.

    Prevention strategies, including the right footwear, orthotics, regular foot exercises, and maintaining a healthy weight, can help prevent a recurrence of a bunion. There are numerous services available to support patients throughout this journey, simplifying the process of getting back on their feet, free from the discomfort of a bunion. 

    It’s crucial to remember that as a patient, your active participation in taking care of the affected body part, filling in necessary patient forms, and staying engaged with your healthcare provider can greatly contribute to a successful bunion surgery outcome.


    The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

    Vaishnavi Bawa
    Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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