Bunions are common foot deformities and one of the most common sources of foot pain. With the exception of wider shoes, padding, and inserts, there is not a lot that can be done to reduce the pain outside of correcting it surgically. While this surgery is very effective when the proper procedure is selected, it seems to have a bad reputation in the general community. This article will discuss this surgery, the proper way to recover from it, and why some people needlessly have a difficult recovery period.
A bunion is a complex foot deformity involving both bone and soft tissue (ligaments, tendons). Usually inherited from one’s parents or grandparents, bunions have several underlying causes. The most common cause is flat feet. Over time, muscular changes needed to adapt to walking with flat feet will contract the great toe towards the second toe, and make prominent the 1st metatarsal head ( the bone one sees sticking out ). This can create pain in the bunion when it is rubbed against tight shoes. Joint pain in the great toe can develop over time due to its abnormal position and eventual onset of arthritis. The great toe can also crowd into the lesser toes.
Treatment often includes conservative measures that either separate the big toe from the second toe next to it, place padding over the bunion bump. Wider shoes may also help relieve bump pain. Orthotics (prescription shoe inserts) may help to lessen the progression of the bunion by controlling it’s underlying cause (usually flat feet). However, the joint changes already in place cannot be reversed. In most cases, surgical correction with an alteration of the bone position and soft tissue tightness is necessary to permanently treat this condition.
Bunion surgery is one of the most common types of foot surgery performed. In the majority of cases, the bone involved in the deformity must be cut and moved over towards the central part of the foot. Simply shaving the bone ‘bump’ will not correct the deformity, as the bunion will continue to develop over time, with some patients having a return of their symptoms in as little as a few months. The bone that is cut during a bunion procedure is the 1st metatarsal, the long bone whose head creates the bunion bump at the base of the big toe. This bone is angled too far away from the 2nd metatarsal next to it, owing to a very complicated and slowly developing series of events related to one’s foot structure. The bone position must be moved back over so it is in proper angle alignment with the 2nd metatarsal (essentially parallel to it, not angled outwards). The area where the bone is cut in surgery is dependent on how big of an angle the bone creates. If the angle is generally under 14-15 degrees, a cut in the area near the head of the bone can correct the bunion. This has an advantage of being easier to heal, as it is more stable. If the angle is more than 15 degrees, a cut in the bone back at the base of the bone (near the mid-length aspect of the foot) is needed in order to fully correct the abnormal angle. This area is not as stable, and recovery usually demands non-weight bearing until the bone heals.
The cut bone needs to be secured together to help it heal. Essentially, the bone cut is a controlled fracture. The bone will heal at a faster rate by holding it closely together. This is typically accomplished with internal screws or an external wire. This process takes 6 weeks at least, sometimes 8-12 weeks depending on the location of the healing bone and one’s state of health. Any excessive motion or pressure at the bone cut site while it is trying to heal can result in a delayed healing, or even healing that occurs in an abnormal position.
The recovery process for bunion surgery should be relatively uneventful. Most cases will have moderate pain for a couple days due to the incision in the skin. If one has a lower pain tolerance, this pain may be more severe. The pain slowly evolves into aching and throbbing discomfort from the inflammation of the healing process, which lasts for a week or two. Both of these periods of pain are usually made tolerable through pain medication, anti-inflammatory medications, and the all-important icing and elevation necessary after foot surgery. To be certain, no bunion surgery recovery is pain-free. As in all surgical procedures, one needs to expect some level of discomfort following the procedure, even when pain medication is used. The difference between those who have a good recovery from bunion surgery and those who have a bad recovery is how closely they follow their surgeon’s post-operative instructions. This is the key to keeping pain and discomfort to a minimum, and limited to a few weeks following surgery.
The reason why some people have difficult recoveries from bunion surgery, and therefore why the procedure sometimes can have a poor reputation, is not due to the surgery itself, or the skill of the surgeon. In most cases, difficult bunion recoveries are due mainly to too much activity following the surgery. In many other types of surgery, such as abdominal or pelvic surgery, one usually feels lousy as a whole for the time following the surgery. With foot surgery, the rest of the body feels normal while the foot itself feels uncomfortable. In this situation, many people are tempted to resume some of their normal routine and activity level a few days to a week following surgery. Unfortunately, this activity will directly lead to more inflammation of the foot, and therefore more pain. This heightened level of inflammation, spurred on by gravity pushing fluid into the foot and by the strain of foot motion and the weight of the body, will often persist for several weeks following the procedure, and can lead to delayed healing of the bone. Once this process starts, it is difficult to reverse it without complete activity rest. This ultimately can lead to a difficult recovery process, and therefore to a bad reputation of the procedure. If one carefully follows their surgeon’s instructions, the likelihood of this recovery difficulty is significantly lessened. To be certain, bunion surgery, like all other surgery, can have potential complications. These include infection, nerve damage, scar tissue, reduction of big toe joint motion, and chronic swelling. These can also be a source of pain following surgery, and can delay the healing. However, the vast majority of bunion procedures do not have these complications. If one smokes, the healing of the bone will be delayed due to the chemicals in tobacco smoke. Smokers do tend to have more recovery problems than non-smokers, so this must be kept in mind when considering bunion surgery. Most surgeons recommend smoking cessation during the recovery process, especially if there are other health problems present.
In general, most bunion surgeons recommend home rest for a couple weeks. This rest period can include some light movement around the house, and light home chore activity for less than ten minutes after the first week. Icing and elevation are absolutely necessary, and must be performed regularly to ensure a comfortable recovery. If one has a sit-down job at work, returning to work after two weeks is possible as long as one can elevate their foot on a chair, and does not have an excessive long commute where the foot would be dangling in the car for awhile. If one has had surgery on their right foot, driving is generally not possible until the foot is nearly healed. When one keeps in mind all these activity restrictions, and follows their surgeon’s instructions carefully, the likelihood of a comfortable recovery period is high. Of course, these recommendations are generalized, and may not reflect the specific instructions of one’s actual surgeon, who may be more stringent or liberal depending on his/her experience and personal preferences. One should always follow their own surgeon’s instructions, and simply take this article as a general guide.
If one has a painful bunion, surgery should be considered as a viable option to relieve the pain. Despite the reputation of the procedure, this surgery is very successful, involves only moderate and temporary post-operative pain, and can have a gentle recovery course as long as the proper instructions are followed.