An incision is made along the inner side of the big toe. The bony prominence is removed and the first metatarsal bone is cut with a small saw, repositioned, and fixed with one or two screws. An additional osteotomy of the big toe bone (Akin osteotomy) may be performed to further straighten the toe. The exact type of osteotomy (scarf, chevron, or Lapidus) depends on the severity of the deformity. The operation takes 45–90 minutes and is usually performed as a day case.
Surgery is recommended when a bunion causes significant pain, difficulty with footwear, and functional limitation that has not responded to non-operative measures. Surgery should not be performed for cosmetic reasons alone. The decision is based on pain and functional impact rather than the appearance of the foot.
Wide, comfortable footwear, bunion pads, toe spacers, orthotics from a podiatrist, pain medication, and activity modification. These measures can manage symptoms effectively in many patients.
Pre-assessment may be required. Buy a pair of roomy trainers for after surgery. Arrange for help at home as mobility will be limited. Plan time off work: two to three weeks for sedentary jobs, longer for standing or manual roles.
Research shows approximately 85% of patients are satisfied with bunion surgery. The aim is to reduce pain, improve big toe alignment, and make footwear fitting easier. However, the foot may not be perfectly straight, and some stiffness of the big toe joint is expected.
SwellingExpected
The foot will be swollen for several months after surgery. This is normal and gradually settles.
Stiffness of the big toeCommon
Some reduction in big toe movement is expected and is usually not a functional problem.
Scar tendernessCommon
The incision site may be sensitive for several weeks.
Transfer metatarsalgiaUncommon
Pain under the ball of the foot (second toe area) due to altered weight distribution.
RecurrenceUncommon
The bunion may gradually return over time. Occurs in approximately 5–10% of patients.
Non-unionRare
The cut bone may not heal, particularly in smokers. May require further surgery.
Nerve injuryUncommon
Numbness along the big toe from damage to small sensory nerves. Sometimes permanent.
InfectionUncommon
Wound infection requiring antibiotics.
Over-correctionRare
The big toe drifts too far in the other direction.
DVT or PERare
Blood clots are rare with foot surgery but remain a risk.
CRPSRare
Complex regional pain syndrome is a rare complication causing chronic pain.
Usually performed under general or spinal anaesthesia with a local anaesthetic ankle block for post-operative pain relief. Can sometimes be performed entirely under local or regional anaesthesia.
A special post-operative shoe or boot is worn for four to six weeks. Weight-bearing is through the heel. Swelling is significant and takes three to six months to fully settle. Driving resumes at six to eight weeks. Normal shoes (roomy trainers) at six weeks. Fashionable footwear may take three to six months. Full recovery takes six to twelve months.
Wound check and X-ray at two weeks. Further review at six weeks. The screws are usually left in place permanently unless they cause irritation.
Can the bunion come back?
There is a 5–10% chance of recurrence. Wearing appropriate footwear helps maintain the correction.
When can I wear normal shoes?
Roomy trainers from about six weeks. More fashionable shoes from three to six months, though narrow or high-heeled shoes should be avoided long-term as they may contribute to recurrence.
Why is the foot swollen for so long?
Foot swelling after surgery is normal and related to the dependent position of the foot. Elevating the foot regularly helps. Most swelling settles by three to six months.
Will the screws need to be removed?
Not usually. Screws are only removed if they cause discomfort, which occurs in a small minority of patients.