How does Bunion Surgery Affect Our Lives?

A Foot Surgeon's Reflection

The honest answer teeters between two cliffs; one reflects success and a positive change in life, comfort, and greater freedom for shoe selection, while the other has a darker story that drifts between problems and absolute disaster.

For every hundred success stories, there will be ten stories where the recipient of surgery wishes they had never had treatment. I will cover the distinction between impact and risk in the article. Out of the 10%, most problems arise through a slower healing process than the patient initially expected.

Comparing progress with others can turn into a fool's paradise. You will find real data taken from a reliable source below.

Read my article, Looking for Information About Bunion Surgery.

Great Stories of how bunion surgery affects our lives

I have seen patients with tears of emotion after their foot has improved in shape following surgery. Perhaps for many, this is the key objective. Others want to wear better shoes, which essentially means a style they feel happy with. Should High Heels Be Banned?

On one occasion, a patient found her hip pain had disappeared entirely. She had walked so poorly due to her foot problem for so long that her posture had become altered. To many, these changes may seem small, but for others, a deformed foot can be visually unappealing, and life changes accordingly once corrected.

In a rare but exciting moment, a 34-year-old fitness instructor was back at work in two weeks. This is wonderful, but not quite so usual; however, the patient was ecstatic. Now I would like to claim the prize for such a success, but that would be sheer arrogance, as healing is down to the patient, not me. I also believe that my physiotherapy colleagues continually advance recovery because wound stability, joint movement, and posture correction are vital to recovery and overall satisfaction. Sure, I wielded the knife that made the cuts, I used my skill to correct the bunion, but after theatre (O.R.), that was me done.

Problems and Patient Concerns

My patients had access to experienced nurses and podiatry colleagues, so unless there was a problem, my patients followed our advice. Now I don't claim to have been perfect, but I believed that letting my patient know when things may not have gone quite to plan was the right thing to do.

The truth is that not all surgery goes to plan. Infection can occur, slow healing may arise, and the end result may not be what anyone had expected.

A procedure may lead to toe stiffness. In 1988, I operated on a young woman with a large bunion. It all went well. But it took her three years to gain a full range of movement, from a post-operation 25 degrees to a full 60 degrees later. The textbooks don't provide this information, so we must pass it on. Time and experience make us better.

The top overall problem recorded by an audit system for 10,153 episodes of foot surgery involving the big toe joints showed that 146 patients experienced joint pain and after stiffness at three months. This represents a risk of 2.7% for stiffness and pain to arise. (Royal College of Podiatry, London. Data Recorded for the period between 1/1/22 - 31/12/24).

Patient Fault

As methods have become more complex and equipment sophisticated, the truth is that we cannot always anticipate all aspects of surgery. Patient fault or non-compliance occurs in approximately 0.8% of cases, which accounts for a relatively low contribution. Yes, patients can contribute to problems by doing too much; however, I believe that much remains outside the control of both the patient and the clinician.

The screw that breaks during surgery is a nightmare and has to be replaced, which means removing the end buried in bone. Rare, but even metal has fatigue. Fixation problems arise in 2% of cases, making this the second most significant complication recorded in the RCoP audit records.

Facebook, as a source, shows a cross-section of problems

In many cases, my heart goes out to people on the Facebook page above. Some have contacted me directly for advice, and what is apparent to me is the breakdown in patient-clinician relationships. Now, for the most part, the site shown above is a private site in the USA, and I am delighted to be able to make a few comments, which I hope are helpful.

Wounds can take months to sort out, and in rare cases, we have to go back and surgically clean out necrotic (dead) tissue. This comes with the role, and calling it out when a nurse has struggled with wound healing is essential. Once the wound is thoroughly clean, restored with a good blood supply, and intended to bleed, healing can advance. The impact can lead to months before the wound settles. There may be a lack or increased sensation, and scar tissue is a big problem in young patients under 25 years.

Healing can be grouped into bone, wound and complete breakdown (necrosis). Collectively, this accounts for 2.6% of 10,153 surgical cases. Wounds that require further surgery occur in approximately 0.03% of cases, which is a tiny percentage. Without doubt, these types of wound problems will take longer to heal. The risk might be low, but the impact is going to be notable and set people back weeks and sometimes months.

Impact

Impact means complications affecting mobility, work, family life, holidays, shoe fit, recovery, and a range of everyday activities, from bathing and sleeping to shopping and hobbies. And then there is pain and discomfort that is prolonged. Of course, pain is not normal after 6-8 weeks, generally speaking, and peak pain subsides 48-72 hours after surgery.

Broken hardware, including surgical plates and screws, can break during recovery. It shouldn't happen, but it does. When a problem arises, one must address it efficiently. Some metals can cause allergies, and this is often not known until later. The dark tattoo effect gives the game away, together with discomfort. I covered this in my patient guide books . Tom's metallosis is one of many cases described in 'What You Need to Know About Bunion Surgery'.

The complete patient guide includes both ebooks plus a section on surgery.

Grading the Impact of a Problem

Some of my colleagues and I collaborated on developing an IMPACT ASSESSOR, which grades impact on a scale of 1 to 5. This impact factor is associated with how it affects our lives after surgery, but we can also use it to inform patients before they go ahead with surgical treatment.

Rather than owning up to a problem, some surgeons, as indicated by Facebook (FB) comments, appear to be reluctant to engage with anyone who represents poor results.

FB Case Histories

#1 One case reported on the Facebook page was an 18-year-old female with a congenital club foot and had her toe fused (arthrodesis) as well as other hindfoot surgery. The wound became infected, and one of two screws broke. This could be regarded as an impact level 4-5. The foot deformity was very complex and represented a challenging correction. It is more than likely that the patient will require some form of amputation.

#2 Another case involved a deformity that was undercorrected. Again, impact level 4 would be likely as second surgeries leave more stiffness and take longer to recover.

Complex regional pain syndrome (CRPS) is a rare but horrible condition, and I have seen plenty and have written about it, but it is often missed.

Read What to expect after bunion surgery. This article covers different types of surgery with short videos.

What’s the Worst-Case Scenario?

Well, you may not survive the operation. Is this the worst-case scenario? If you went in for bunion surgery, you would not expect to die. In one exceptionally rare case, a surgeon gave adrenaline that the patient was allergic to. The patient died. Of more relevance, another patient died of an overwhelming infection that caused septicaemia. This was called necrotising fasciitis, not to be confused with the usual common fasciitis in the foot.

The flesh-eating condition occurs so swiftly that death arises, and the heart stops. Both of these cases were rare. The first problem can be prevented by undertaking the World Health Organisation's pre-surgical checks, introduced into surgery in 2008.

The second problem is difficult to predict, as it can occur in healthy patients. There is no way of knowing in advance if this can happen. This type of risk is very, very low, but the impact of such a condition occurring is very high. The same condition might require amputation of a leg. All of this is pretty remote from the planned surgery. We call this a Level 5 impact risk, and the Royal College of Podiatry first developed its system on a trial basis in 2010, launching it in 2014. I published the basis of risk and impact in two books, Morton’s Neuroma (2018) and A Complete Patient Guide to Bunion Problems (2025).

There is No Such Thing as Simple Surgery

The one thing everyone must appreciate is that there is no NO RISK. In the RCoP data, 80% of episodes had no problems that impacted patients' lives after bunion surgery.

Some problems arise, and we might anticipate these, but these only have a minimal impact. Such problems are not complications but inconveniences. Swelling and pain after surgery are expected and, as such, form a Level 1 impact risk.

You may not be able to wear shoes after surgery, but you will be able to in a few weeks, or a month to three months, depending on the complexity of the operation. Of course, no two patients heal in the same way. If swelling continues, it may escalate to a Level 2 impact risk. This is still minor when compared to the level 5 impact risk. 

The impact goes further and affects income, causes depression, leads to job loss, and strains marriages. The surgeon may say this is a 1% risk, but the impact may be 100%. High risk, as in 1-3, maybe 20%, but the effect may be low, at say 5%, and temporary. High-impact risks are often permanent and, at best, long-lasting. Few surgeons still relate to impact and prefer risk. There are arguments that we don't want to deter patients from having useful surgery, but there are patients who have minimal deformity, no pain, and may consider surgery for the aesthetic benefits. In these cases, I would advocate caution.

This article is not intended to scare people, but to redress the balance that if you have a problem, it is more likely not uncommon, but frustrating. It is far better to go back and discuss concerns rationally without blame seeking. It is also rare that clinicians won't do their best to help and support you, but even then, time is an integral part of the healing process; healing alone is not the only guide to success. Bone takes months to settle, and inside the foot, the swelling you see is just the tip of the iceberg.

The impact grade table is part of the Guide to PASCOM-10 and provides further details on risk impact (2018). It is available on the Royal College of Podiatry (UK) 's PASCOM-10 website, which has an open-access platform.

Thanks for reading 'How Does Bunion Surgery Affect Our Lives?' by David R. Tollafield. The views within this article are not intended to reflect those of the Royal College of Podiatry. Readers can use the CONTACT on this site to ask questions.

David is a past Fellow of the RCoP and retired in 2018 as Consultant Podiatric Surgeon, having practised in NHS and independent hospitals in the UK, and partially trained in the USA in 1981 & 1990. He now continued to write about foot health and podiatry as an independent author and publisher under Busypencilcase Communications & Publishing.

ConsultingFootPain is part of Busypencilcase Communications & Publishing.