What to Expect After Bunion Surgery
- David Tollafield
- Aug 27
- 4 min read
It is curious to read posts from different people and follow their experiences after having their foot operated on. Although podiatric surgeons are fewer in the UK than in the USA, I believe that both podiatric and orthopaedic foot surgeons offer sound advice. In reality, many people seem to be searching in the dark, failing to understand why they are not improving faster.
Videos are included in this article, which show illustrations only. All are under two minutes long.
Read related articles. Looking for information after bunion surgery, & How does bunion surgery affect our lives?
The first port of call is to examine the advice given and in what format. ConsultingFootPain has been around since 2014 and focuses on patient advice. I have written a short article on facts and fact sheets as well as published books on the subject of bunions and other foot conditions.
There are many operations performed for bunions (hallux valgus). We used to say over 100, but there's a good chance there are more. Many procedures have been abandoned as more reliable techniques have been proven effective. Here are a few reasons why bunion surgery is so diverse.
Extent of deformity.
A combination of other foot problems, such as hammer toes or dislocated toes.
Patient age and mobility.
Surgeon preference.
Principal Operation Methods
Three main types of surgery exist and can be described as:
Osteotomy (includes Scarf, Akin, Chevron).
Arthrodesis (includes Lapidus).
Arthroplasty (includes Keller and replacement).
The osteotomy is the main aim. It preserves the joint while also correcting the deformity. In many ways, this type of procedure offers faster recovery if the internal fixation (screws) is stable. Walker casts made of removable two-piece components allow early mobility. The most common procedure performed today is probably the Scarf osteotomy. See video 1.48 min. Source UK. No voice over.
The arthrodesis is very popular because it may be more reliable, which means recurrence of the deformity can be better assured; however, it permanently stiffens the toe. Screws or plates are used to ensure the joint fuses into solid bone. The LAPIDUS is a different fusion of the main metatarsophalangeal joint. Because the bone is stabilised further back in the foot, more correction can be achieved for higher angles of deformity.
Arthrodesis of the first toe joint - video 1.59 min. Source USA.
Lapidus fusion. Base of metatarsal - video 1.32 min. Source South African. US English.
This is often unpopular with women and those wishing for a variable heel height.
The last procedure is called a salvage procedure. This comes in the form of removing bone or using a plastic or metal joint. A newer procedure for replacing cartilage has been popularised and shown as one of a number of replacement procedures. Interestingly, this video contrasts the arthrodesis procedure of the same joint. Video 1.30 min. Source USA.
Taking both bulleted lists, we can see how much variation can arise between conditions and techniques. Put another way, because of the variations, every operation carries different outcomes. The outcome is the pathway to the end goal.
Expectations After Bunion Surgery
If patient A says I was back on my feet within 10 days, she is one lucky lady. If patient B says, 'It's taken me four weeks before I could walk,' that is still pretty good. However, if someone says they are not mobile or cannot wear any shoes at three months, then something may not be right. The timeline ideally represents improvement over time, but varies for each person.
Recovery
We all heal at different rates, so a wound may close and stabilise within 10 days, but equally may take 3 weeks. Minor wound problems arise, with a 2% risk of delayed healing. Infection is less common but should be dealt with quickly to prevent the wound from deteriorating. A compromised incision line can take 6 weeks or more to heal.
The foot will swell. Some have more swelling than others, and so shoe fit and comfort will alter.
When a neighbour moved next door, she had just had bunion surgery. Desiring more mobility, I provided her with a removable two-piece moulded walker cast-boot. Seventy per cent of people find these valuable because they appreciate the early function, which helps reduce swelling.
There is no doubt that too early expectations lead to disappointment and wound problems. The need to balance rest, elevation, and swelling control is a significant priority to avoid pain and complications.
Surgical teams may have dedicated nurses to follow through after an operation, and then there is the all-important physiotherapist. However, in truth, fewer surgeons engage a physiotherapist for recovery than those who do. The physio works to ensure the correct posture when learning to walk and ensures that correct muscle balance is achieved. A pain in the back or hip after foot surgery is not ideal. There might be many who say you can do your own physio; that's fine if there are good instructions.
This article does not tell you how to recover; that should be down to your surgeon and the team. However, there is a right way and a wrong way. Get it wrong and you will have more pain and delayed recovery, and that is not part of our timeline of expectation.
Full recovery can take 6 - 12 months, but functional recovery should be earlier. This means you can return to work, undertake various tasks, and resume driving your car, but it depends on all of those bulleted points, which highlight the variations. Sporting activities may take longer depending on the type of sports.
Remember, there is no one time frame for recovery for everyone. My best tip is to only compare like for like:
same procedure.
same deformity and problem.
same gender.
same age range.
same body morphology (body shape.
Even then, there will be variations between race and psychological attitudes.
Comments