What the operation is
Most bunion operations are an osteotomy. The surgeon removes the bump, cuts and realigns the long bone behind the big toe (the first metatarsal), often with a Z-shaped cut called a scarf, and sometimes cuts the big toe bone itself too (an Akin osteotomy). Tight tissue between the first and second toes is released, and the bones are held with small screws or a staple that usually stay in for good. Removing the bump alone rarely works, because the toe drifts back.
Severe deformity or arthritis may need a fusion of the big toe joint, or of the joint at the base of the first metatarsal, and some operations need a spell with no weight on the foot. Surgery is usually a day case, under a general anaesthetic, a nerve block or both. In some NHS services a specially trained podiatric surgeon does the operation.
Sources 1, 2, 3, 4, 5, 6, 7
Who it's for
It's for bunion pain that affects walking and daily life despite wider shoes, pads and other simple measures: not to improve how the foot looks, and not to stop a painless bunion getting worse. Our bunions guide covers that decision.
In a Finnish trial of 209 people with painful mild to moderate bunions, a year after the operation 83% felt better, against 46% with insoles and 24% on a waiting list, and walking pain was about 19 points lower (out of 100) than in those waiting. By 2 years, after most people had been operated on, pain was similar in all the groups, so waiting a year didn't harm the final result. A Cochrane review rated this evidence low certainty, and no trial has compared bunion surgery with a sham operation.
Sources 1, 6, 8, 7, 9, 10, 11
What recovery usually looks like
NHS leaflets agree on the shape of recovery, with different timings. Your own team's plan comes first.
- Weeks 0 to 2: a bulky dressing holds the toe in place. Rest with the foot raised most of the time, walking only for essentials in the post-op shoe.
- About 2 weeks: a wound check and the stitches out. Toe movement often starts now or at 3 weeks; some teams keep the bandage on to 6 weeks and start the toe moving then.
- About 6 weeks: a clinic check, often with an X-ray, and out of the post-op shoe into a wide, supportive one. One podiatric surgery service changes to a trainer at 4 weeks.
- 6 to 12 weeks and on: walking built up gradually. In one service's leaflet the bones take about 6 weeks to heal and at least 12 weeks to regain full strength; another puts average bone healing at about 4 months.
- Swelling: commonly up to 6 months, and sometimes a year. Full recovery often takes about 6 months, and occasionally up to a year.
Sources 6, 2, 4, 12, 13, 14, 3, 5, 7
Complications, and how often people are happyEmerging evidence
The British Orthopaedic Foot and Ankle Society (BOFAS) tells patients that complications happen after about 1 in 20 operations, and that up to 1 in 10 people may not be happy with their surgery. A review of 229 studies found 10.6% dissatisfied.
NHS consent leaflets list infection (deep infection in under 1 in 100), numbness near the scar (usually settles, sometimes permanent), a stiffer big toe, pain under the ball of the foot, bones that don't heal (more likely in smokers), over-correction so the toe points the other way (about 1 in 100), screws that can be felt, blood clots and complex regional pain syndrome. Stiffness usually doesn't matter, though dancers and athletes may notice it. One NHS board gives an overall success rate of about 80%.
Sources 6, 15, 2, 5, 3
Teenagers and older adults
The American Academy of Orthopaedic Surgeons (AAOS) says surgery for a teenager's bunion isn't recommended unless pain is severe despite shoes and insoles, and usually waits until growth is nearly complete, because bunions operated on earlier often come back.
In later life, the post-op shoe, crutches and swelling make the first weeks a falls risk. BOFAS expects a walking aid for 2 to 6 weeks, and in a trial people felt steadier in a flat, rigid post-op shoe than in a heel-weight shoe.
Sources 8, 6, 16