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Bunions: Should I Have Surgery


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Bunions: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Bunions: Should I Have Surgery?

Get the facts

Your options

  • Have bunion surgery.
  • Don't have surgery. Try other treatment for bunions.

Key points to remember

  • Surgery for bunions usually isn't done unless you have already tried other treatment and it did not relieve your pain. Other treatment includes wearing shoes with lots of room for your toes and using pads and supports in your shoe for protection and comfort.
  • Surgery may be right for you if your toe is too painful, if your bunion is very big, or if you can't easily do your daily activities. About 70 out of 100 people who had surgery for bunions were happy with the results. That means that 30 out of 100 people were not happy with the surgery results even though they had less pain and their toe was straighter.1
  • It's not clear how well bunion surgery works or which kind of surgery is best. How well the surgery works depends on how bad your bunion is, the type of surgery you have, and your surgeon's experience.
  • Your expectations will play a big role in how you feel about the results of surgery. If you want surgery mainly to improve the way your foot looks, you may be disappointed.
FAQs

What is a bunion?

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be swollen and tender.

What are the risks of bunions?

A bunion can hurt and make it hard to walk. Shoes may rub on the bunion, causing pain, blisters, calluses, or sores.

You could also get skin and bone infections around the bunion, especially if you have diabetes or peripheral arterial disease. If you have one of these problems and you start to get sores, talk to your doctor.

Some people are embarrassed by how their bunion looks.

What are the types of bunion surgery?

There are more than 100 surgeries for bunions. It's not clear which type of surgery is best. Surgery needs to be tailored to your condition. More than one procedure may be done at the same time.

Types of bunion surgery include:

  • Removing the part of the foot that is bulging out. This procedure is called exostectomy or bunionectomy.
  • Realigning the tissues around the big toe joint.
  • Making small cuts in the bones of the foot and moving the bones into a more normal position.
  • Removing bone from the end of the first metatarsal bone. Both the big toe and the metatarsal bones are then reshaped.
  • Fusing the big toe joint. The surgeon removes part of the joint so the bones join together, or fuse.
  • Fusing the joint where the metatarsal bone joins the mid-foot.
  • Implanting all or part of an artificial joint.

How well does bunion surgery work?

It's not clear how well surgery works or which surgery is best. How well the surgery works depends on how bad your bunion is, the type of surgery you have, and the surgeon's experience.

How well surgery works also depends on what you expect. After surgery, you won't be able to wear some types of shoes. For example, you will need to avoid high heels and narrow shoes. Your toe may be stiffer and less flexible compared to your other foot.

It's important to know that surgery isn't a cure-all. In a study, about 30 out of 100 people who had surgery for bunions did not like the results, even though they had less pain and their toe was straighter.1 But this also means that 70 out of 100 people who had surgery were pleased with the results.

What are the risks of bunion surgery?

You may still have problems with your toe after surgery, such as:

  • Pain and swelling.
  • A toe that is stiffer and less flexible.
  • A bunion that comes back.
  • A shorter big toe, if bone was removed during surgery.
  • Numbness, tingling, or burning in your toe from damage to the nerves.
  • An outward or upward bend in your big toe.

Other problems that can occur after bunion surgery include:

  • An infection in the tissue or bone of the foot.
  • Side effects from anesthetic or other medicines used to control pain and swelling.
  • Damage to the tendons that pull the big toe up or down.
  • Joint disease (arthritis) or problems with blood supply to bone tissue.
  • A callus that grows on the bottom of the foot.

Why might your doctor recommend bunion surgery?

Your doctor may suggest surgery if:

  • You have tried other treatment and it has not worked to relieve your pain.
  • You have severe pain or a severely deformed foot that prevents you from doing your daily activities.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have bunion surgery Have bunion surgery
  • The procedure takes about an hour, depending on the type of surgery. It is usually done in an outpatient clinic.
  • You may need 6 weeks to 6 months to recover from surgery. Complete healing may take as long as 1 year.
  • You may need a walking cast or splint. After some surgeries, you won't be able to put weight on your foot for 6 to 8 weeks.
  • You may be able to wear regular shoes in 4 to 5 weeks. But most procedures require wearing special shoes for up to 8 weeks.
  • Most people return to their regular activities in about 6 to 8 weeks. But this may take longer for some people, such as runners or those who are on their feet most of the day.
  • Surgery may make walking easier.
  • You should be able to return to doing your daily activities.
  • It may be easier for you to find shoes that fit.
  • It may relieve your pain.
  • You may have limited toe motion.
  • The bunion may come back.
  • You may feel numbness, tingling, or burning in your toe.
  • You may still have pain and swelling, especially if you don't wear roomy shoes.
  • Even after surgery, your foot may not look completely normal.
  • All surgery has risks, including bleeding, nerve damage, and infection. Your age and your health can also affect your risk.
Don't have surgery Don't have surgery
  • You wear roomy shoes and avoid activities that put pressure on your toe and foot.
  • You use bunion pads, arch supports, or custom-made supports (orthotics) for protection and comfort.
  • To relieve toe pain, you can try over-the-counter medicine such as ibuprofen or aspirin.
  • You can decide to have surgery later if you feel you need it.
  • Using other treatments may relieve your pain, allowing you to do your daily activities.
  • You avoid the cost and risks of surgery.
  • You will still have a bunion.
  • Your pain and deformity may be so severe that you can't do your daily activities.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about surgery for bunions

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I was really surprised when I read that fewer people have painful bunions in parts of the world where they don't wear shoes. I guess I didn't realize how much my choice of shoes was affecting my foot until the pain got so bad that I asked my doctor about it. She asked what kind of shoes I usually wear and if I had tried wearing shoes with a lower heel and more room in the toes. I was skeptical. I mean, women have been wearing heels for decades! But I told her I would try it for 1 or 2 months and see what happens. I'm not much into surgery if I can avoid it at all.

Darlene, age 54

The dress code at my company requires women to wear suits, preferably with skirts and heels. Although I have switched to the lowest possible heel with the widest toe box, my bunion is still really painful. I can control the pain with anti-inflammatories, but the medicine irritates my stomach. I'm going to have surgery to see if I'll be able to cut back on the medicines and have less pain.

Leslie, age 47

I'm an active person. I like to run and hike. My bunion is making this difficult, but I really don't like the idea of surgery. For the time being, I'm making changes in my shoes. I've cut my running shoes to make room for my bunion and use pads in my hiking boots. I've also made sure my work shoes are roomy and comfortable so I don't make things worse. So far, this has been working.

Giacomo, age 40

I really enjoy my daily walks with my two dogs, but lately it has been pretty painful. My bunion rubs on the top of my walking shoe and feels like it's going to wear a hole right through it. I've thought about cutting a hole in the shoe, but that doesn't seem like a reasonable option for every pair of shoes. It's important to me to be able to keep walking comfortably, and my doctor tells me that my type of bunion has an excellent chance of successful repair. I'm going to have surgery.

Marjorie, age 60

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for bunions

Reasons not to have surgery

I'm not very worried about the risks of bunion surgery.

I'm worried about the risks of bunion surgery.

More important
Equally important
More important

I'm in pain and can't do my daily activities.

My pain isn't too bad, and I'm still able to do my daily activities.

More important
Equally important
More important

I've already tried wearing roomy shoes, pads, and cushions. These treatments haven't worked.

I haven't tried other treatments yet. I think they might work for me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having bunion surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is surgery the first choice for treating bunions?

  • YesSorry, that's not right. Surgery for bunions isn't usually done unless you've already tried other treatment and it didn't relieve your pain. Other treatment includes wearing roomy shoes and using pads and supports.
  • NoYou're right. Surgery for bunions isn't usually done unless you've already tried other treatment and it didn't relieve your pain. Other treatment includes wearing roomy shoes and using pads and supports.
  • I'm not sureIt may help to go back and read "Key points to remember." Surgery for bunions isn't usually done unless you've already tried other treatment. Other treatment includes wearing roomy shoes and using pads and supports.
2.

Is surgery a good choice if you want it mainly to improve the way your foot looks?

  • YesSorry, that's not right. If you want surgery mainly to improve the way your foot looks, you may be disappointed.
  • NoYou're right. If you want surgery mainly to improve the way your foot looks, you may be disappointed.
  • I'm not sureIt may help to go back and read "Get the Facts." If you want surgery mainly to improve the way your foot looks, you may be disappointed.
3.

Is surgery right for you if you have occasional toe pain?

  • YesSorry, that's not right. If you have pain only now and then, surgery may not be right for you. But if your toe is too painful, if your deformity is too great, or if you can't easily do your daily activities, you might think about surgery.
  • NoYou're right. If you have pain only now and then, surgery may not be right for you. But if your toe is too painful, if your deformity is too great, or if you can't easily do your daily activities, you might think about surgery.
  • I'm not sureIt may help to go back and read "Get the Facts." If your toe is too painful, if your deformity is too great, or if you can't easily do your daily activities, you might think about surgery.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical ReviewerGavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery

References
Citations
  1. Ferrari J (2008). Bunions, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Bunions: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have bunion surgery.
  • Don't have surgery. Try other treatment for bunions.

Key points to remember

  • Surgery for bunions usually isn't done unless you have already tried other treatment and it did not relieve your pain. Other treatment includes wearing shoes with lots of room for your toes and using pads and supports in your shoe for protection and comfort.
  • Surgery may be right for you if your toe is too painful, if your bunion is very big, or if you can't easily do your daily activities. About 70 out of 100 people who had surgery for bunions were happy with the results. That means that 30 out of 100 people were not happy with the surgery results even though they had less pain and their toe was straighter.1
  • It's not clear how well bunion surgery works or which kind of surgery is best. How well the surgery works depends on how bad your bunion is, the type of surgery you have, and your surgeon's experience.
  • Your expectations will play a big role in how you feel about the results of surgery. If you want surgery mainly to improve the way your foot looks, you may be disappointed.
FAQs

What is a bunion?

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe may turn toward the second toe. The tissues around the joint may be swollen and tender.

What are the risks of bunions?

A bunion can hurt and make it hard to walk. Shoes may rub on the bunion, causing pain, blisters, calluses, or sores.

You could also get skin and bone infections around the bunion, especially if you have diabetes or peripheral arterial disease. If you have one of these problems and you start to get sores, talk to your doctor.

Some people are embarrassed by how their bunion looks.

What are the types of bunion surgery?

There are more than 100 surgeries for bunions. It's not clear which type of surgery is best. Surgery needs to be tailored to your condition. More than one procedure may be done at the same time.

Types of bunion surgery include:

  • Removing the part of the foot that is bulging out. This procedure is called exostectomy or bunionectomy.
  • Realigning the tissues around the big toe joint.
  • Making small cuts in the bones of the foot and moving the bones into a more normal position.
  • Removing bone from the end of the first metatarsal bone. Both the big toe and the metatarsal bones are then reshaped.
  • Fusing the big toe joint. The surgeon removes part of the joint so the bones join together, or fuse.
  • Fusing the joint where the metatarsal bone joins the mid-foot.
  • Implanting all or part of an artificial joint.

How well does bunion surgery work?

It's not clear how well surgery works or which surgery is best. How well the surgery works depends on how bad your bunion is, the type of surgery you have, and the surgeon's experience.

How well surgery works also depends on what you expect. After surgery, you won't be able to wear some types of shoes. For example, you will need to avoid high heels and narrow shoes. Your toe may be stiffer and less flexible compared to your other foot.

It's important to know that surgery isn't a cure-all. In a study, about 30 out of 100 people who had surgery for bunions did not like the results, even though they had less pain and their toe was straighter.1 But this also means that 70 out of 100 people who had surgery were pleased with the results.

What are the risks of bunion surgery?

You may still have problems with your toe after surgery, such as:

  • Pain and swelling.
  • A toe that is stiffer and less flexible.
  • A bunion that comes back.
  • A shorter big toe, if bone was removed during surgery.
  • Numbness, tingling, or burning in your toe from damage to the nerves.
  • An outward or upward bend in your big toe.

Other problems that can occur after bunion surgery include:

  • An infection in the tissue or bone of the foot.
  • Side effects from anesthetic or other medicines used to control pain and swelling.
  • Damage to the tendons that pull the big toe up or down.
  • Joint disease (arthritis) or problems with blood supply to bone tissue.
  • A callus that grows on the bottom of the foot.

Why might your doctor recommend bunion surgery?

Your doctor may suggest surgery if:

  • You have tried other treatment and it has not worked to relieve your pain.
  • You have severe pain or a severely deformed foot that prevents you from doing your daily activities.

2. Compare your options

Have bunion surgery Don't have surgery
What is usually involved?
  • The procedure takes about an hour, depending on the type of surgery. It is usually done in an outpatient clinic.
  • You may need 6 weeks to 6 months to recover from surgery. Complete healing may take as long as 1 year.
  • You may need a walking cast or splint. After some surgeries, you won't be able to put weight on your foot for 6 to 8 weeks.
  • You may be able to wear regular shoes in 4 to 5 weeks. But most procedures require wearing special shoes for up to 8 weeks.
  • Most people return to their regular activities in about 6 to 8 weeks. But this may take longer for some people, such as runners or those who are on their feet most of the day.
  • You wear roomy shoes and avoid activities that put pressure on your toe and foot.
  • You use bunion pads, arch supports, or custom-made supports (orthotics) for protection and comfort.
  • To relieve toe pain, you can try over-the-counter medicine such as ibuprofen or aspirin.
  • You can decide to have surgery later if you feel you need it.
What are the benefits?
  • Surgery may make walking easier.
  • You should be able to return to doing your daily activities.
  • It may be easier for you to find shoes that fit.
  • It may relieve your pain.
  • Using other treatments may relieve your pain, allowing you to do your daily activities.
  • You avoid the cost and risks of surgery.
What are the risks and side effects?
  • You may have limited toe motion.
  • The bunion may come back.
  • You may feel numbness, tingling, or burning in your toe.
  • You may still have pain and swelling, especially if you don't wear roomy shoes.
  • Even after surgery, your foot may not look completely normal.
  • All surgery has risks, including bleeding, nerve damage, and infection. Your age and your health can also affect your risk.
  • You will still have a bunion.
  • Your pain and deformity may be so severe that you can't do your daily activities.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about surgery for bunions

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was really surprised when I read that fewer people have painful bunions in parts of the world where they don't wear shoes. I guess I didn't realize how much my choice of shoes was affecting my foot until the pain got so bad that I asked my doctor about it. She asked what kind of shoes I usually wear and if I had tried wearing shoes with a lower heel and more room in the toes. I was skeptical. I mean, women have been wearing heels for decades! But I told her I would try it for 1 or 2 months and see what happens. I'm not much into surgery if I can avoid it at all."

— Darlene, age 54

"The dress code at my company requires women to wear suits, preferably with skirts and heels. Although I have switched to the lowest possible heel with the widest toe box, my bunion is still really painful. I can control the pain with anti-inflammatories, but the medicine irritates my stomach. I'm going to have surgery to see if I'll be able to cut back on the medicines and have less pain."

— Leslie, age 47

"I'm an active person. I like to run and hike. My bunion is making this difficult, but I really don't like the idea of surgery. For the time being, I'm making changes in my shoes. I've cut my running shoes to make room for my bunion and use pads in my hiking boots. I've also made sure my work shoes are roomy and comfortable so I don't make things worse. So far, this has been working."

— Giacomo, age 40

"I really enjoy my daily walks with my two dogs, but lately it has been pretty painful. My bunion rubs on the top of my walking shoe and feels like it's going to wear a hole right through it. I've thought about cutting a hole in the shoe, but that doesn't seem like a reasonable option for every pair of shoes. It's important to me to be able to keep walking comfortably, and my doctor tells me that my type of bunion has an excellent chance of successful repair. I'm going to have surgery."

— Marjorie, age 60

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for bunions

Reasons not to have surgery

I'm not very worried about the risks of bunion surgery.

I'm worried about the risks of bunion surgery.

More important
Equally important
More important

I'm in pain and can't do my daily activities.

My pain isn't too bad, and I'm still able to do my daily activities.

More important
Equally important
More important

I've already tried wearing roomy shoes, pads, and cushions. These treatments haven't worked.

I haven't tried other treatments yet. I think they might work for me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having bunion surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is surgery the first choice for treating bunions?

  • Yes
  • No
  • I'm not sure
You're right. Surgery for bunions isn't usually done unless you've already tried other treatment and it didn't relieve your pain. Other treatment includes wearing roomy shoes and using pads and supports.

2. Is surgery a good choice if you want it mainly to improve the way your foot looks?

  • Yes
  • No
  • I'm not sure
You're right. If you want surgery mainly to improve the way your foot looks, you may be disappointed.

3. Is surgery right for you if you have occasional toe pain?

  • Yes
  • No
  • I'm not sure
You're right. If you have pain only now and then, surgery may not be right for you. But if your toe is too painful, if your deformity is too great, or if you can't easily do your daily activities, you might think about surgery.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical ReviewerGavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery

References
Citations
  1. Ferrari J (2008). Bunions, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: February 24, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery


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