Bunion Surgery: Q&A with Mr Pinak Ray

Q: What is a Bunion?

A bunion is a bump on the inside of the foot, at the base of the big toe – bunions are mostly caused by a deformity of the big toe joint. Anyone can get a bunion, but they are more common in women.  50% of my patients have a strong family history of Bunions. Tight and badly fitting shoes can worsen bunion deformity and pointed high heels make this progress more quickly.

Q: Why does the Bunion hurt?

A bunion can be present for many years without causing any pain.  Bunions start to hurt because they rub against footwear.  Your shoes that started off being comfortable can become a cause of pain when the deformity gets worse.

Most people try different shoes to accommodate the bump, but even then the bunion can rub or cause overcrowding and deformity of other toes.

The pain can be felt under other toes, mostly the second.  This is due to overloading of body weight as the big toe fails to take its share of the load.

Q: What treatments are there for Bunions?

Footwear modification and compromises in shoes are the first treatments.  This means that high heels and pointed shoes should only be worn for special occasions.

There are a number of splints and toe separators available in the market that can reduce the discomfort but only temporarily.  If your arches are dropped then you may need arch supports which your doctor, podiatrist or physiotherapist can provide for you. Unfortunately, bunions tend to worsen over time despite these measures as the mechanics of the foot are very powerful.

Surgery for bunions is only for pain relief and is not cosmetic, although some patients do wish to undertake surgery for cosmetic reasons.  If you have a bunion that is not painful, I would advise you against any surgery.

Q: What does Bunion Surgery involve?

Specialist Orthopaedic Foot and Ankle Surgeons perform bunion surgery regularly using modern techniques resulting in excellent results.  It is important to note that there are a number of non-specialists who also undertake foot surgery, which I would recommend avoiding.

Bunion surgery is performed under a general anaesthetic and patients can go home the same day.  Surgery involves dividing the bone in the foot and sometimes toes as well, then moving the bone and fixing them in the corrected position with screws.  This takes about 45 minutes to an hour.

The surgeon or anaesthetist will put local anaesthetic around your ankle whilst you are asleep to help with post-operative pain relief. Patients are discharged home fully weight bearing in a special protective shoe and bandage a few hours after surgery, so there is no need to stay overnight.

Q: What is the recovery period after Bunion Surgery?

After surgery, patients will recover for a few hours in hospital until ready to go home and will usually be given something to eat and some painkillers.  Physiotherapists will assess walking in a specific post-operative shoe.  90% of patients do not feel any post-operative pain because of the ankle block injection anaesthetic injection given at the time of surgery.

For the first 2 weeks after surgery, you are advised to do as little as possible.  You can, of course, be active in the house but are advised to avoid long periods of standing and walking.  When not walking you will be advised to keep the foot elevated and to take painkillers.

After 2 weeks, the surgeon will see you in an outpatient clinic and take down the surgical bandages.  Stitches will be removed at this stage and the toe will be strapped again for 2 more weeks.  You will be advised to continue walking in the special post-operative shoe. Between 2 and 4weeks, you will still not be able to get your foot wet at all.  At 4 weeks all the strapping will be removed and you will have no more dressings, at which point it’s now fine to get your foot wet.

Your surgeon is likely to then see you at 6 weeks when you are allowed to return to normal shoes, driving and work (if it is a sit-down job).  The swelling in the foot can take 3-6 months to settle down and therefore you may find that after 6 weeks you can only get your trainers on. By 12 weeks, nearly all patients (90%) are pleased with the outcome of surgery.  It is important to be aware that the foot, however, does not completely recover until 1 year after surgery.

Q: Are there any risks from Bunion Surgery?

Unfortunately, all surgical procedures have associated possible complications.  The good news is that about 90% of patients are happy with the outcome.  The remaining 10% can have post-operative complications.1 in 100 patients can have an infection of the wound.  This may mean a course of antibiotics or very rarely a wound washout in theatre. 1 in 50 people have some numbness on the big toe after surgery due to nerve injury, some of these have it before surgery as well. 5 in 100 patients can have a recurrence after surgery.  This may mean repeat surgery is required. Over or under-correction can also be a problem sometimes. Blood clots or DVTs are associated with all surgery, but the risk after bunion correction is relatively low.  I do not prescribe blood thinning products after this surgery – the only patients who would need it are those who are at high risk of blood clots.

Mr Pinak Ray is a Consultant Orthopaedic Surgeon at Highgate Private Hospital specialising in bunions and forefoot deformity, ankle surgery including sports injuries and ankle replacement, knee Surgery including sports injuries and knee replacement, foot and ankle arthritis surgery, sports injuries and trauma.

Mr Ray is available for patient appointments every week at Highgate Private Hospital. To book an appointment please call 020 8341 4182 or email enquiries@highgatehospital.co.uk