You've talked to your doctor about having surgery to fix your bunions that have been killing you in all of your shoes. You've tried different shoes, anti-inflammatories, padding, injections, orthotics and maybe a little physical therapy. You are more than ready to get them fixed! A little apprehension about surgery at this point is very normal. You have talked to your doctor about the risks and possible complications associated with surgery and you have a date picked out. Your biggest question is what to expect after surgery?

All bunion surgeries are not the same; just like every patient is not the same. You may have some medical issues or personal issues that can complicate your postoperative course. Talk to your surgeon about any specific questions that you have, but here are some general guidelines.

I will separate bunionectomies into three basic categories. Ask your surgeon what kind of bunionectomy they are performing to correct your foot.

Austin Bunionectomy

This can also be called a chevron bunionectomy, Kalish bunionectomy or even a modified Scarf bunionectomy. This is the most common type of bunionectomy performed in the United States today. Your surgeon takes the extra bone off from the side of the joint, then makes a cut in the bone to correct the angle causing your bunion; and then fixes the bone cuts with one or two screws. Wires, pins, and absorbable fixation can also be used.

  • Dressing - A soft, compression dressing is placed on your foot and usually a short, removable walking boot is placed over the dressing to protect your foot. You should keep this clean and dry until your stitches are taken out. Do not try to change the dressing yourself. If the dressing becomes wet, you should contact your surgeon to have it changed. A dirty, wet dressing can lead to infections!
  • Weight-bearing - You may be placed on crutches or a knee roller for up to two weeks after surgery, depending on your particular surgery. Many people are allowed to weight bear on their heel after a few days, but always make sure you discuss weight bearing specifics with your surgeon. You are usually in the walking book for 4 weeks, then progress to a wide sneaker or tennis shoe for 4 more weeks. No running, jumping or playing with the other kids for at least 8 weeks, sometimes 10 weeks.
  • Pain management - Narcotic pain medication is often needed for a few days after surgery. This is usually a codeine based narcotic like Norco or Vicoden. For those patients that are allergic to codeine, Tramadol is commonly used. All narcotics may make you a little sleepy and goofy, or in some cases, actually wired. They can also upset your stomach and make you constipated. Your surgeon will usually give you an anti-nausea medication like Phenergan or Zofran just in case the nausea is severe. If you are itching all over, you are having a codeine reaction and should call your doctor. Some patients prefer to try to tough it out and use just Tylenol or Advil. Many do well with Celebrex, which is a non-steroidal anti-inflammatory used for pain control. Keep the narcotics as a back up. Bunion surgery usually hurts for the first 48 hours after surgery then calms down. The worst time is 24-48 hours after surgery when the local anesthesia that was used to numb up your foot completely wears off. Ice and elevation almost constantly are the best way to manage your pain! They also help keep the swelling down that can lead to prolonged swelling, infection, joint stiffness and scarring. Ice is your best friend after surgery!
  • Post-operative appointments - Every surgeon has their own protocols when it comes to post-operative follow up visits. You should talk to your doctor about their specific protocols. My protocol for an Austin bunionectomy is to see the patient 3 to 4 days after surgery; take an x-ray and change the bandage. I then see them at 12 to 14 days postop to take out their stitches. Their next visit is at 1 month postop; an x-ray is taken to determine if they can progress out of the walking boot and into a sneaker. The last postop visit is at 8 weeks; another x-ray is taken to determine if they can start running, jumping and playing with the other kids. If the patient does not already have custom orthotics pre-operatively, they may be precerted for this appointment so they can be fabricated.
  • Realistic Expectations - No, we cannot make your foot perfect. Your bunion took years of wear and tear to form. 80-90% better after surgery is a home run. Outcomes studies show 95-97% of patients have a good to excellent outcome. Stiffness, swelling, scarring and toe drift is normal. Osteoarthritis (wear and tear arthritis) is not alleviated by surgery. We have no way to make cartilage reform after it has been damaged. The best we can do is realign the joint so it is as functional as possible. Bunionectomies are done to alleviate pain, not to make a perfect looking foot. Every patient is different, so talk to your surgeon about realistic expectations. Most patients can get back to an active lifestyle 2-3 months after surgery. Almost no one can get into 4 inch heels after surgery! Shoe gear modification and orthotics are important post-operatively in order to prevent recurrence and progressive arthritic of the joint.

Lapidus Fusion

This can also be called a Lapidus bunionectomy or a First Metatarsal Cuneiform Fusion. This is the most common type of bunionectomy performed in younger patient with severe deformities and hypermobility (super flexible feet). Your surgeon makes a cut in the base of the metatarsal bone (long bone behind the big toe) and removes a wedge of the joint to correct the angle causing your bunion and realign the arch of the foot that is causing your hypermobility; then fixes the bone cuts with some type of compressive fixation. There are so many ways to fixate and stabilize the fusion that your hardware may include screws, plates, staples, wires, pins, and even absorbable fixation can also be used. I've even seen an external fixator used, but this is not common. Your surgeon will choose the best fixation for your fusion during your surgery.

  • Dressing - A soft, compression dressing is placed on your foot and usually a below-knee fiberglass cast is placed over the dressing to protect your foot. You should keep this clean and dry until your stitches are taken out. Do not try to remove the cast yourself. If the cast becomes wet, you should contact your surgeon immediately to have it changed. Dirty, wet casts and dressings can lead to infections!
  • Weight-bearing - You may be placed on crutches for up to 6 to 8 weeks after surgery, depending on your particular surgery. Many people are allowed to weight bear on their heel at about 6 weeks, but clarify this with your surgeon. You are usually in the hard cast for 4 to 6 weeks, but maybe up to 8. Then you are in a walking boot for 2 weeks, and progress to a wide sneaker or tennis shoe for 2 to 4 more weeks. No running, jumping or playing with the other kids for at least 10 weeks, often 12 weeks.
  • Pain management - Narcotic pain medication is often needed for a few days to a few weeks after surgery. This is usually a codeine based narcotic like Norco or Vicoden. For those patients that are allergic to codeine, Tramadol is commonly used. All narcotics may make you a little sleepy and goofy, or in some cases, actually wired. They can also upset your stomach and make you constipated. Your surgeon will usually give you an anti-nausea medication like Phenergan or Zofran just in case the nausea is severe. If you are itching all over, you are having a codeine reaction and should call your doctor. Some patients prefer to try to tough it out and use just Tylenol or Advil. Many do well with Celebrex, which is a non-steroidal anti-inflammatory used for pain control. Keep the narcotics as a back up. Bunion surgery usually hurts for the first 48 hours after surgery then calms down. The worst time is 24-48 hours after surgery when the local anesthesia that was used to numb up your foot completely wears off. Ice and elevation almost constantly are the best way to manage your pain! They also help keep the swelling down that can lead to prolonged swelling, infection, joint stiffness and scarring. Ice is your friend after surgery! To ice with a cast, put the ice pack behind your knee so it cools the whole leg.
  • Post-operative appointments - Every surgeon has their own protocols when it comes to post-operative follow up visits. You should talk to your doctor about their specific protocols. My protocol for a Lapidus bunionectomy is to see the patient 3 to 4 days after surgery; take an x-ray and make sure they are doing OK with their pain management. I then see them at 12 to 14 days postop to change the cast and take out their stitches. Their next visit is at 6 weeks postop; an x-ray is taken to determine if they can progress out of the hard cast to a walking cast. They are again seen at 8 weeks, another x-ray is taken to determine if they can progess to a sneaker. The last postop visit is at 10 to 12 weeks; another x-ray is taken to determine if they can start running, jumping and playing with the other kids. If the patient does not already have custom orthotics pre-operatively, they will be precerted for this appointment so they can be fabricated. Some patients need physical therapy as well, this is determined usually at 8 to 10 weeks post-operatively.
  • Realistic Expectations - No, we cannot make your foot perfect. Your bunion took years of wear and tear to form. 80-90% better after surgery is a home run. Outcomes studies shoe 95-97% of patients have a good to excellent outcome. Stiffness, swelling, scarring and toe drift is normal. Osteoarthritis (wear and tear arthritis) is not alleviated by surgery. We have no way to make cartilage reform after it has been damaged. The best we can do is realign the joint so it is as functional as possible. Bunionectomies are done to alleviate pain, not to make a perfect looking foot. Every patient is different, so talk to your surgeon about realistic expectations. Most patients can get back to an active lifestyle 2-3 months after surgery. Almost no one can get into 4 inch heels after surgery! Shoe gear modification and orthotics are important post-operatively in order to prevent recurrence and progressive arthritic of the joint.

Keller Bunionectomy

This can also be called an "old lady" bunionectomy or an Arthroplasty of the First MPJ. This is the most common type of bunionectomy performed on older patients with severe deformities and less than optimal bone stock. Your surgeon removes the extra bone from the side of the joint, then makes a cut in the bone removing part of the joint. Then a wedge of soft tissue is placed in between the pieces of bone to alleviate bone on bone contact. The joint is the pinned straight so it will scar in this straightened position. The pin is usually paced so that it is sticking out the end of your toe so that it can be easily removed in 3 to 4 weeks.

  • Dressing - A soft, compression dressing is placed on your foot and usually a funny wedge shoe that makes you weight-bear only on your heel is placed over the dressing to protect your foot and keep you from bending your pin. You should keep this clean and dry until your stitches are taken out. Do not try to change the dressing yourself. If the dressing becomes wet, you should contact your surgeon immediately to have it changed. A dirty, wet dressing can lead to infections!
  • Weight-bearing - You may be placed on crutches or a walker for up to 2 to 4 weeks after surgery, depending on your particular surgery. Many people are allowed to weight bear on their heel almost right away, but clarify this with your surgeon. You are usually in the wedge shoe for 4 weeks , then progress to a wide sneaker or tennis shoe for 4 more weeks with a soft splint worn at night to splint your toe in the optimal position. No running, jumping or playing with the other kids for at least 8 weeks, often 10 weeks.
  • Pain management - Narcotic pain medication is often needed for a few days after surgery. This is usually a codeine based narcotic like Norco or Vicoden. For those patients that are allergic to codeine, Tramadol is commonly used. All narcotics may make you a little sleepy and goofy, or in some cases, actually wired. They can also upset your stomach and make you constipated. Your surgeon will usually give you an anti-nausea medication like Phenergan or Zofran just in case the nausea is severe. If you are itching all over, you are having a codeine reaction and should call your doctor. Some patients prefer to try to tough it out and use just Tylenol or Advil. Many do well with Celebrex, which is a non-steroidal anti-inflammatory used for pain control. Keep the narcotics as a back up. Bunion surgery usually hurts for the first 48 hours after surgery then calms down. The worst time is 24-48 hours after surgery when the local anesthesia that was used to numb up your foot completely wears off. Ice and elevation almost constantly are the best way to manage your pain! They also help keep the swelling down that can lead to prolonged swelling, infection, joint stiffness and scarring. Ice is your friend!!
  • Post-operative appointments - Every surgeon has their own protocols when it comes to post-operative follow up visits. You should talk to your doctor about their specific protocols. My protocol for a Keller bunionectomy is to see the patient 3 to 4 days after surgery; take an x-ray and change the bandage. I then see them at 12 to 14 days postop to take out their stitches. Their next visit is at 1 month postop; an x-ray is taken to determine if the pin can be removed; and if they can progress out of the wedge shoe and into a sneaker. They are also given a soft night splint when the pin is removed. The last postop visit is at 8 weeks; another x-ray is taken to determine if they can start running, jumping and playing with the other kids. If the patient does not already have custom orthotics pre-operatively, they will be precerted for this appointment so they can be fabricated.
  • Realistic Expectations - No, we cannot make your foot perfect. Your bunion took years of wear and tear to form. 80-90% better after surgery is a home run. Outcomes studies shoe 95-97% of patients have a good to excellent outcome. Stiffness, swelling, scarring and toe drift is normal. Osteoarthritis (wear and tear arthritis) is not alleviated by surgery. We have no way to make cartilage reform after it has been damaged. The best we can do is realign the joint so it is as functional as possible. Bunionectomies are done to alleviate pain, not to make a perfect looking foot. Keller bunionectomies are performed to make your foot fit in a normal shoe. Every patient is different, so talk to your surgeon about realistic expectations. Most patients can get back to an active lifestyle 2-3 months after surgery. Almost no one can get into 4 inch heels after surgery! Shoe gear modification and orthotics are important post-operatively in order to prevent recurrence and progressive arthritic of the joint.

That is the skinny on what to expect after a bunionectomy. Make a list and ask your surgeon about the specifics of your post-operative course. A well-informed patient is usually a compliant patient!

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Join The Conversation
bunion deformity 09/08/2011 04:32 AM
My girlfriend has a rather minor bunion, and has decided to try to workout her bunion naturally. I think all she is accomplishing is slowing the worsening of her bunion, but not exactly solving it. There is a lot to consider before committing to surgery, but we'll see how it goes in time. Thanks for the informative post!
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Knee Pain 02/07/2012 06:45 AM
Great Post. Keep it up
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Orthopedic Doctor Naples 03/09/2012 01:23 AM
I am glad that I landed on this blog and got to know about a great information. Thank you for sharing and appreciate your efforts!
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Vicki Flynn 10/04/2012 02:32 PM
I had a keller bunionectomy 8 days ago. Everything looks great, I am walking pretty good BUT I have nerves or something tightening up. It is in different spots , mostly behind my toes and between the big toe and next one it feels like a string is wrapped and strangling my big toe. At times it does go down my heel. I have noticed if I massage the back of my foot it eases up sometimes. What should I do about this it is annoying. I have talked to my Dr and he said he hadn't ever heard of this and if massaging the foot works then do that. Today has been pretty much painful all day. Please tell me what you think. Thank You
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Annette 03/18/2013 05:44 PM
I had a Bunionectomy removal and Taylor Bunion removal and after 6 weeks did not have the feeling in some toes so I started going to my massage therapist twice a week for three week and he would massage only the foot for a half hour. I now have complete feeting in the foot and no knumbness.
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Evelyn 04/10/2013 10:51 PM
My surgery is fri. 12th, I'm a bit worried, but I trust my Dr. I have stairs all over my house so will be restricted to bedroom/bathroom for awhile. Thank goodness for my new iPad hubby just bought me, haha. Wish me luck.
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Evelyn 04/10/2013 10:53 PM
My surgery is fri. 12th, I'm a bit worried, but I trust my Dr. I have stairs all over my house so will be restricted to bedroom/bathroom for awhile. Thank goodness for my new iPad hubby just bought me, haha. Wish me luck.
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Mitchell Sexner 09/09/2013 05:30 AM
Surgery is a very complicated procedure and every patient who has gone through one should know it by now. That is why it is very crucial for new patients who are going for surgeries to take note of the pre and post surgery details to prepare themselves both physically and mentally. One thing that is often not thought of or not highly anticipated is the possibility of any surgical errors or medical malpractice. Patients should find out who should they contact if any of such unwanted circumstances were to befall them in the future after any surgery.
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Hannah 12/11/2014 08:28 PM
Great Info. It is too pity I didn't check your info before my surgery on both feet. I am 67. It has been 13 days after surgery. I have some numbness skin on both big toes. Two screws inserted to the Metatarsal connecting to the big toes' joint on my right foot (Dr told me bone was too soft). I have had strong pains on my right ankle, knee and hip after surgery. The ultrasound on two lower extremities indicates a small blood clot on left foot, not right one. Based on your experience, can the numbness skin be recovered? Why I have knee and hip pains? Does it mean any injury from operation procedure on joint or muscles or tendons? My right leg is normal before surgery, except the bunion. Thank you millions.
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