Bunion Surgery
Bunion surgery (hallux valgus correction)
Hallux valgus is a deformity in which the big toe points towards the lesser toes and the head of the first metatarsal becomes prominent on the inner side of the foot. A bunion is not simply an extra piece of bone. Some bunions are painful, while others cause little difficulty and need no operation.
Why do bunions develop?
Inherited foot structure, joint alignment and other biomechanical factors play a role. Narrow shoes do not solely cause bunions, but may make pressure symptoms worse. Symptoms can include a painful bump, footwear intolerance, big-toe joint discomfort, lesser-toe crowding and sometimes pain under the smaller metatarsal heads.
Assessment
The clinical examination checks the skin and bump, first MTP joint movement, lesser-toe problems and foot alignment. Weight-bearing foot X-rays help measure deformity and identify associated arthritis. Procedure choice depends on symptoms, deformity pattern, joint quality and overall foot mechanics rather than the appearance of the bump alone.
Treatment without surgery
A wide and deep toe-box, softer shoes, protective padding, selected orthoses or toe spacers and appropriate pain relief can improve comfort. These measures do not usually reverse an established bony deformity, but they may make surgery unnecessary.
When is surgery appropriate?
Surgery is usually considered for persistent pain or functionally troublesome deformity despite appropriate shoe modification and other non-operative measures. It is not generally recommended for cosmetic appearance alone. The goal is a comfortable, functional and well-aligned foot; it is not possible to guarantee a particular appearance or shoe type afterwards.
What does surgery involve?
Bunion correction generally realigns the first metatarsal and big toe, and may also balance soft tissues. Simply shaving the bump does not reliably correct the underlying deformity.
Metatarsal osteotomy and Akin osteotomy
A surgeon may cut and reposition part of the first metatarsal, holding it in place with screws or another implant. Common examples are the scarf and chevron osteotomies; different osteotomies suit different deformity patterns. An Akin osteotomy of the proximal phalanx may be added when indicated.
Lapidus procedure
For selected cases, the first tarsometatarsal joint is corrected and fused. The decision depends on deformity features, joint disease, stability and other anatomical factors. It is not the default operation for every bunion. It is generally used for larger deformities or an unstable (hypermobile) joint, and recovery is usually longer because the joint has to fuse.
Minimally invasive correction
Some bunions can be corrected through smaller incisions under imaging guidance (for example, the minimally invasive chevron and Akin technique). A 2024 systematic review found that modern open and minimally invasive techniques gave similar improvements in patient-reported outcomes. Small incisions alone do not establish superior outcomes, and successful correction, union, soft-tissue protection and surgeon familiarity remain more important than an incision-size claim. Mr Senthi currently performs open bunion correction and does not offer minimally invasive bunion surgery at present.
Recovery
Patients commonly wear a surgical shoe or boot and need foot elevation, wound care and progressive activity. Weight-bearing restrictions vary according to the osteotomy or fusion performed and its fixation; some techniques allow earlier protected weight-bearing than others. Swelling can take several months to settle, and return to narrower footwear is gradual. As a general guide, a post-operative shoe is usually worn for about 6 weeks, desk work is often possible after 2–4 weeks with the foot elevated, and most people return to wider everyday shoes and to driving at around 6–12 weeks (see When can I drive after foot or ankle surgery?). Contact the rooms promptly if you develop a fever, increasing wound redness or discharge, severe worsening pain or calf swelling after surgery; call 111 for chest pain or breathlessness.
Important risks
Risks include infection, wound problems, nerve irritation or numbness, swelling, stiffness, painful implants, delayed or failed bone union, recurrence, overcorrection (the toe drifting the other way), transfer pain and persistent symptoms. No operation removes the possibility of recurrence.
Common questions
Can a bunion be straightened without surgery?
Shoes and padding can reduce symptoms, but they do not reliably reverse established bony alignment.
Is minimally invasive surgery always better?
No. Both open and minimally invasive methods can work well for the right deformity and surgeon expertise.
Will I get back into all my old shoes?
Comfort often improves, but swelling and changes in anatomy may limit some footwear.
Can both feet be corrected at once?
Occasionally, but rehabilitation and safe mobility may favour staged surgery.
Seeking specialist advice
Persistent pain, shoe problems or progressive associated toe deformity may justify assessment. A personalised plan should explain the proposed correction and the recovery demands.
Related pages: Big toe arthritis, Driving after surgery.