Bunion - Treatment 

Treating bunions 

Healthy feet in old age

As you get older, you might not be able to look after your feet as well as you used to. A podiatric surgeon describes the problems that bad foot care can cause and where to get help with foot care.

Media last reviewed: 14/05/2013

Next review due: 14/05/2015

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for bunions

Bunions may only need to be treated if the deformity is severe and you experience significant pain and discomfort.

Non-surgical treatment

Where possible, non-surgical treatment for bunions will be used. Your GP can discuss the options with you.

Non-surgical treatments can ease the pain and discomfort caused by a bunion but cannot prevent a bunion from becoming worse over time.

Possible non-surgical treatments include:

  • painkillers
  • bunion pads
  • orthotics
  • wearing suitable footwear

These are discussed in more detail below.

Painkillers

If you have a painful bunion, painkillers, such as paracetamol or ibuprofen, may be recommended.

When using painkillers, always read the patient information leaflet that comes with the medicine and follow the recommended dose.

Bunion pads

As well as taking painkillers, using bunion pads may ease the pain of a bunion.

Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe.

Bunion pads protect your foot from rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. You can also use an ice pack or cold compress to help numb pain and reduce any swelling (see below).

Orthotics

Orthotics are devices placed inside your shoes which help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there is little evidence orthotics are effective in the long term.

It is important the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.

You can buy orthotics over the counter from pharmacies or they can be custom made by a podiatrist to fit your feet. Whether you need to buy an over the counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion.

You can also use special bunion splints, worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use. However, there is little evidence to indicate splints are effective.

Toe spacers are also available, which can help reduce the pain caused by bunions.

However toe spacers or orthotics may be of limited use as they often compete with the bunion for the already limited space in the shoe.

Ice packs

If your toe joint is painful and inflamed, applying an ice pack to the affected area several times a day can relieve pain and inflammation. Never apply ice directly to the skin, wrap it in a cloth or tea towel first. A bag of frozen vegetables makes a good ice pack.  

Suitable footwear

If you have a bunion, you are advised to wear flat or low-heeled, wide-fitting shoes. Shoes made from soft leather are ideal because they will relieve any pressure on the bunion. 

Avoid narrow or slip on shoes. High heels can also make your bunion worse by putting excessive pressure on your toes.

Read more about choosing suitable footwear.

Surgical treatments

Surgery is the only way to correct a bunion. Bunions usually get worse over time, so a bunion left untreated is likely to get bigger and become more painful.

If your bunion is causing a significant amount of pain and affecting your quality of life, your GP may refer you to be assessed for bunion surgery.

The aim of bunion surgery is to relieve pain and improve the alignment of your big toe. Surgery is not usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.

The operation will either be carried out under local anaesthetic or general anaesthetic.

Bunion surgery is often performed as a day procedure, which means you will not have to stay overnight in hospital.

Deciding to have surgery

When deciding whether to have bunion surgery, there are several things to consider, including:

  • your age
  • your medical history and general health
  • your occupation and lifestyle
  • your expectations of surgery
  • the severity of your symptoms

These are discussed in more detail below.

Age

Your age will be taken into consideration when deciding on bunion surgery. In children, bunion surgery is often delayed due to an increased risk of the bunion returning. This is because the bones are still growing.

You may be advised that non-surgical treatments are a better option than bunion surgery.

Medical history and general health  

After surgery, your risk of developing problems is increased if you have other medical conditions that prevent or slow down the healing process. For example, problems with wound healing and infection are more likely if you have diabetes or problems with your circulation.

Following bunion surgery, you are also more likely to encounter problems if your bunion occurred as a result of another condition, such as rheumatoid arthritis.

Occupation and lifestyle

If you are a professional dancer or sportsperson, bunion surgery may only be recommended if you are unable to perform in your chosen field. 

If you are very active and play a lot of sport, being able to move your big toe freely may be more important to you than how your toe looks.

Bunion surgery can make your toes less flexible, meaning you may not be able to return to the same level of physical activity as before the operation.

Your expectations of surgery

The success of your surgery will depend on the skill and experience of the surgeon, the severity of your bunions, the type of surgical procedure you have and your ability and willingness to rest after the operation.

Bunion surgery may be up to 85% successful in people who have it. However, after you have had surgery, there is no guarantee your foot will be perfectly straight or pain free. Surgery may reduce the flexibility of your big toe joint and you may experience stiffness in the area where the bunion was. Your toe may also be shorter than it was before you had surgery.

Read more about the complications of bunions.

The severity of your bunion

Surgery will only usually be recommended if your bunions cause considerable pain and non-surgical treatment has failed. This is because of the risks and complications associated with bunion surgery.

Your specialist will examine your foot and look at the results of your scans to assess the severity of your bunions and will help you decide whether surgery is right for you.

Types of surgery

There are many different surgical procedures used to treat bunions. The type of surgery recommended for you will depend on the severity of the deformity.

Your surgeon may use pins, wires or screws to hold the bones in place while they heal. Depending on the type of surgery you have, these may be left in your foot or removed later on. 

Some of the surgical procedures for bunions are outlined below.

Osteotomy  

An osteotomy is the most common type of bunion surgery. Although there are many different types of osteotomy, they generally involve cutting and removing part of the bone in your toe.

During the procedure, your surgeon will remove the bony lump and realign the bones inside your big toe. They will also move your toe joint back in line, which may involve removing other pieces of bone.

A procedure called distal soft tissue realignment may be combined with an osteotomy. This involves altering the tissue in your foot to help correct the deformity and improve the stability and appearance of the foot.

Arthrodesis

Arthrodesis involves fusing together two bones in your big toe joint (metatarsophalangeal joint). This procedure is usually only recommended for people who have severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint or when there is advanced degeneration of the joint.

After arthrodesis, the movement of your big toe will be severely limited.

Excision (Keller's) arthroplasty

An excision arthroplasty involves cutting out the bunion and part of the bone of the joint at the base of the big toe. This creates a false joint that later heals when scar tissue forms. The procedure involves pinning the joint in place with wires, which will be removed around three weeks after surgery is carried out. 

An excision arthroplasty can only be used in certain circumstances, and is usually reserved for severe, troublesome bunions in elderly people. 

Minimally invasive bunion surgery

The National Institute for Health and Care Excellence (NICE) has published information about a new, minimally invasive surgical procedure that can be used to treat bunions. However, as the procedure is new, there is currently little reliable evidence of how effective or safe it is.

Whichever type of surgery you have, you will be under a local anaesthetic or general anaesthetic. One or more incisions will be made near the big toe so that bone-cutting instruments can be inserted. These are used to remove the bunion and to divide one or more bones located at the front of the foot.

The procedure aims to repair the tilting of the big toe and uses wires, screws or plates to keep the divided bones in place. It may be carried out using X-rays.

After the procedure, you may need to wear a plaster cast or dressing to keep your foot in the correct position until the bones have healed. It is likely you will given a special surgical shoe that enables you to walk on your heel.

After surgery

After bunion surgery, expect your foot and ankle to be swollen for three months or longer. While you are recovering, you will need to elevate your foot to reduce swelling and you will need crutches to move around.

You will not usually be able to wear normal shoes for at least six months after surgery. You may have a cast or bandage and postoperative shoes (shoes specially designed to allow heel walking and protect the bony cuts) before you can start wearing regular footwear. This will keep the bones and soft tissues in place while they heal. 




Page last reviewed: 01/11/2012

Next review due: 01/11/2014

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Comments

The 20 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Casperjf2002 said on 21 June 2014

I had bunion surgery 8 wks ago. I didn't require any pain relief after surgery, it was very uncomfortable and unusual pain but I wouldn't say painkillers would help. I had 2nd toe fused and had a pin sticking out the top for 6 wks. I was bandaged and after a few weeks on crutches I hobbled about on the heel. After 6 wks I got pin pulled out and was told I could start trying to walk on it. I can wear trainers and little flat shoes depending on the swelling and can walk pretty well I'd say. I don't see my surgeon for another 6 wks. I am very pleased with the result and the 3 scars have practically disappeared. I've got practically no movement in my big toe and joint and the only negative I would say is I have no information as to what I should or could do to help the movement. No physio offered. I would certainly recommend getting this done especially if it is very painful and impedes what you wear on your feet and what you can do.

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Smilyangel said on 16 June 2014

Hi, I'm sixteen and I was administrated to the hospital when I was twelve I've has really painful bunions for ages and they just keep getting more painful I had four injections those local anestatic ones and they don't help the dr says that I'm too young for an operation but even though he says its my choice to have the op he discourages me to have it. What should I do? Should I wait till I'm eighteen to twenty or take the operation?

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oddbod55 said on 18 March 2014

I have been to my GP about my feet RE: bunion's and middle toe on left foot has crossed over the other toes. I work as a nurse ( 30 years ) on my feet all the time, its not only very painful now, I get dreadful cramps in my feet. I have been told that as i am in pain for just a few hours that i cannot have an operation. This is so unfair, as I can't even kneel down to do a patients dressing, my feet go into spasm. The only other option is going private and paying. This operation is so expensive.
Also finding shoes is a night mare , for work I have to wear mens trainers. I only take paracetamol as even getting stronger pain relief has been refused.

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lindawy65 said on 14 March 2014

I had surgery on my left foot two weeks ago. The surgery was straightforward and I feel that I am recovering well although I feel that more information should be given out. I have no bandages on now just toe alignment splint so have been having showers. If you look on various sites especially in USA they talk about wearing plastic covering for at least 3-4 weeks after when showering. Thank goodness for internet as it gives good and sensible advice. I am happy with result so far and will have the second done asap, although I think I will try and have the MIS for this one as it seems you are up and mobile far quicker although not sure if the NHS do this? Anyone had the MIS op ?

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Sleepless Milton Keynes said on 24 February 2014

My wife had bunion surgery a year ago and has been in chronic pain since, it has completely taken over our lives. She was taking co-codamol and tramadol with no effect, she is now taking fentanyl paracetamol and tramadol, she might as well take smarties .
Three weeks ago she had another op to fix the problem and the pain is now worse.

I posted this to point out that this op can lead to years of pain if you are unlucky.

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Rizzle said on 15 December 2013

Im 19 and a week away from having another operation. I first has this operation at 12 and then my second foot at 13. A few months after having the operation one of the bunions grew back on top of my foot and I had to have another operation. Which after this I was pleased with the operation and finally being pain free. The operation pain was nothing compared to what I was suffering before hand. For the last 2 years though I have been suffering cramping, stiffness and the bunions are back in my right foot, which my consultation then explained that the best thing to do would be to have cortisone injected into the joint.. This did nothing so I am yet to have another operation.. Is it worth it? Im not sure. I was in cast twice but had no problems with shoes after, I think i must of braved it though after having a ugly cast on for 6 weeks. I am also having a cast this time too. Hope all of your operations go well.

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Beanie1 said on 09 November 2013

I am 8 weeks post op and although no pain my foot is extremely swollen still and turns bluey purple when not raised. Having slight problems moving toes and skin very flaky
Have had regular GP and nurse checks in between seeing the consultant

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surfchic said on 30 September 2013

Clarissabelle can I just ask you as you seem to have had the exact same experience with this surgery as me but are a few months ahead - how were you with walking/pain/wearing shoes 2-3 months after surgery date? I am almost 3 weeks on and have had none of the excruciating pain I heard so much about (same as you I had none at all for 2 days and even then it was just a little achey) and my surgeon told me I'm healing really well. I too had no cast but dressing and a heal weight bearing shoe with crutches and so now just have a large breathable plaster thing over the scar which I can take off after a week and (hip hip hooray) can start having "light" showers instead of baths when that comes off:)

I only ask as I have a friends hen party just over 2 months after surgery date and a holiday (long haul in the sun so would only be in flip flops anyway) a couple of weeks after that. I am wondering whether it's an idea getting to the airport super early in the hopes they might be able to let me have a seat with a leg rest or something?! Just trying to plan ahead while I sit doing very little haha!

My advice though to anyone struggling with bunions is ask for a surgical referral to discuss your options...I inherited my bad feet and just put up with them for the last decade until it became painful wearing closed toed shoes. In my experience it is nowhere near as painful as I was led to believe, in fact I can say hand on heart that having a wisdom tooth out was worse for pain...this is just debilitating for a while!

So thabk you in advance Clarissabelle for any pearls of wisdom you can share and I hope you are well on the road to full recovery, if not all the way there already!

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Ladywriterwriter said on 23 August 2013

Thanks everyone for your feedback with this. alas its even worse then I thought, I saw my doc about 3wks ago with a little lump my toe, he said, its a bunion, now I have never had anything like this before I am 45 now. He said over time it will get bigger and need surgery and 6wk+ recovery, but when I read here of peoples like 3 month later before swelling go down etc, well I wont swear on here but you know where I am coming from, right!!! its small at the moment so I will leave it until I have to have it done, the thought of recovery period of taking months I mean omg. Thanks everyone this has helped me understand.

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Clarissabelle said on 08 May 2013

My surgery was done as an NHS referral in Manchester. No I wouldn t have both feet done at once. I am now 7 weeks post op. The plaster came off after 5 weeks. My foot is still really swollen and goes a red/purple colour unless elevated. I really cannot beleive the results I have had from this op. My foot is amazingly straight and hasn t been like this for many years.

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shinglewood said on 27 April 2013

Anyone.....please can you tell me in Southeast UK if NHS refer....who do they use as the specialist....thanks

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shinglewood said on 27 April 2013

clarissabelle......pls can you tell me where you had this surgery done?
was it an NHS referral or private
would you do both feet at once knowing what you know now?
thanks

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Clarissabelle said on 24 March 2013

I had bunion and toe surgery done 6 days ago. I can honestly say it was not what I was led to beleive by people pain wise. It was done under GA and I went home a few hours later. Scarf osteotomy and Akins osteotomy. I came home with pain releif and actually felt no pain for the first couple of days. Day 3 was achy and throbbed a bit but the pain killers kicked in fairly quickly. I am allowed to heel walk on crutches and walked out of the hospital after surgery. The front of my foot is in plaster. Wish I could see what has been done but will have to wait another 2 weeks for dressings to be removed and stitches out. I would definitely have the other foot done without hesitation. A definite must is to rest as much as you can. It does ache with over use

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Babbsy said on 13 October 2012

I had the bunion on my left foot done 3 years ago and please believe me when i say that whllst the operation, which i had done under a general anaesthetic, is relatively straightforward the recovery is extremely painful and takes many weeks. I did not have plaster on my foot, just a dressing, and wore an orthopaedic shoe to protect it. I was unable to drive for 6 weeks and could not wear any of my shoes as my foot was swollen for at least 3 months.I had to buy shoes with velcro fastenings to accomodate the swelling, not very glam but at least I was able to wear shoes.
3 years down the line and my foot is just fine. 2 days ago I had the bunion on my right foot done. The pain is indescribable and I truly had forgotten just how excruciatingly painful it is. Think long and hard before having the op, your bunion has to be extremely bad to put yourself through this.

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cinderella1 said on 12 October 2012

Question to Salsadancer

Sorry you are suffering so much. I sympathise. Did you find out more about this proceedure?

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Mell123 said on 01 September 2012

I am having my bunion removed next week and should be at a wedding a week later- do you think there is any chance I will make it? :-(

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missywoman said on 01 August 2012

just had opp 1 week a go under local 1week to dressing off. rest rest and more rest is the anwser

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salsadancer said on 12 April 2012

I am a dancer and former dance teacher who has suffered from bunions for several years, however the pain is now so severe that I experience excruciating pain when walking or putting weight on my feet, regardless of the type of shoe I wear -- I saw an NHS podiatrist just 3 months ago who recommended I wear trainers when not dancing, so I have been trying to do this, however even these hurt now. I am currently using everything -- splints, spacers, toe socks, bunion cushions, NSAIDs, pain gels, etc -- but still suffering pain every minute of the day, even when resting.

When surgery was suggested a few years ago, I couldn't consider taking the time off from teaching to recover, and it was always explained that it wouldn't necessarily cure the pain or prevent the bunion returning anyway -- so I could hardly see the point of going through all that only to maybe have a result or just better-looking feet.

Now that it seems like it may be necessary for me just to remain functional on a day-to-day basis, I would really prefer to have this newer, less-invasive treatment that has been pioneered -- so would like to know how soon this may be available on the NHS? I can't afford the £3,948 to have it done privately, but I also can't afford to become a miserable cripple, unable to walk or enjoy an activity that has been a lifelong passion. If all these other surgical procedures offer only a 50% chance of cure, why would this newer procedure be any less risky? I, for one, would be willing to take that risk far more than any other procedure!

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crissymac28 said on 01 December 2011

i have a very painful bunion after reading this article i will be getting it sorted out

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tek3 said on 19 June 2011

found this very helpfull has i,m waiting for an opp on my toe thankyou

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