Bunion surgery recovery: elevation, footwear, walking aids and return to activity

The NHS says the most common bunion operation is an osteotomy: small cuts over the big toe, removal or scraping of the bump, straightening of the toe bone and fixing it with screws or staples that are often left in permanently. The society describes other options, including fusion of the big toe joint, which removes movement at that joint, and fusion of the joint at the base of the big toe for a very small group.

Both organisations stress that surgery is not done for appearance. It is considered for severe or constant pain, deformity that affects daily life, ulceration over the bump, or an inability to get comfortable shoes, once simple measures such as podiatry, physiotherapy, shoe changes and splints have not helped.

The society says most people go home the same day or after one night, are expected to be up and about the day after surgery doing normal tasks such as walking around and getting dressed, and also to rest and elevate the foot strictly for 10 to 14 days. That combination can feel contradictory, so it helps to organise the day into short spells of walking and longer spells of resting with the foot raised.

Elevation matters because the foot swells easily after surgery. The NHS gives rest with feet raised for at least 2 weeks as its guide. Ask the ward or your surgeon how long to keep the dressing dry and when stitches will be checked, because this varies.

For the first six weeks the society says you may need a modified shoe to protect the foot together with walking aids such as crutches, and that you will need a walking aid for between two and six weeks. The type of operation affects this, so the plan on your own discharge sheet matters more than a general rule.

The NHS lists what you may find afterwards: toes can be weaker or stiffer than before, may not be perfectly straight, and the foot may still be painful. It also says bunions sometimes come back after surgery, a point the society repeats when it lists rare further surgery if the deformity recurs or the bones do not unite in the ideal position.

• Wear the shoe you are given, and do not switch to ordinary footwear until you are told.

• Use the walking aid for as long as the team advises, even if the foot feels comfortable.

• Report a toe that changes colour, becomes numb or increasingly painful.

The NHS says to avoid driving for 6 to 8 weeks, and the society adds that you may drive earlier in an automatic car if you can make a safe emergency stop. Time off work is given by the NHS as 2 to 12 weeks, a wide range reflecting how much a job demands standing and walking, and sports should be avoided for 3 to 6 months.

The society also says that after surgery you will be asked to complete outcome questionnaires, partly to monitor your improvement and partly to improve knowledge about results, so do not be surprised by repeated forms at follow-up.

A Cochrane review of 25 trials involving 1,597 adults found that surgery may reduce pain compared with no treatment or non-surgical treatment, and may slightly improve function and satisfaction, but that complications such as wound infection or irritation from hardware need to be balanced against these benefits. In the one trial comparing surgery with no treatment, mean pain at 12 months was 21 points on a 100-point scale in the surgery group compared with 39 in the group without surgery. The evidence was rated as low certainty.

Most of the remaining trials compared different operations. The review found that complex osteotomies and simple osteotomies gave similar pain results, although complex procedures may increase reoperation. The society says complications occur in about one in 20 operations and that up to one in 10 people may not be happy with the result, which is why expectations should be realistic.

The society says that if you are overweight, smoke or are not active, you are at greater risk of complications and recovery may take longer, and recommends discussing this with your GP or another health professional before surgery. Risks it lists include stiffness or persistent pain, nerve damage, a low risk of blood clots, infection that may need antibiotics or further surgery, and a small number of people who need insoles or podiatry help afterwards because the foot is unbalanced.

A very painful or hot swollen foot, fever, discharge from the wound, a calf that becomes swollen, tender or red, or breathlessness are reasons to seek medical help promptly. Use your hospital's advice line or NHS 111 for the first group of symptoms, and call 999 or go to A&E for chest pain or sudden shortness of breath.

If the problem is slow progress rather than an emergency, ask your surgical team or a podiatrist. The NHS says you may be able to refer yourself directly to a podiatrist in some areas without seeing a GP.