Is bunion surgery painful?

Is bunion surgery painful? Bunion surgery is unlikely to be painful, as the use of minimal incision techniques and better medications given during the surgery, significantly reduce postoperative pain. Also, because you can walk straight after surgery, postoperative swelling is reduced. 

“Bunions have been shown to reduce health-related quality of life, make fitting footwear difficult and increase the risk of falls and balance problems”. Bilateral bunion surgery can be performed safely as an outpatient procedure in selected patients with acceptable levels of patient satisfaction. Bunion surgery has also been found to be the most effective intervention in scientific studies.

Bunion surgery is unlikely to be painful, as the use of minimal incision techniques and better medications given during the surgery, significantly reduce postoperative pain. Also, because you can walk straight after surgery, postoperative swelling is reduced. Most patients are back into supportive footwear by week 4 and at week 6 can resume most activities. Residual swelling can take several months to completely subside.

Causes

The cause of bunions may include genetic predisposition, local and systemic musculoskeletal diseases such as rheumatoid arthritis, ill-fitting footwear and structural anomalies.

Diagnosis

Diagnosis is made simply through observation although x-rays are used in surgical planning. Clinical assessment involves ascertaining the exact nature of the patient’s symptoms.

Symptoms may be broken down as follows:

  • Medial eminence pain [redness over the bunion with or without bursa formation]. This is likely caused by friction between footwear and the bunion.
  • Sesamoidal pain. Pain is reproducible upon palpation of the fibular or tibial sesamoid and/or its metatarsal articulation.
  • Intermetatarsal bursitis. Pain is elicited upon compression of the 1st and 2nd metatarsal or direct compression of the Intermetatarsal space.
  • Pain on the range of motion of the 1st metatarsophalangeal joint, indicating osteoarthritic changes within the joint.

Conservative Management

  • Adjusting footwear to accommodate medial eminence pain
  • Orthotic therapy may be helpful in offloading sesamoids
  • Injection therapy may be a useful treatment in alleviating symptoms associated with Intermetatarsal bursitis

Surgical Management

Bunion surgery involves: Bone limiting joint motion and/or protruding from the joint is removed and the big toe is realigned. Usually a bone cut is made to allow for realignment of the metatarsal bone. Tight soft tissues are released on the inside of the joint and loose soft tissues on the outside of the joint are tightened. A combination of bone and soft tissue procedures allow the big toe to be properly aligned. A pin is used under the skin to hold the bone in its new position. Occasionally these pins need to be removed although this is rare. The majority of bunion surgery is performed as day surgery and allows for immediate walking after surgery.