Today I’m going to talk about a common question that I often receive, or a common concern regarding bunion surgery. Oftentimes I’m faced with a patient who has a bunion that I can’t do anything further for and they need surgery to correct it. The question I’m often asked is, “I’ve heard that bunion surgery is extremely painful, and several people I’ve talked to had a lot of problems going through the recovery period.”
Why does it hurt so much?
It’s always difficult to answer that question because bunion surgery in and of itself isn’t more inherently painful than any other foot and ankle procedure, but the problem often lies in what people expect out of the surgical process itself. A lot of people assume that a bunion is a fairly simple deformity that just simply needs the bone shaved down in order for the condition to be corrected.
Because people only see the external bump a bunion causes, the assumption is all you have to simply do is shave it down and the situation’s solved. There’s no more bunion. The problem is is that the deformity actually lies in the angle of this bone being too far angled over, creating the bunion process. Just by simply shaving the side of the bone you’re not accomplishing anything, because over the course of 10-15 years, that little side or that bump is just simply going to go back again, and you’ll end up with the same problem.
What you have to do is you have to correct the actual angle deformity itself. So you have to make a cut in the first metatarsal bone somewhere and move the bone back over to a straighter position so that the toe can straighten out again, so it’s in a better proper position and functioning more like it should anatomically.
That procedure can involve several different types of surgeries. If the deformity is moderate or low, you can make a cut at the bone right at the top of the bone, which moves the bone over and then it’s secured with a screw or wire or some other type of implanted device that’s going to hold the bone together for the 6 weeks that it takes it to heal. If the bunion is really bad though, and this bone is really angled far out, then you have to do a procedure more back at the base of the bone in order to slide it back over. That’s a little less stable. It requires a little bit longer on the recovery period.
Extreme cases where there’s a really bad bunion and there’s also instability where this bone moves up and down too much, you actually have to fuse this joint right here, and that requires basically using screws and plates and other types of hardware to hold that joint together. That takes about 6 to 8 weeks to recover from.
Inherently, in an of itself, bunion surgery, when compared with other bone and joint surgery of the foot and ankle really doesn’t take that much longer to heal, nor is there anything about the bunion surgical process itself that is more inherently painful than any other foot and ankle procedure. The problem lies in the expectation, as I said, that people have. A lot of people are expecting that, even if they’ve been instructed or told what’s going to happen in surgery, they’re still of this mindset, “Well, it’s just a bump that’s being removed. I’ll be back on my feet very quickly.” The fact of the matter is is that people often will become way too active following a bunion procedure, especially if it’s the more common procedure where you don’t have to be in a cast and be off of your feet for the 6 to 8-week period that the bone has to heal, if you just have to have the procedure up at the top here. Most people are in just sort of a walking boot during this recovery period. Some more aggressive surgeons might place their patients in simply a surgical shoe to stabilize that foot as it goes through the healing process.
Activity levels after surgery
The initial problem with bunion surgery is that people simply become way too active, way too soon. Instead of taking 2 to 3 weeks off of major activity and even minor activity, just allowing the inflammation process to go through its course, which takes a week to 2 weeks to occur, people will often be at rest for 4 or 5 days, and then decide, “Well, my body feels pretty good, so I think I can get a little bit more active. People start to walk on that foot and become more active, and then it becomes very inflamed as a result of that overactivity. That inflammation, unfortunately, if it starts up too early will stay with you throughout the course of the recovery period.
That’s one problem with foot and ankle surgery is that unlike abdominal surgery or having some major procedure done, your body feels pretty good afterwards because the only part that was operated on was the foot. But the problem is that the foot needs just as much rest as the rest of the body does after a major procedure. If you’re not giving your foot that rest, then you’re priming yourself to develop a lot of inflammation because you become more active on that body part that’s not quite ready to take the full body weight and take the activity of the body. As that inflammation process increases, so does pain and so does discomfort.
A lot of people who do have a significant amount of pain following a bunion surgery, the pain develops because they’re just simply too active on that body part too soon, and that creates pain either of a throbbing or a burning nature.
Now sometimes there can be complications that can occur during bunion surgery. There are several nerves in that area than can inadvertently become harmed during the surgical process and the inflammation can develop around them, and that can lead to some sharp burning pain or some other types of situations can arise which can cause pain in and of themselves. But those are very, very uncommon. The majority of people that do develop discomfort and pain following bunion surgery, even up to a severe level, it’s usually just simply overactivity, not letting the foot having its time to rest, and simply sometimes not even following the instructions of the surgeon and feeling your way through the recovery process, and just not giving the foot the time it needs to heal and become more comfortable.
Wrapping it up
If you are considering bunion surgery, if you do have a painful bunion, consider this. Yes, there are cases in which people do have unnecessary, significant pain following surgery for reasons because of complications and other problems. Some people do have a very low threshold of pain, and so any minor amount of pain can sometimes be amplified in their minds. But the majority of people who do have problems following bunion surgery usually have them because they’re overactive.
The way that you can prevent that is to simply follow your surgeon’s instructions, give your foot the time it takes to rest. From there you will generally have a pretty good surgical recovery, some brief discomfort in the beginning, but overall it should feel pretty good, and you really shouldn’t be one of those that say that bunion surgery was one of the more painful things you went through. It’s a minor discomfort, and it lasts briefly, but it really shouldn’t cause that much significant discomfort that one would have to think that.