What will my recovery be like following bunion surgery?

This is one of the most frequently asked questions about bunion surgery that I encounter. In my opinion, it is one of the most important questions to ask. Bunion surgery requires some down time to let things heal properly. This bigger the surgery, the more down time involved.

Since most surgery is elective, it’s always a good idea to plan your life in accordance with the recovery. There is no convenient time to recover from something like this in anyone’s life, so plan accordingly.

In general, bunion surgeries are associated with limited weight bearing for about 6 weeks. Most Bunion surgeries do not require strict non-weight bearing as long as the patients bone quality is good. We use a special shoe with a rigid plastic sole. The shoe allows for swelling and protects the foot.

I break the recovery for bunions into 3 phases: 1. Immediate Post-Op. 2. Bone and Joint Healing (structural healing) 3. Soft tissue Recovery

Immediate Post-Op – Immediately following your surgery, it is important that you not put any weight on the surgical foot. Often the foot is completely numb (if a “block” type anesthetic was used). While the block is in place, if you were to walk on the foot, you could slip or trip or in some other way damage the surgery. Usually within the first few days, we will allow some limited weight bearing on the heel, avoiding pressure on the front of the foot. The first week to 10 days, the foot should be kept elevated to diminish swelling, which in turn will cut down on complications, improve comfort and decrease the risk of infection.

Bone and Joint Healing – During the first four to six weeks, the surgery must be allowed to heal. Cuts in the bone and sewn tendons and joints capsules are held together with suture (surgical thread) and bone screws that are strong enough to hold the repair in place, but not strong enough to support your body weight. Healing of the bone and soft tissues must occur to ensure a successful result. In most cases, we ask that the patient walk on their heel only for the first four to six weeks. Some patients will use crutches or a specialized knee cart during this period. During this period, I will typically check the foot every 2 weeks and change the dressings at those visits.
Specialized dressings reinforce the repair and protect the foot. These are changed in the office, not by the patient. Depending on the type of surgery, the second phase can last up to 2 months.
Medical problems such as diabetes, rheumatoid arthritis and other medical problems can delay healing and lengthen this stage significantly. Smoking can cause significant delays in Bone healing.

Below are average recovery times (time to weight bearing) for procedures I commonly perform for bunions:

Silver/Akin/McBride procedures– These procedures are uncommonly done alone, since they are designed to correct very minor bunion deformities (which I mostly manage without surgery). Recovery is pretty quick and some patients can weight bear within 2 weeks when these procedures are done alone.

Distal Metatarsal Osteotomy (Distal Chevron) – Typically, full weight bearing is allowed at 4 weeks.

Proximal Metatarsal Osteotomy – Typically full weight bearing is allowed at 6 weeks.

Lapidus (Bunion correction with midfoot fusion) – This is a bigger operation, and healing of the fusion may take 6 to 8 weeks before full weight bearing can be allowed.

MTPJ Fusion – Fusion of the great toe is done when a bunion is accompanied by arthritis or to revise failed previous surgery. Full weight bearing is typically allowed at 4 weeks. Previous surgery on the great toe can lengthen this period.

Soft Tissue Recovery - For most procedures, full weight bearing is allowed after bone healing has occurred. During this phase, we sometimes use taping or toe spacers to hold the correction. During this time, the patient can discontinue the post-op shoe. Most are back in a regular walking shoe or gym shoe 2 to 3 months following the surgery.

Recovery is a team effort between myself and the patient. When we are in sync, things tend to go smoothly. If post-op instructions are ignored, poor results can follow. Always remember that my goal is your goal… to fix the problem, and to get you back to life as quickly as safely possible.


This is intended as general information only and not intended as treatment or diagnosis of a medical condition. Any concerns should be followed up with a doctor. Recovery times are generalized and may vary depending on the specific procedure done and other factors in your specific case.

Should I have My Bunions Fixed?

The word “Bunion” is derived from the latin word for Turnip… I guess at some point, someone must have looked down at the red swollen area by their big toe and thought it looked like that. Bunions can be painful or painless. In general, we only recommend surgery for bunions that hurt or cause pain. Bunion surgery is a much bigger deal than most would think. I’ve had patients who came to the office and asked if we could just “laser” off the bunion. What is not so obvious looking at your foot from the outside is that it is rare for a bunion to be just a bump on the toe. Usually the bunion is a combination of the big toe angling too much towards the lesser toes (we call that Hallux Valgus) and the bone that supports the big toe (the metatarsal) angling too away from the middle of the foot. The joint that connects the big toe to the foot (The MTP Joint), becomes unbalanced and with time, this can make the whole thing worse.

It never stops amazing me how many patients come into the office who have been told that they “have to” have their bunions fixed (and fixed now… or it will get worse). There is much misinformation spread about this condition… I’ve had patients leave the office crying in gratitude when I told them “yes… you have a bunion, but no… we wouldn’t operate on it if it doesn’t bother you.” It is also quite a folly that patients seem to be regularly told that they will be back hiking, running, working out and back in their regular shoes in 3 or 4 weeks. The combination of exaggerating the importance of surgery and minimizing the recovery pre-operatively can make patients very unhappy indeed.

Surgery usually involves cutting the bones of the foot and rebalancing the joint. Sometimes, particularly in cases where ther is a lot of arthritis, a joint may need to be fused to correct the problem (fusion is where a joint is made immobile and stiff). As you can imagine… regardless of who does this surgery, you will not be back running on your foot 3 weeks later!

When a patient comes in to be evaluated for their bunion, I look at four important factors: 1. How much does it hurt 2. How bad are the X-Rays 3. What does the patient expect from surgery and 4. Has the deformity (the size of the bump and the amount of angling of the toes) been increasing over the last year.

1. How much doe it hurt? We ask patient to rate their pain 1 to 10 with 10 being the worst imaginable. A patient who has no pain or rates their pain as 1 – 4 will likely not need any surgery (a few exceptions are listed below). Patients with pain in the 5-7 range might need surgery. Patients with pain that are 8-10 have a high likelihood of needing surgery. We usually recommend that patients try using wider shoes with soft leather. Shoes can also be stretched to accommodate the bunion with a Hoke “ball-in-ring” device that can be purchased online and is inexpensive. Orthotics (specialized insoles) are often recommended for bunions, but I’m not entirely convinced that they help bunion pain. If they make the shoe too tight, they will actually make the pain worse. In general, a shoe insert can help pain on the bottom of your foot, but won’t help pain on the sides or top.

2. How Bad are the X-Rays. X-Rays of the foot will help me classify the bunion into one of three categories… mild moderate and severe. As you can imagine, the surgery that is recommended for severe bunions is usually more involved and has a longer recovery time than that needed for mild and moderate bunions. I also look for sings of instability and arthritis which can change the type off surgery that is recommended.

3. What does the patient expect from the surgery? My goals following bunion surgery are for pain relief, a straighter toe and a better fit in normal shoes. Those are things that can be accomplished with bunion surgery. If the patient’s goals match mine, then I consider that patient to have reasonable expectations of their surgical result. Unrealistic goals include… “squeezing my feet more comfortably into shoes that are too small”, “being able to wear those pointy toed shoes that look so cool” and “finally being able to wear those really high heels again”. In many cases, women’s designer shoewear is partially the cause of the bunion and returning to this type of shoewear will invariably spell failure of the surgery and recurrence off the bunion.

4. What has the bunion been doing over the last year? Bunions that are stable (ie. have not changed) present no urgency in their repair. Bunions that are changing, getting bigger… toes angling more and more… having increasing pain... present a different scenario and may be better served by earlier surgical treatment. Bunions from trauma (after an injury) or from arthritis or infection may also need more urgent surgical attention.

If you are concerned about your bunion, seek the advice of an Orthopaedic Surgeon… they have a great deal of training and can help steer you in the right direction. Some bunions are probably better treated earlier than later, but most can be safely watched. Some orthopaedic surgeons have a specialty training in bunion surgery and may be able to give you more options and newer techniques for treatment. Make sure that your goals with surgery match what the surgeon can do.

This is intended as general information only and not intended as treatment or diagnosis of a medical condition. Any concerns should be followed up with a doctor.

New Techniques in Bunion Surgery

The painful bunion deformity is a common and relatively disabling condition that affects individuals of all ages. Over 150 procedures have been described for the treatment of hallux valgus and the orthopaedic literature has focused predominantly on surgical management of this condition; however, successful treatment is often achieved by simple off the shelf orthotic devices and appropriate shoe wear modifications. Given the potential for surgical complications, the significant recovery period associated with bunion surgery and the occasional patient dissatisfaction with otherwise technically successful procedures, it is recommended that non-operative treatment be initiated prior to proceeding with surgery. It is not uncommon for a patient to present with an asymptomatic bunion who is actively seeking surgical correction for cosmetic concerns or because they are unable to comfortably wear fashionable shoes. While pain alone is not the only indication for surgery, it is not recommended that surgery be performed for cosmesis alone.
Bunion deformity is typically classified as mild, moderate and severe. In general, the more severe the deformity, the greater the magnitude of surgery required and the greater the recovery time. Recent research has shown that some procedures are inherently more stable than others and allow for large correction of deformity while remaining biomechanical stable.
The technique pioneered by Dr. G. James Sammarco, MD was correction of the bunion deformity with a proximal “chevron” type osteotomy and was adopted internationally. Dr. Sammarco’s technique remains one of the most frequently performed surgeries for moderate and severe hallux valgus correction.
Recent biomechanical studies have both validated the proximal chevron osteotomy, but have also show that some newer osteotomies may provide higher levels of stability while maintaining the same excellent correction. Dr. Vincent James Sammarco, MD recently published a new surgical technique for hallux valgus correction which utilizes an osteotomy of the first metatarsal which has proven extremely stable. This technique allows for earlier weight bearing and more reliable bone healing. Dr. Sammarco has been using this technique for moderate and severe bunions for over 2 years with excellent success.
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Publications by Dr. Sammarco & Dr. Sammarco on Hallux Valgus

1. SAMMARCO, G.J. and RUSSO-ALESI, F.G.: Bunion correction using proximal chevron osteotomy: a single-incision technique. Foot Ankle Int, 19: 430-7, 1998.

2. SAMMARCO, G.J.; BRAINARD, B.J.; and SAMMARCO, V.J.: Bunion correction using proximal Chevron osteotomy. Foot Ankle, 14: 8-14, 1993.

3. SAMMARCO, G.J. and CONTI, S.F.: Proximal Chevron metatarsal osteotomy: single incision technique. Foot Ankle, 14: 44-7, 1993.

4. SAMMARCO, V.J. and NICHOLS, R.: Orthotic management for disorders of the hallux. Foot Ankle Clin, 10: 191-209, 2005.

5. ACEVEDO, J.I.; SAMMARCO, V.J.; BOUCHER, H.R.; PARKS, B.G.; SCHON, L.C.; and MYERSON, M.S.: Mechanical comparison of cyclic loading in five different first metatarsal shaft osteotomies. Foot Ankle Int, 23: 711-6, 2002.

6. SAMMARCO, V.J. and ACEVEDO, J.: Stability and fixation techniques in first metatarsal osteotomies. Foot Ankle Clin, 6: 409-32, v-vi, 2001.

7. SAMMARCO, V.J. : Mau Osteotomy for Correction of Moderate and Severe Hallux Valgus Deformity. Foot Ankle Int, 28: 857-864, 2007.

8. Sammarco, VJ “Techniques in Hallux Valgus Correction: Proximal Metatarsal Osteotomy with Distal Soft Tissue Correction and Metatarsophalangeal Joint Arthrodesis” in Instructional Courses Lectures, Volume 57 pages 414-428, American Academy of Orthopaedic Surgeons 2008

9. Sammarco, VJ “Mau Osteotomy for Correction of Moderate and Severe Hallux Valgus”. Video Supplement for Instructional Course Lectures Vol 57; Editor, Duwelious, PJ; Azar, FM. American Academy of Orthopaedic Surgeons 2008 (Surgical Technique Video)

10. Sammarco, VJ “Surgical Correction of Moderate and Severe Hallux Valgus. Proximal Metatarsal Osteotomy with Distal Soft-Tissue Correction and Arthrodesis of the Metatarsal Joint” J Bone Joint Surg. AM., 89: 2520-2531. November 2007

Welcome to the Foot and Ankle Medical Blog

Welcome to my blog on Disorders of the Foot and Ankle.

I am an orthopaedic surgeon who specializes in disease of the foot and ankle. My practice is dedicated to excellence in medical care for those with problems of the foot and ankle.

My goal is to offer advanced orthopaedic care using the newest technologies and procedures. I offer expert diagnosis, treatment for adolescents and adults with bone, joint and tendon disorders of the foot and ankle.

Please visit my practice website for more detailed information about my training and qualifications.

Feel free to E-Mail me with specific topics you'd like to see on this blog. Realize, however, that I can't provide medical advice over the internet. OrthoFoot@Gmail.com

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