July 2013

Patient Perspective: Bunionectomy recovery is more than just healing

9_FA_patient_perspBy Karen Bakar

I can’t recall exactly when the bunion on my left foot started causing discomfort, but it was probably when I was about 40. I waited some time to get a referral to a podiatrist, and when I finally saw one, life with two kids and a full-time job stalled my pursuit of treatment for another three and half years.

The podiatrist diagnosed moderate hallux valgus–not the worst case scenario, but I was definitely a good candidate for surgery. He explained that, while the procedure would correct the problem, the decision to go that route was ultimately up to me, based on my willingness to tolerate the discomfort of doing nothing.

I knew people who had gone through the procedure, and their accounts of severe pain in the immediate aftermath, as well as weeks of inconvenience scared me off, so I opted to first try managing my pain with new footwear. My shoe budget expanded, and I found salvation in several pairs of clogs and other more sensible, but expensive, styles. Even so, eventually the moderate discomfort I was experiencing turned to excruciating pain that often kept me awake at night and disrupted my workouts.

On my next visit to the podiatrist, in June 2012, I was intent on scheduling a date for surgery. Anticipating about a month of major life disruption, I targeted January 2013 for the procedure, when the craziness of Thanksgiving and Christmas would be behind me, work would be reasonably slow, and family and travel commitments were minimal.

Healing the bone

Figure 1. The soft boot worn immediately after surgery.

Figure 1. The soft boot worn immediately after surgery.

On January 9, my podiatrist performed a bunionectomy with distal osteotomy. He prepared me well for the surgery and reviewed milestones and expectations for the first two months. As he described it, this period is about healing the bone. The progression is predictable–from five days with absolutely no pressure on the foot, to the resumption of modified activities in six to eight weeks. Nearly five months postsurgery, I’ve learned that “healing the bone” is only one part of the full recovery.

The initial pain was not as severe as I had expected based on my friends’ accounts, and I never felt the need to fill the Vicodin prescription the nurses gave me. I think my podiatrist’s advice was sound–to let the local anesthetic wear off, and then evaluate the pain level. In my case, over-the-counter relief was sufficient.

I found that during the first few critical days it was important to have lined up help. Friends had arranged meal deliveries every night for the first week, a lifesaver given my inability to get out of bed without crutches. Having a husband who works at home and kids old enough to be somewhat self-sufficient certainly didn’t hurt. The relatively manageable level of pain continued to surprise me, though knowing how fragile my foot was, I was petrified that someone would bump it or that I’d accidentally step on it. One wrong move could send the pain meter off the charts and me back to the operating room!

My biggest concern was sleeping, when things beyond my control could come into play–the dog could jump on the bed and onto my foot, I could get up in the middle of the night and forget I had just had foot surgery (thankfully, that never happened), or I could make involuntary movements while sleeping that might jostle my foot. I wore the soft boot the podiatrist gave me for moderate protection, and had to sleep on my back for several weeks with my foot elevated and outside the heavy covers. It didn’t make for a great night’s sleep, but it worked well enough.

Getting back into a routine

After four weeks, I returned to work, mainly sitting at a computer. I’m fortunate to have great health benefits, so I was able to maximize disability leave. I arranged parking inside my building during the first two weeks of my return, and, with swelling still an issue, I brought a pillow to prop up my foot. I also had my podiatrist provide me with a medical certificate so I could apply for a disabled parking placard from the State of California.

The walking boot I started using five days postsurgery was unattractive and clunky, but did the job and sure beat crutches. Because it didn’t go far past my ankle, it allowed me to walk with a somewhat normal gait. Wearing a flat but elevated shoe on the other foot helped keep my hips aligned and minimized the limp. I found that Dansko clogs were almost the perfect height (1.5-in heel) to match the boot’s elevation.

Once out of the walking boot, a little less than six weeks after surgery, it was time to venture into real footwear. (Even today, more than six months postsurgery, shoe selection is a bit of trial and error and one of the more unexpected frustrations of my recovery.) The podiatrist suggested soft tennis shoes as a first step, but I found the laces were too constricting, and I couldn’t fit the sneaker onto my foot. The best postsurgery shoes, for me, were shearling Ugg boots. Assuming the boot is not too snug to begin with, there’s generally enough room to accommodate some swelling. The soft, flexible material and internal padding were so comfortable I almost forgot I had just had foot surgery.

Figure 2. Examples of shoes the author still was unable to wear five months after surgery because they cut across the incision area.

Figure 2. Examples of shoes the author still was unable to wear five months after surgery because they cut across the incision area.

By two months, I still hadn’t started working out even though my podiatrist said I could begin exercising after four weeks. Exercise means different things to different people, so when doctors have that discussion with patients, it’s wise to be specific about the types of exercise the patient enjoys and what their goals and expectations are.

My particular routine involves aerobic classes, yoga, and dance. All of these require a high degree of toe flexibility, and are thus harder to resume than activities with little to no strain on the toe, such as swimming or riding a bike. I waited three months after the surgery to resume working out, and even then, began at a modified level and pace. It took a good four months to ramp up to my preferred routine. Five months after surgery, I’m enjoying these activities with a lot less pain than I had presurgery; however, I’m not yet pain-free, and I continue to notice the difference in flexibility between my two feet.

Bumps in the road

By the two-month mark, the danger of complications related to the bone healing had passed, and up to that point, my recovery was pretty much textbook.

Figure 3. The author’s active lifestyle requires a high degree of toe flexibility.

Figure 3. The author’s active lifestyle requires a high degree of toe flexibility.

Swelling and moderate pain continued to be issues, however, something I hadn’t expected at this stage of the game. I knew the recovery would be difficult, but I didn’t realize how prolonged it would be. Everything I had focused on up to this point was about healing the bone and keeping it safe. The milestones my doctor outlined so clearly were easy to define, and I understood exactly what I needed to do.

After the eight-week mark, though, as I was transitioning into normal activity levels, I realized my recovery would depend as much on me as it would on my doctor. The podiatrist had guided me successfully through the precarious first few weeks of healing, and while follow-up visits were still on the calendar, the homestretch to recovery–including the ability to do my normal workouts and wear halfway attractive shoes–would involve more time, effort, and some unexpected bumps in the road.

One day at work, two months after surgery, I noticed my foot had become unusually swollen and was turning a disturbing shade of purple. My calf started to throb unbearably with what could only be described as a warm sensation. I had developed a blood clot, and if a coworker hadn’t suggested the possibility, it never would have occurred to me. Sufficiently alarmed by my colleague’s observation, I did some amateur research and discovered that I had almost every symptom and risk factor one could have for deep vein thrombosis (DVT).

Blood clots: Rare but risky

Surgery is a general risk factor for DVT, but the condition is not common after a bunionectomy. Statistics about the risk of clotting after this procedure are hard to come by, and according to my hematologist, bunionectomy is not the type of high-risk procedure that typically causes clotting.

Figure 4. Physical therapy helped significantly improve forefoot range of motion in the operated foot.

Figure 4. Physical therapy helped significantly improve forefoot range of motion in the operated foot.

Nevertheless, my surgical history combined with the facts that I was taking oral contraceptives, had been on a recent flight, and had been relatively immobile for so long after the surgery, seemed to have created a perfect storm. It’s unlikely the surgery caused the blood clot, but I’m convinced it played a role.

Doctors performing bunionectomies might do well to warn patients, especially women on birth control, about the possibility of DVT, despite the low risk. I might have opted not to fly when I did. I might have been more conscious of staying mobile, elevating my foot more frequently, and staying better hydrated to minimize the risk of DVT. I certainly would have stopped taking oral contraceptives, the most significant risk factor.

Recovery after healing

Five months after surgery, I’m on track to what I hope and expect will be a full recovery. Even though my foot has technically been healed for months, it’s not 100% recovered. I still experience minor swelling around the incision, and that keeps me from wearing about a third of my shoes–the ones that have the least flexibility and that cut across the surgical site. “Thickness or puffiness” is how my podiatrist describes this swelling, and I usually notice it at the end of the day, especially with tighter-fitting shoes. He explained that the bunionectomy procedure itself results in trauma to the toe joint capsule and surrounding soft tissue. Compared with bones, soft tissue is slow to remodel, which is why full recovery extends beyond the initial healing.

Figure 5. The additional forefoot flexibility has helped the author get back to favorite activities like yoga.

Figure 5. The additional forefoot flexibility has helped the author get back to favorite activities like yoga.

Toe joint mobility wasn’t something my podiatrist and I discussed in great detail during those early appointments, but it is a helpful conversation to have, if not early on, at least after the first critical six to eight weeks have passed. In my last and final appointment with my podiatrist, he explained that by six months, the flexibility in my toe should be “good to very good,” and that by a year, things should finally “look and feel normal.”

In my case, a month of physical therapy to mobilize the joint capsule has helped me regain some of that lost flexibility. My podiatrist did not initially discuss therapy as part of the longer-term recovery strategy, but I requested the referral because I was afraid that, without it, my foot would forever be stiff and inflexible, an unwelcome scenario given my level of activity.

My podiatrist and I were impressed with the results. After four visits, supported by a handful of home exercises to force greater joint mobility and break up scar tissue, I’ve achieved measurable improvement. From the first therapy session to the last, the flexion of my toe increased from 10° to 30°, and the extension from 52° to 70°.

Would it be enough for a ballerina on pointe shoes? Probably not, but for me, it’s what I need to finally kick up my heels and do the things I’m used to doing.

Karen Bakar is a freelance writer in the San Francisco Bay Area.

123 Responses to Patient Perspective: Bunionectomy recovery is more than just healing

  1. Euniqua says:

    This was helpful. Has anyone had an issue with walking straight flat foot? I am at my 4 week mark and I cannot walk flat. I had both feet done and I’m walking on the sides of my feet even though I’m trying not to. I don’t want to cause any damage but it’s hard.

  2. Jeff Kolodny says:

    I planned my surgery for Jan 9th. On Jan 2nd I photographed a wedding and picked up COVID. That delayed my surgery until March 3rd. I am almost one month into my bunion surgery. When I went into the hospital they would not put me under general because I had high blood pressure. They said I had scaring in my lungs from the COVID and they may be why I had high blood pressure. They kept me over night and did the surgery the next day. When I left the hospital I felt no pain. That night when the pain killers wore off it hurt big time. The prescription painkillers made it manageable. I’m a photographer so I figured doing the surgery during Covid is the best time because everything is shut down. After two weeks off my foot, I started to get calls for small jobs. My doctor gave me the ok to work but with the boot. It’s been about 4 weeks and with the boot shooting even small jobs hurts . Two hours on my feet is painful. My next appointment is in two weeks. I hope at that point I’ll be out of the boot and in loose sneakers. As a photographer , I hate turning away jobs. Because it’s my right foot I can’t drive. Getting rides to jobs is not easy. I’ll looking forward to being able to work longer hours and drive.

  3. Louise says:

    I had a botched tailor’s bunion procedure in August 2019, and still suffering. Had another opinion, and the surgeon immediately noticed she cut it wrong. Should have checked her credentials, but trusted the fact she was an orthopedic surgeon. My foot is ruined with major pain syndrome, and chronic aching sesamoid bone.

    The lateral side where this neophyte cut has turned into a painful internal scar where I continuously load. A simple diagnosis went terribly wrong. I’d like to sue for all the agony Miss Nikki Kelsall has put me through.

  4. Deirdre Gallagher says:

    Great help very encouraging

  5. Phillip LoCascio says:

    After 8 months I still cannot hike more than 1/2 hour. Lots of pain. My foot is worse now than before the surgery, even though ,my surgeon insisted the bunionette repair was a “sure thing”. I realize my experience may not be universal, but do not believe anyone who tells you it’s not risky.

  6. Ann says:

    I had bunion surgery on 4/2/21 is 6/4/21 and still wearing the boot . Incisión got infected. The pain was the worst pain I have ever experienced during the fist 2 weeks and 1/2 post op. I wasn’t prepared for this and the only thing I had was a office chair. It works Office chair .. crutches and now 6/2 I’m 30% weight bearing with crutches. Because of the infection.. the incision area is dark ?. Hopefully it gets better. I will NOT get this surgery on my right foot. The complications are too many. Might as well keep my bunion.

  7. Lynda says:

    Hi I got my bunionectomy june 6 th so went with a friend to a fast shopping for food on my boot 15 mins maybe and another 10 to get birthday cards cause it’s my right foot so can’t drive. Last night n this morning my foot throbbing with a burning pain as bad as it was when I first started .Did I do something wrong to set me back scared .was hoping to drive see dr on 26 th next Monday

  8. Colleen Coner says:

    The knee scooter and the electric scooter so I can get out and shop and do all my errands is the best thing in the world. I would not hop and I will not use my crutches my two scooters give me freedom beyond belief and I can’t believe no one else uses both these items or at least I have never read anyone that uses the electric scooter which is the best thing in the world!!

  9. Sara Hasty says:

    Was unable to learn if the above post bunionectomy graduates gained any weight or a lot of weight during immobility. Please reply concerning this. Thank you!

  10. Kim says:

    Great information! Wish I’d found this article earlier. My progression from pain and finally decision for surgery mirrors a lot of the authors. 6 weeks after bunion and similar hammer toe surgery done as well, which seems to be common. I didn’t feel as prepared for how long and hard this process of recovery is. Pins(2) were necessary and removed at 3 weeks. Still in post surgery boot, and told when I was ready to transition to a soft tennis shoe. The specialty for store said that closer to 8 weeks i could try a stiff shoe instead of a flexible tennis shoe, though might have to get 2 sizes to accommodate the continued swelling. Appreciate the mention of Danskin, and looking for good options for me. Uggs sounds good though hot for summertime. Guess the surgery boot is a must for a little longer. Unfortunately I might have to wear a boot or similar to my son’s wedding in less than 6 weeks. Could always add glitter, lol. Physical therapy might be good later too. Even though doc said not usually done after this surgery, I can sense it might help and makes sense.

  11. Dan P. says:

    Thank you for the thoughtful post. Tomorrow will be exactly 8 weeks after my lapidus bunionectomy. Reflecting back on the experience so far, there are a few things I didn’t hear a lot about that I wish I did.

    I think it’s pretty crucial that people know how much they’ll rely on their good foot and leg after the surgery. For me, I used it for everything. If I had a weak leg or a bad knee, it would have been a lot tougher. So I urge people to keep that in mind. Do whatever it takes to ensure that leg is ready to go. Make it strong for recovery. And then during recovery, treat that good leg well and be gentle to it.

    The other subject I didn’t hear as much about is stiff toes and regaining the range of motion. My big toe was under two different splints, then wrapped up and in a boot for a solid month. It was impossible to exercise it. If I did then the wound on the top of my foot could have opened up. My point is similar to the one made in this great post. Healing the bone is one thing but regaining the flexibility and range of motion is another. I didn’t expect my big toe to be so stiff! But of course it would be because of all the scar tissue along the length of the area from the big toe to the mid foot. I’ve been stretching it as instructed by my doctor and videos I’ve seen on YouTube. I see how flexible the other foot is so I know it’s going to take a good amount of time for it to get anywhere near normal.

    It’s so great now at the two month mark to see a normal looking foot that isn’t purple, or covered in dried flaky skin, and doesn’t feel super swollen. I have no regrets at all so far but the 6 weeks of non weight bearing definitely felt like a long time. And yet in the grand scheme of things, six weeks is really nothing. (At the 6 week mark, I got the ok to walk in the boot.) I’m hoping my doctor will tell me that I can walk without the boot tomorrow. Then I can begin doing (easing into it of course) all the things I love: walking, hiking, cycling, yoga, running. There’s so many things I miss doing!

    If you’ve read this far, thanks! And if you’re going to be having surgery, I wish you all the best! Be well!

  12. Patrick says:

    Good morning. I have a big to where I could move it different ways I was double jointed. So he broke my big toe and wired it. Well this has been almost 10 yes ago and my foot stays swollen I’m 51. I also notice about two weeks ago my foot goes numb and it goes half of my leg on right side anyone know how I can get my foot down? And why my foot goes numb and half of my leg goes numb.

  13. Amanda says:

    Ok so got to say I’m feeling a bit alarmed reading some of this. I’m now 2.5 weeks post surgery. As well as the bunion and hook toe I also had surgery for a Morton’s neuroma. Days 2-10 on crutches but pretty mobile. Only on paracetamol. Today I drove my automatic car, went to work in the office for 3 hours with my foot elevated as much as possible. Cooking dinner, done the ironing and generally pain free but mindful of possible swelling if on my foot too long. Still taking stairs one at a time mind you. More pain in my back from walking carefully. Surgeon told me to get weight bearing as soon as 2 weeks in. Had dissolvable stitches so no pain after the dressing was removed.

  14. Rosemary Allan says:

    I’m only on day 3 after surgery with bunion and hammertoe. I’ve had both knees completely replaced successfully and the pain from that was nothing compared to this.thank goodness i have a wonderful husband who can’t do enough for me even waking several times a night for something i need. yes sleeping doesn’t come easy, my hubby picked up an over the counter sleep aide that helps a great deal called healthy sleep by jamie son.

  15. gabriella mayenburg says:

    I am getting my bunion surgery on my pinkie toe, I haven’t seen many comments about this particular one, usually only the hammertoe. But nonetheless, I have a huge bump, it hurts like crazy when I walk in certain shoes. My back and knees are yelling to get it fixed so I went in for a consultation. Fast forward my surgery is in two days and I am terrified! I hope and pray that I will regain my flexibility and will be able to wear the shoes I love and do the things I love to do. I wasn’t told much about the flexibility issues or exercises after surgery, but I was told that I would be off my foot for quite some time, a month to be exact. I’m only 18 years old and have been vaping for three years now, after I get my surgery I am throwing my vape away and will be going through withdrawals as well as healing from surgery. It will be so hard but it is worth it. I hope that my nicotine history does not mess up the anesthetic or my healing time, but I will update if anything wrong happens, keep me in your thoughts!

  16. Mj says:

    I had a fusion 11 years a goon my left and now need the right foot done. EVERYONE, please do your homework and get 2nd & 3rd opinions! You may want to hear that you can get an a walking boot and just stays after your surgery but I’m telling you that may not be your best option. The fusion is the best surgery almost guaranteed not to have your bunion return But you must stay off your foot 4 to 6 weeks. No pressure at all in that time on your foot. Many people cannot do this or don’t want to and are willing to take the shortcut. The shortcut would’ve been a toe fusion for me but thank God I did not agree to that because that would’ve limited sports that I like and also some exercises. Please please please I cannot stress enough do the procedure that not only has your short term goals in mind but also your long-term physical goals as well. Good luck to all!

  17. Elizabeth says:

    I’m surprised at the above posts. I had Hammer toe surgery and bunion surgery on 21st December, left hospital on crutches the same day, told to walk flat footed, 5 days later using just one crutch. I have my stitches removed 2 weeks post op, leaving the pin in my toe for 6 weeks. Taken no painkillers since day 4. Advised to elevate foot as much as possible for first 2 weeks. Can actually walk without crutches now, 9 days post op, but feel more confident using one crutch!

  18. Beth says:

    I had a double bunionectomy done October 1. October 6th I fell due to instability on my feet. Broke 3 ribs in 5 places, punctured a lung and a myriad of other things. Almost died. Hospitalized for 2 weeks. Convalescence at fiancé’s house for a week. Bunion surgery is no joke! One foot is fine now (3 months later) other foot has pain on bottom. See doctor this week.
    My advice? Don’t do it. If you do, only do one at a time.

  19. Tracey says:

    Thank you so much for sharing . I cannot get into any shoes and walking is not easy. I was non weight bearing for 8 weeks due to a little more invasive but similar surgery. The pain is unbearable .

  20. Lilly Ausbon says:

    I had bunion hammer toe surgery January 21 2022. My doctor said no weight on it at all and keep it elevated at all times. I was only allowed to go to bathroom on a knee scooter then back to bed. Saw dr and had X-ray and bandage changed in 5 days. No pain at all the first 5 days then after the bandage was changed the pain started. I only took a pain pill at night to get to sleep. Back to doctor in another week and stitches and pin in 2nd toe were removed. Bandage removed and I can now set my foot down with the other foot but still non weight on it. I used a walker instead of crutches. Can get in shower now and get foot wet, I had been covering the foot and sticking it out of the shower. My husband had put a hand held shower head in which really helped. My foot is swelling and I have used ice packs regularly all waking hours. At 5 weeks my doctor said I can put weight on it and walk . Strange feeling. My doctor says I am healing and my swelling has not been as bad as most people. I am 70 years old and have never had any problems with swelling. I am now 6 weeks in and my toes are not swollen when I get up in the morning but by noon they are swollen some. I do keep them up a lot. The only shoes I can get on are crocs. I am taking one day at a time, the worst is behind me.

  21. Suzanne says:

    Left foot bunion surgery on March 9th 2022 (11days) very little pain (I requested a nerve block) and very little swelling. I kept it elevated and iced constantly for the first 9 days. I used a knee scooter which is great, however, the hardest thing about this surgery so far is the little annoyances of getting around.
    I was very well prepared, cooked and froze food, shower ready, recliner chair, important things always close by.,
    Do the time, it’s all part of the deal:)

  22. Mark Patrick says:

    I had open bunion surgery on February 17, 2022 on my right foot. I found I was not really prepared for the pain and swelling post surgery. I have been in a walking boot for about two weeks and find some days better than others. Last evening it felt really good and I was able to tentatively bear weight on the heel without too much pain. This morning the swelling was worse and pain elevated. I have my 6 week appointment next Friday and hope to be able to drive after that. The incisions do look well and he Doctor says that they appear to be healing from the inside. I am now able to get around pretty well on the boot, and I came back to work last week. I have found the mental aspects to be more challenging than the physical.

  23. Karen Reynolds says:

    Who would of known that a big toe could cause so much grief!!! I had surgery January 18, 2022 . Have a plate and screw fusing my toe. Must admit that the first 2 weeks I had no problems with pain as long as I kept my foot elevated and iced. I had to wear a boot and was told no weight bearing on my foot for at least 8 weeks. This is week 9 and now my Surgeon says it’s healed and I can start walking full weight with my boot. After sitting and not using my right leg at all I have lost my muscles in my calf and walking around with full weight has made my knee so sore I can hardly bend it. So I am now walking with crutches just putting weight on my heel. How did some of you get back to walking??? Or is it just a long drug out recovery ?? Would appreciate your ideas. I now wish I would of never had this procedure done. But for those that are going to have it please 🙏 get yourself a scooter!!! It is a lifesaver!! Thanks Karen.

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