5 Facts About Pain After Bunion Surgery

Pain after bunion surgery is a common and “normal” phenomenon

Firstly, it’s important to know that pain after hallux valgus surgery is well recognized and studied. There are numerous studies aimed at better understanding and alleviating post-operative pain after hallux valgus surgery.

Two factors can explain this pain:

• Surgical procedures performed during the operation. Despite surgical techniques becoming less invasive, tissues are inevitably damaged during the procedure. It takes time for these tissues to heal, and pain is a symptom of the inflammation occurring in the operated area, which aids in tissue repair.

Here are the words of an international research team (from Belgium, UK, Sweden, Switzerland, and USA) that reviewed all studies on pain after hallux valgus surgery:

Repair of hallux valgus is associated with moderate to severe postoperative pain.

Korwin-Kochanowska et al., 2020

I will discuss this study further later in the article because these researchers specifically sought to determine what was most effective in relieving post-operative pain after hallux valgus surgery.

It’s also worth noting that there are over 200 variants of hallux valgus surgeries documented (Hernandez, 2020)! In this article, I discuss the operation in general regardless of the technique used (osteotomy, minimally invasive technique, or percutaneous technique under radiography).

There are several types of pain after the operation

It is possible to feel very different pains after the operation.

Here are the most commonly described ones, along with some explanations:

Type of pain after hallux valgus surgery	Explanations
Burning sensation	A burning sensation in the toe or foot is often described. This could simply be due to inflammation, which is necessary for tissue healing. It could also be from irritation of nerve endings during the surgical procedure. Nerves can also heal: this is known as “nerve regeneration,” and pain diminishes over time.
Pain under the foot (arch of the foot)	Pain under the foot, especially at the arch, may be attributed to biomechanical changes related to correcting the hallux valgus deformity. Redistribution of forces can create unusual tension on the foot arch. Your body needs time to adjust!
Stabbing pain	A pain described as stabbing could have various causes. There may not necessarily be a link between the intensity of the pain and the severity of the triggering problem.
Tingling sensation in the foot	Tingling sensations in the foot may have the same origin as burning sensations. Alternatively, it could be due to reduced foot and body movement due to pain apprehension.
Stiff toe	Feeling a stiff big toe is very common. One explanation is related to swelling of the toe, which limits its range of motion in flexion and extension. It could also be related to the surgical technique and anatomical modifications made to correct the deformity.
Ankle pain	Even if the operation was on the toe, it’s common to experience swelling (edema) throughout the foot. Fluids responsible for this swelling accumulate throughout. The accumulation of these fluids compresses and can cause pain.
Calf pain	Similar to ankle pain, fluids can accumulate and cause swelling and pain throughout the foot and even the operated leg. Sometimes this occurs on the non-operated side if there is reduced movement.
Pain similar to before the operation	It often takes time to feel less pain than before the operation. I will discuss later how pain evolves over time after hallux valgus surgery.

Pain without other symptoms is not a sign of complication

Like any procedure, there can be complications following hallux valgus surgery. However, these complications affect a minority of people; most people recover well without complications.

Complications occur in 1 out of 10 to 1 out of 2 people (Monteagudo 2020).

Additionally, in case of complications, you generally experience other symptoms besides pain.

Here are the most common complications (though they are still rare) following bunion surgery:

• Recurrence of deformity or pain
• Overcorrection (hallux varus)
• Transfer metatarsalgia (pain in adjacent metatarsals)
• Poor or non-union
• Avascular necrosis
• Arthritis
• Hardware removal (due to discomfort)
• Nerve damage
• Dissatisfaction

As you can see, infection is not listed among these most frequent complications after bunion surgery. Therefore, pain is rarely a sign of infection, which typically presents with fever, wound healing issues, or suspicious fluid drainage.

We know how pain evolves after surgery

Some research teams study the progression of pain following hallux valgus surgery. Here are the data we have (Chen 2016):

• 70% of people no longer have any pain 6 months after the operation.
• 2 years after the operation, 83% of the 30% who still had pain at 6 months experienced a reduction in their pain (some no longer having any pain at all).

What can be concluded from this: you can continue to recover and experience less pain several months and even years after the operation.

Based on my experience (I have not found specific data on this), pain tends to decrease rapidly within the first few days following the operation for the majority of people.

Generally, one can resume walking with crutches and appropriate footwear on the same day as the operation.

To walk normally after bunion surgery (without limping or pain), it typically takes a few days at best, and at worst, 3 to 4 weeks, rarely longer.

There are several ways to relieve post-operative pain after hallux valgus surgery

I’ll discuss what can be done in the days following the operation, as well as in the months afterward if pain persists.

What can be done to relieve pain right after the operation?

Here’s what the research team concluded in 2020 after compiling all treatments that could be effective for relieving pain after hallux valgus surgery.

Interventions that improved postoperative pain relief included paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) or selective cyclooxygenase-2 inhibitors, systemic steroids, and local anesthesia techniques.

There was insufficient evidence for the use of gabapentinoids or wound infiltration with extended-release bupivacaine or dexamethasone. Contradictory evidence was found for percutaneous chevron osteotomy.

No evidence was found for homeopathy, continuous local anesthetic infusion into the wound, clonidine and fentanyl as sciatic nerve adjuvants, bioabsorbable magnesium screws, and orthopedic shoes.

No studies on sciatic nerve block met the PROSPECT methodology inclusion criteria due to a broader scope of included surgical procedures or lack of a control group (no block).

The analgesic regimen for hallux valgus repair should include, in the absence of contraindications, paracetamol and an NSAID or selective cyclooxygenase-2 inhibitor administered preoperatively or intraoperatively and continued postoperatively, along with systemic steroids and postoperative opioids for rescue analgesia.

(Korwin-Kochanowska et al. 2020)

Applying cold to the painful area can also provide relief. Similarly, elevating your foot above heart level or as high as possible relative to your heart can help.

For example, using pillows under your leg when lying down or resting your leg on a footrest when sitting.

This helps prevent body fluids from pooling at the bottom and further compressing damaged tissues, which can cause pain.

I’ll summarize all this in a table format:

Treatment	Effectiveness
Paracetamol	✅
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) OR selective cyclooxygenase-2 (COX-2) inhibitors	✅
Corticosteroids	✅ (only if other options are insufficient)
Opioids (morphine)	✅ (only if other options are insufficient)
Local/regional anesthesia techniques	✅ (during the procedure)
Gabapentinoids (medication)	❌
Specific surgical techniques over others	❌✅ (contradictory evidence)
Homeopathy	❌
Orthopedic shoes	❌

Conclusion: It is mainly medications that help relieve post-operative pain after hallux valgus surgery. If you prefer not to take them, you can try cold therapy and elevation as alternative methods with a good chance of effectiveness.

What to do if hallux valgus pain persists several months after surgery?

If the pain persists beyond 6 months and is bothersome, your surgeon may suggest removing the screws.

The hardware can usually be kept in place, but some people tolerate it less than others. In such cases, it is removed to see if it helps relieve persistent post-operative pain that lasts several months.

Sometimes, persistent pain is not due to the hardware but rather to unlucky circumstances: hallux valgus surgery does not provide complete relief for 100% of individuals who undergo it.