Where to look for information after your bunion surgery?
When a reader sought a common question, she mentioned that her surgeon was busy and thought it was her oversight as she left the hospital to have forgotten to have asked some basic questions. Not everyone wants to read a book, even though it is crammed with real patient advice, so here are some options for the reader.
ConsultingFootPain is about supporting clinicians and patients with trusted advice. So let’s delve into bunion surgery more and look at some basic information. REMEMBER – no one can give precise information, we can only guide you to the best fit.
Check out the quick summary first.
Quick Guide
- Pain peaks at around 16 -24 hours, reduce over 72 hours and can be fairly negligible by 5 days.
- Swelling reduces slowly from 2 weeks, 4-6 weeks, 3-4 months, and 6 months.
- Footwear may be tolerated by 6 weeks to be tolerated but don’t be surprised if it takes longer. Some shoes don’t fit because the foot shape has changed.
- Mobility commences slowly after 5-7 days. Two weeks should allow some walking, better with aids. Normal activity can take time 6 weeks to 6 months. Returning to heavy industrial work with risk no earlier than 8-12 weeks and for active work, e.g. teaching 8-12 weeks. Sedentary office work 3-6 weeks.
- Wounds take 2-3 weeks to stabilise but may take 6 months to reach their optimum strength.
- Hygiene can be maintained by careful showering using a special cover rather than a plastic bag.
- Numbness may persist for up to 9 months, gradually improving. Massage to reduce the delay in recover
If you wish ConsultingFootPain to answer your questions about bunion surgery, you can post a comment below. Please provide some information about what you have had done. I can only provide information based on factual information.
Since writing this article, I have been amazed at the positive responses. The latest one comes from Sable, who had surgery 6 weeks ago at the time of writing. My reply concerns swelling, toe separation and shortening of her big toe. Only by sharing can we offer the best information. While surgeons might be clever, I am afraid we do not always answer every query hence why this article has offered strong responses. Thanks to everyone for replying. Do look at the comments below as well for further information.
Available from AMAZON books, it covers topics your surgeon may not have time to tell you.
As a podiatric foot specialist and author of this site, I have produced one of the few books covering the day-to-day expectations of patients and queries in an unedited – speak-as-you-find style. The books are in colour and can be found at Amazon as an ebook and paperback. I have kept the cost as low as possible and published not-for-profit. Bunion Behind the Scenes contains personal information covering detailed patient diaries.
The consent
consent for complex surgery should not be signed on the day of the operation
The consent form might only provide limited information, and ideally, in today’s currency, supportive information material should be digested before surgery. This aspect of care is not new. A list of do’s and don’ts make sense. Clearly, you cannot drive or go shopping and should not fly or take any transport that exposes you or others to risk.
You may want to familiarise yourself with the concept of risk and what this really means in another article released by ConsultingFootPain. The range of different operations will determine what you can and cannot do. And it will also determine to have much latitude you have.
A patient had a scarf-akin osteotomy – a successful technique rated among orthopaedic and podiatric surgeons. For more information on this condition, a great site is footeducation.com.
Let us look at the big five areas of post-bunion recovery
The big five WHAT you really need to know
Pain (the lion)
You can expect anything from little pain to a lot of pain. Now that’s just as helpful as using a bent penny in a slot machine.
I guess you could say that we want to avoid that ‘roar’ of the pain stab that stops us from thinking, sleeping or even eating. The truth is we all have different pain thresholds. More complicated surgeries may be more painful, but the Scarf-akin is moderate. Take the painkillers regularly as guided—anti-inflammatories with or after food. Paracetamol (acetaminophen) and codeine are useful but watch out for codeine. It is good but can make you feel dizzy and give you hallucinations in rarer cases. The big downside is constipation – and this can be nasty.
Eat loads of fruit and vegetable, and keep hydrated to avoid the worst effects. Forty-eight hours is when pain should descend, but it can hang on in there, giving you the odd surprising jip for a week or more.
Swelling (the water buffalo)
Swelling is good, and swelling is bad, a contradiction that needs some explanation. Swelling reminds us of hurt and the need to rest. It stops movement. We do less damage with rest. The swelling goes down in time. Sudden swelling after surgery, when all seemed well, is bad. We must think about infection for up to 72 hours. Obviously, an infection can happen later, but we need to talk about this when we get to the wound.
We must elevate the limb to reduce swelling – the higher, the better. This practical act stops nerve endings in tissue from being excited as pressure builds. Keep the pressure down, and the nerves are kept calmer.
Next, ice or cooling methods stop excessive swelling and slow nerve conduction. The benefit provides more comfort. Many methods are available, but try out the download here for more information.
There is a warning. Ensure you do not use ice for too long or on fragile skin. Place ice around the ankle rather than the toes. Allow time to recover from your surgery. Use ice after periods of movement and when pain escalates. Icing and elevation can achieve 40% pain control – that’s impressive.
Exercise & mobility (the cheetah)
The cheetah is well known for bursts of speed. This is not you; after bunion surgery, gentle movement is important, so you must take your time and be realistic. (1) Use those alphabet exercises. This means you need to draw an imaginary figure A, then B, then C and so on, all the way to Z. Move from the ankle, and you will exercise every muscle. Maybe three times a day, but do something while resting. (2) Cycle movement exercises bend the knee and hip and rotate. To do this, lay on your back and pedal first one leg, then the next. Do five pumps each hour while you are not on your feet. Squeeze your buttock cheek muscles, which is good for venous blood movement. Once the wound is healed and the pain controlled, you can press the toe against the ground and lift the heel to help create more upward movement. Toe joint mobility can take over six months to return and, in many cases, does not fully flex because it has been placed into a new position after being dislocated for so long.
Stop clots before they happen.
Exercises are for when you are not moving and are important to stop clots. In some cases, you may have been given an anti-clotting injection and have to follow up at home, but don’t stop exercising. The risk of a leg clot after foot surgery is small, but it can happen. If you get sudden chest pain and breathing problems, then DO phone 111 or 999 (in the UK). Lung clots are life-threatening.
Standing
Standing after foot surgery is a NO-NO. Why? Pain, more swelling, and remember you probably have had a fair amount of surgery, which needs to heal. It is not helped by standing up, cooking or driving, shopping or caring for others in the family. It would be best if you were cared for. How long should you rest? We want you to exercise then build up with short walking periods, but during the first week (5 days), any standing or walking should only involve visits to the bathroom. Once you pass the first week, gentle walking can be increased, but you need aids.
Aids to help mobility
Remember, you have been temporarily disabled. This means you are vulnerable and can fall over. The first thing you should have are crutches, and these should be demonstrated with practical instructions for correct length and stride when in use and how to go up and come downstairs. Now you can use a walker boot. Chances are you will have a post-op shoe. This allows you to cope with that big dressing, but once it is stripped down at around 2 weeks, the shoe is loose. A walker boot is great, and I found Aircast secure and adjustable. Some services provide these, while others don’t. Many will say you don’t need them but take it from me. As a patient, you will advance far quicker with a boot than not. My neighbour had a scarf-akin, and she was stuck with not being able to get around until I recommended she had one. If you can move around and build up active walking, three positive things will happen.
- circulation increases and flows around the foot and limb
- swelling reduces as the calf pump is activated
- wounds heal better with less swelling and better circulation
The downside is –
- you can over-exercise and increase your pain
- swelling can increase with overuse
- the wound opens up and becomes infected
One set of bullet points cancels out the other. But as patient HFP says, she knows her limits and will be sensible. Put this way, non-compliant patients delay their recovery and fail to benefit.
Return to work and normality
Everyone wants to return to normal, and this is as expected. How long does a scarf-akin take to settle? If you are lucky, within a month, if you are unlucky, 4 months. What is normal?
- return to walking 1/2 mile
- returning to the gym
- shopping
- going back to work
- standing all-day
- wearing most shoes in your cupboard
- flying to a holiday destination
- swimming in water
- driving a car with clutch and gears
Let me level with you. Bunion surgery and other types of foot surgery take 6-12 months for some, but not everyone. Younger people do recover better. Heavier people have the added problem of weight and gain in body size during recovery. Normal will be different for everyone. Don’t go back to work too soon; when you do, ease back if you can on a reduced-time basis. Don’t forget surgery has a psychological level as well as physical. After returning to work –
- Allow your foot to be raised.
- Do not work or stand for longer than 30 minutes.
- Reduce your hours for the first 2 weeks when going back
- use ice if swelling becomes notable and uncomfortable
Wound (the rhino)
Skin is tough, but not when it fails to heal. If it gets soggy and wet, an infection can thrive. The type of wound for a bunion is either on the side of the joint or on top. A wound takes 2 weeks to stabilise, even with stitches (sutures). Steristrips are thin tapes and may be used with absorbable stitches. If you cannot see any stitches, they will most likely dissolve. Because this form of closing the wound is invisible and beneficial, the strength of the wound depends upon how long the stitch retains its form. Once an external (visible) stitch is removed, the wound may open slightly. This is not uncommon but tries not to overuse the foot for a further week. By week three, your wound should be ready to be left open even earlier if all appears well. Air is good and dries out wounds if slightly moist. Dressings are no longer required unless needed to avoid shoe rubbing. Taking care of wounds will be dealt with within the next section, but first, let’s be aware of the late infection.
Infection
Infections are characterised by increased pain, swelling and failure of pain medication to work. The wound starts to ooze, perhaps, and the foot feels hot. If you have red streaks going up the leg or feel unwell, this is an emergency and should not be taken lightly as such a condition can be life-threatening. If the wound opens, seek early assistance for assessment. It is not good enough to have antibiotics prescribed over the phone.
Hygiene & bathing (the elephant)
The elephant in the room wants to spray water, keep it clean and feel good. Having just discussed wounds, it makes sense that the wound does not become wet and soggy by allowing showers or baths to soak. If you do soak your dressings, these must be changed as soon as possible to avoid infection. Showers are better in many ways for two reasons. Firstly you can sit under a shower, so you do not have to climb in and out. Secondly, the showerhead can avoid direct soaking of the dressing. If you have not been provided with a shower cover for your limb, invest in buying your own.
Limbo Cover(TM) is recommended because you can order them, and they come quickly by mail. They are designed and reinforced for multiple uses. I have used them for hand injuries and foot surgery, and they have a high patient acceptance rate. The version shown is above the ankle, but a lower-leg version also exists for extra security. This author does not recommend using tapes up plastic bags because they leak and tear. Why go through surgery and risk problems for a product designed for the job?
Massage and care of the incision line
Start the massage as soon as the wound is closed and appears calm. Use Bio oils or anything you like for the skin. While this helps moisturise the skin, you are trying to break up adhesions around the scar line. Apply your lubricating oil first. Press down firmly to tolerance and move along the scar forwards and backwards. Now try little circling movements along the scar line. Does it hurt and feel sensitive? If yes continue pushing yourself, which may make you queasy or dislike the sensation. You are desensitising the wound and removing tightness which breaks down excessive scar tissue. This will help toe movement. The nerve recovers as it is released from the scar tissue. Massage promotes circulation, enhancing healing. Unpleasant to start with, yes. Benefits almost instant, but after a few days, it does get easier.
If you need more information or have a burning question, why not write below, ConsultingFootPain will answer your question. Find out more about the author. This article does not replace any information your specialist may feel appropriate, but hopefully, it will take you in the right direction. All surgeons have different ways of approaching post-operative care, but occasionally, patients require a little extra help.
FURTHER INFORMATION ON BUNIONS & SURGERY
The following information is available on this website. Click on the highlighted text:
When is surgery indicated for the bunion?
Hallux Valgus is known as a bunion
Helping your bunion yourself
Jo’ Bunion Surgery
Risks from surgery
Bunion surgery the best age?
Bunion-joint-fact-sheet-2021-3
Thanks for reading one of my top articles, ‘What you really need to know after bunion surgery?’ by David R Tollafield
Last updated 4th February 2023
Published by Busypencilcase Reflective Communications Est. 2015
I needed this article!!! Thank You so much. I am 6 weeks after reconstruction foot surgery and still so many questions and you answered almost all of them. The details is what I was looking for.
Editor: Thanks Amy for your feedback. The behind closed doors book on Bunion surgery is even more detailed and gives a true account with patients diaries after surgery.
10weeks after buion operation my legs are very stiff and painful.I struggle to walk CRP: I am afraid everyone is different PJ Adams and it is not always possible to identify with another person but recovery depends on a wide range of factors. Hopefully you can seek out a physiotherapist to assist you.
Hi, thanks for the article!
I am 1 week post scarf and akin osteotomy. The wound looks like it’s healing well, I had a District nurse come out today to change my dressing, and only reapplied a little gauze to protect the stiches, not the full padding to wear in my post op shoe so I have done a handmade job with it with some bandages the hospital gave me last week. (the district nurse obviously didn’t know much about the particular surgery I had so couldn’t offer any advice) should I be seeking out seeing someone to dress it and pad it back out properly?
I haven’t been given any advice on when to try walking on it, if I need to do any exercises and what’s going to help it heal. The only thing I’ve been told is to keep it elevated for 50 mins of every hour for the first few weeks and keep using the post op shoe until my appointment with my surgeon (which is in 6 weeks time from the surgery, so 5 weeks today) I’m only assuming I should be heel bearing until that point but I don’t know for sure? I don’t want to delay my recovery by not moving enough if I should be doing more than just resting it and keeping it elevated.
Hope you can help
Editor’s comment – thanks Chloe for your enquiry. I think as clinicians we sometimes do fail to fill in the gaps for patients, not intentionally, but unless you have been there it is easy to dismiss the minor concerns. You should have some post operative information provided, but it may be limited.
The nurse has provided a light dressing. This is normal as we don’t want the wound to sweat. However shoes and walking can be a little tender without thicker covering, so don’t over do it. Elevate, ice to reduced the swelling certainly. The scarf-akin does well from early walking so if pain if not an issue and swelling is not too bad, built that up daily.
You don’t give your age and there are quite a few factors that make giving advice tricky but unless pain creeps up or the wound discharges or bleeds, you are in the right track. PLEASE NOTE Readers comments are not passed onto other people. ‘Bunion Behind the Scenes’ is a comprehensive publication for patients with stories to help guide people through day to day experiences following bunion surgery. This is available through Amazon as kindle and paperback.
I had bunion and bone spur removed from my left foot a a year ago. I still have swelling, although it has reduced. My left foot is very sore with pain to the arch and a weak ankle. I see improvement but it is slow going. I use the compression sock when i am doing a lot of walking. I was told that 18 months and I should be back in heels. Paon is minimal more a burning with some numbness at great toe. I am exercising, stretching the foot and my toes. Shoes are still athletic. Would i do it again, yes because my foot was so bad before.
Thanks for sharing this – The length of time for recovery does indeed depend upon the type of surgery and how each of us recovers. Some faster than others. At the end of the day if we are better then this is all we may be able to say even when no perfect. David
Hi
I had foot surgery in 2018 – both feet at the same time. swelling on sides have remained in fact now bigger than original bunions size is high can make wearing shoes uncomfortable. Even though now no foot pain as before the surgery – the swelling remains and seem to ‘flatten’ considerably better when I’m close fitting shoes such as say trainers – but soon returns to the bulbous sides when removed. I have done foot massages/physio etc and no result. Any suggestion how to reduce the swellings? When flattened feet are fine in shoes with no discomfort. Please help!🙏🤞
Editor’s comment: Anne-Marie it is always difficult to comment with limited information. Reviewing x-rays and the type of surgery used before and after are important to make any decision. The truth is that some bunions fail to settle after surgery and footwear becomes critical in coping even though it may have been your main intention. The fact that some shoes are better is encouraging. Send more information to me at busypencilcasecrp@gmail.com
I had bunions removed both feet 14 months ago. Left went great , right which was bigger was good and swelling was going down then stopped. Something was sticking in bottom of foot identified as sesamoid bone. This was shaved which stopped the pain but swelling remained the same as before shaving. Doc said swelling would go down but at 6 weeks it hasn’t changed. I think it’s still the same swelling from bunion surgery not the shaving. How do I find out what is causing this. It gets sore when pressed during exercising, walking extended periods. There is no infected wound. Thanks.
Thanks, Kate, for your query. If the left foot was larger, did you have the same operation performed? Sesamoid pain can be tricky; additional swelling may be related to shaving and prolonged subsequent recovery. However, something sticking in your foot might require a clinical assessment with an X-ray. Swelling recovery is never easy to predict, and I feel extending this to at least 4 months might be sensible so you have less worry. Often two feet do not follow the same progress.
I would need to know a little more about the type of procedure performed and what internal metalwork was used. I cannot be more specific at this time. David
I had bunion surgery and hammer toe fixed, I guess I have scar tissue or something in the hammer toe it feels terrible. And the arch of my foot it’s swollen it hurts lower than we are the hard weird was put in it will be five months in one week. I don’t know what else I can do.
Editors advice: It is important with post operative problems, even at 5 months that you seek advice from your treating surgeon. Problems do arise as I cover in my articles and books, so it is important to focus what the problem is, why it has occurred and what solutions are available? This is outside the area of self help June. Don’t despair but do seek a professional opinion.
Thanks for this great article!
I am two weeks post op. I have to keep my foot elevated otherwise i am in a lot of pain. The only time my feet aren’t elevated is when i take trips to the bathroom, and during this time i get intense pain until i elevate the foot again. So i am only able to spend my days in bed or on the sofa with my feet elevated.
I am just wondering is this usual for the first few weeks?
Many thanks!
Editor comment: Thanks Hannah; we would like to know more. What you had done exactly and what the original problem was. Was it only a bunion deformity? Are you still taking pain medication? Two weeks is slightly longer to experience extreme pain, although discomfort from surgery can remain for a while. My advice would be to contact your clinic just to have some reassurance. You can reply to busypencilcasecfp@gmail.com for confidentiality but DO get it checked. Surgery is not always predictable.
I’ve had bunion surgery, and I’m a cashier. I don’t know how long I’m supposed w wait to get back to work
I had toe fusion on the other foot, and I returned to work in 3 months, but this bunion surgery is more painful than toe fusion. I had a toe fusion a year ago, and I just now had a bunion removed on December 1
I go to have stitches out on the 21st. My foot is swollen, and I don’t know if I need antibiotics or not
I’ll check on it today. The doctor hasn’t put a date on when I can return to work. I’m not rushing it either
I hope he keeps me off work for six months.
EDITOR REPLY
Thanks, Sharon, for the two amalgamated queries. You should not require antibiotics unless you have a wound problem or known infection. Bunion recovery varies, but we usually advise mobilising slowly with exercises and increasing the load on the toe. Good movement of the ankle is advised to maintain circulation if at rest. Most people find improvement once stitches have been removed. Swelling varies considerably from patient to patient and with different operations. Most find feet swell while a few find swelling very notable affecting footwear. David
I had toe fusion a year ago
I just now had bunion removed on December 1
I go to have stitches out on 21st
My foot is swollen and I don’t know if I need antibiotics or not
I’ll check on it today
The doctor hasn’t put a date on when I can return to work
I’m not rushing it either
I hope he keeps me off work for 6 months
I am three weeks out of bunion and hammer toe surgery. My doctor has me in a walking boot which I can tolerate for only a couple hours each day. The pin is still in the second toe. Staples have been removed. Is it normal to have an aching feeling in my big toe??
Editors comment: Thanks Emily for posting your comment. Many patients write after surgery and limited details make a reply more difficult without knowing more about the type of surgery. You will appreciate while you had an arthrodesis of the second toe, I don’t know how much work you had done, if any on the joint behind this. As far as the bunion is concerned, was this a fusion, osteotomy, excisional arthroplasty? I can only point out that multiple surgery takes longer to heal from and to return to basic walking. Pain at rest should not occur at three weeks except twinges from time to time. Until your pin is removed, (usually at 4-6 weeks) walking certainly will not be normal. You are invited to write to me one on one at busypencilcasecfp@gmail.com where your reply won’t be shared without permission. David
Hi all I would like to know, I have had a Lapidus surgery can I sleep on my side, I have to keep air cast on as I am a really restless sleeper and fidget a lot…many thanks.
Ed. response. Try different positions until you are comfortable. If in an aircast this provides protection but can damage quality bed covers. It is not essential to use an aircast at night however but always use it to use the bathroom during the nighttime period.
This Friday will be 6 weeks after my Bunion surgery. Most of my i nsision scabs are gone now but I stil notice that I have a couple. My question is, can I submerge my foot safety in a bathtub now without damaging my foot. Is it okay to take a bubble bath?
Dear Debra/Lyn Evans
It is usually okay to start bathing after this period unless your surgeon informs you otherwise. The wound should be firm and have no external stitches. As the scabs have gone, it all sounds secure. Try bathing (immersing) initially for a short period despite the bath’s good feel factor. You rub away all the rough skin, which might be flaky. A bubble bath should be okay if the wound is secure and not open. Dry gently with a clean towel or hair dryer on low heat. Best wishes David
I’m nearly 4 weeks post op from scarf akin surgery. It’s starting to feel a bit better, although I’m still struggling to get my trainers on as it hurts too much to bend my big toe.
I’m just wondering if I’m able to wear a silicone toe separator as my big toe seems to be smashing against my next toe??
Editor: Thanks for posting Sarah. 4 weeks is still early and swelling can be expected. You can wear a separator absolutely and I have provided my patients with a toe straightener once they can tolerate the pressure. This is better than silicone in between the toes as it keeps a better tension on the toe. Don’t give up yet and you should feel that you contact the surgeon for advice. In a small number of cases, surgery can undercorrect toes but the judgement has to be made perhaps in another month. I don’t know when you are seeing your surgeon next but ask for an earlier appointment if you are worried. If this is the NHS however there are ‘waiting time’ frustrations reported by other readers.
Hello
I am just over 6 weeks post op.
I had Right foot 1st Metatarsophalangeal Joint Scarf and Akin Osteotomies + 3rd, 4th and 5th Flexor Tenotomies for foot deformities ( my toes curled under but were not hammer toe). So, I had wires in my 3 smaller toes and have been on heel weight bearing only with crutches for 6 weeks.
I had a dressing change at week 1 and then stitches for the bunion removed at week 2. By half way through week 4 I could hobble round the house quite easily without the crutches and mostly pain free but kept the boot on with toe up and weight on heel only.
Last week the wires were removed (31/03/2022) and I really wasn’t prepared for the level of pain and discomfort that followed. I think I thought I would be able to walk normally, possibly drive but have a little swelling however I would say the pain reached similar levels to the first couple of days post op. My foot is ballooned, it is a deeper skin shade than my other one and it throbs and pricks with shooting pain every now and then and only showing marginal improvement by the day. It hurts through the night and I still struggle to sleep comfortably.
I am with NHS and have been given physio exercises to do at home – 10 -20 weight bearing toe raises twice a day (excruciatingly painful – I managed 15 yesterday and today), passive exercises of pulling up and pushing down of the big toe joint as regularly as I can throughout the day and when walking to ensure I go through the whole toe – again excruciatingly painful and not quite possible. I was advised to push through the pain and do as best I can as this is what will help improve mobility and long term ROM.
I think I’d just like to know when is that likely to kick in? Will I suddenly turn a corner and see some improvement ? Is it normal to feel the need for pain killers at this stage and should I or shouldn’t I take them? When can I expect to be able to walk pain free?
All the information I have read on bunion surgery indicates that by week 6 the swelling is reducing a little, shoes can be worn and some normal activities can resume. I am thinking now that as I have also had the wires in and only just come out of the shoe etc I am perhaps still at the stage most people are 2 weeks post-op and what I am experiencing is to be expected. Would you agree? Do you think this was to be expected with the procedures I have had? And the fact I haven’t been able to do any of the big toe exercises that would normally have started at the 2-week stage?
Do you think seeking the help of a private Physio Therapist would help?
I have also been doing the cylcle movement and alphabet exercise you describe and find these bring some relief.
Thank you though for a very informative article
Judith
CFP replies – thanks Judith for this post which will interest many readers. Clearly, this is not an isolated procedure.You have had not one but four operations and the small toes are always that much more difficult as far as the swelling goes.The ideal recovery is based on single procedures, and bunion surgery which includes the scarf-Akin. Age,health, and prior physical fitness will in effect determine recovery. I think you could add on a month and I have seen swelling continue for 16 weeks for larger surgeries. In the foot fluid takes time to disappear because the calf pump is not as efficient at rest. Do continue those A-Z exercises and cycling on your back is good for thigh and calves. Do the ice regimen and tell yourself you do need to be patient.As far as pain goes yes having 3 wires out is a bit ouch. I became a bit kinder at the end of my career to my patients with multiple wires and had my anaesthetist pop some sleepy juice in a vein. Pain killers should be reduced in amount and strength so you get the real idea of limitations. However, the odd painkiller to get you over the occasional bridge is fine, especially at night. Elevation is key even now and ice – when I say elevation I mean high by at least 30 inches above the hip. You ask about going to a private physiotherapist. I have always believed good physio can make a difference post-surgery. Not everyone agrees with me but I had a great team and we were in the private sector. NHS is a system that has leaky holes and is far from perfect. The people are good but the system is not always joined up at all its hubs. You have every right to see someone else for this aspect if you feel you are not doing well. I don’t know who you are under (we don’t publish that of course) but liaise and inform the surgery team of your concerns. The skin colour will look highly coloured for a bit but if pain persists at night with elevation, ice and pain killers then seek reassurance and press for a face to face visit if you can.
Hi
I am 4 weeks post bunion surgery and so far so very good. However I have noticed that along with residual swelling my foot, at the end of the day is swollen but also quite pink and hot. I keep telling myself it’s normal but is it?
Many thanks. Sophie
CFP replies: Sophie swelling can continue for months but the major swelling should be ebbing by 6 weeks depending up the efficiency of your normal venous and lymphatic drainage. The heat is part of the inflammatory process. That said, you should not be in pain at rest and if your foot hangs down when sitting it should be reasonable comfortable. When walking you will find twinges but these should get better day by day and not require more than background pain medication. If you are dependent on strong medication or pain is not tolerable the swelling may indicate a need to seek out your surgeon or the centre for support. Ensure you elevate, rest and ice if the swelling troubles you and don’t expect to get into those old shoes just now. But some inexpensive soft larger shoes that you can throw away later if necessary.
I am second week post-op. I had Austin’s Bunionectomy. So far so good. I go back to my podiatrist tomorrow for another post-op appointment. Do you know if I’ll be able to go from a boot to a shoe, able to bear any weight on it, go back to work? Sorry for all the questions, just anxious I guess.
CFP replies: Hi Donna I think if you are seeing your podiatric surgeon tomorrow the advice should be based on his or her clinical examination. I am sure you will have the appropriate advice. Generally we do wish you early rehab but everyone is different this early on. Austin’s osteotomy generally make a reasonably swift recovery depending upon the internal fixation. Good luck. Let us know how it goes.
Hi I’m on week 8 I had cellulitis after week 6 (I had bunion and 2 toes straightened with pins) cellulitis came 2 days after pins came out, I’ve finished my antibiotics and can see a big difference I.E swelling has almost completely gone and redness has reduced, however it is still darker toned and on my 2 surgery toes and big toe I still get darker skin, and I still can’t walk properly yet, I can’t seam to move my foot the same as my good foot I’m doing home exercises like the cycle legs and moving my ankle and wriggling my toes but it’s the ball joint in my big toe I’m afraid to walk properly on, and I now have pain when walking asif I’m pushing on a bruise kinda feeling. Just hoping all of this is normal. I also can’t fit into a closed shoe just yet.
Good morning I’m weeks out from having Chevron with Akin bunionectomy on my right foot, with 2 screws and a staple in my big toe. I still have swelling and just concerned if my bunion will get smaller as the swelling goes down. I can see a difference in the size, but the bunion still protrudes out some. Thank you
Hi Sabrina, thanks for writing in. Many readers ask this question, and as you have indicated in a follow-up, you are at three weeks, and swelling is expected still and may remain for up to 12 weeks before you see a significant change. Some patients find swelling persists for up to 12 months, but this is usually milder. To the second part of your question, ‘the bunion is still protruding’. Until the swelling subsides, it is difficult to appreciate how significant the correction has been. In the rare situation where the deformity has less correction than desired, I would wait to make that judgement beyond four months. If you are worried about the correction, discuss this with your surgeon to see if an x-ray could offer more information. Again, it is rare for hardware (screws) to move, but it is useful to check if the foot has experienced any knock or trauma. I hope this helps you, but at present, avoid making comparison with anyone who has had surgery before as this can make you more anxious.
Thank you so much. One day after my surgery I had to return to doc because bleeding and gone through my dressing. My doc was not there so I saw another doctor, first she wrapped my foot to tight and she had a lot of gauze on it along with a ace bandages. I explained to her that I didn’t think it would fit in the boot, but she insisted it would. To tried forcing my foot into the boot, even by bracing my foot on her thigh to the point where I was in tears. She unwrapped two layers of gauze and when I left I was in pain. I want experiencing any pain when I got there. I was limping trying to get to my car & took off two more gauze when I got home. Could this have caused trauma to my foot?
In reply Sabrina you did the right thing to loosen the dressing because if the foot has swollen more you would have impeded the circulation. The best guide is also toe colour which can darken, an indicator of too much compression. As you acted fast it is unlikely to have caused a problem. Bleeding is not a big issue and usually seepage but a dressing change best to avoid the bandage becoming hard and slowing wound healing. David
An excellent informative article. Gave me reassurance through the advice given. Thank you so much!!
Hi, thank you for this useful article. I am 10 days post op and had a bunion correction and correction of the 2nd and 3rd metarsal as the plantar plates were fully torn. I have kept elevated for most of the time except bathroom visits. Over the last few days I have tried to increase my activity but find my foot goes extremely numb and tingly if I have been on it for more than 10 minutes at a time. This feeling stays with me and is very uncomfortable and only settles with overnight rest. Is this normal and do I need to just continue building the time standing slowly? Are the nerves adjusting or could there be damage?
Thanks Kim, as surgeries increase in complexity so does the recovery time, the amount of swelling and sensations. If you look at similar queries and responses on this site, the time frame changes, but 10 days is still early and build up to weightbearing can take longer. The 2/3 plate repair is a complex operation conducted in a small space. Nerves lie between each metatarsal and swelling compresses the nerve altering sensation. Adjusting to the assault is an accurate way of looking at the current situation. Hang in there, elevate, ice for short periods and you will see improvement. David
I am 9 days post op from a bunionectomy on my right foot. I feel little to no pain when I’m sat down or laying down and my foot is relaxed however when I stand up to use the bathroom (which is the only standing I’ve done) within the first 5 seconds of standing, I get a hot burning rush to my foot, almost feels like a burning flush of fire + gravity. I find that if I leave my foot to hang and use the crutches it’s more painful so I try to place the foot flat (applying no pressure) and just sliding the foot forward with the support of the crutches. However, sometimes the pain is unbearable and stops me in my tracks so I have to deep breathe until it subsides, which is usually once I’ve sat down again. I was on co-drydamol but it was giving me chest pains so I’ve been prescribed naxopren but it’s doing nothing for the pain. Is this normal?
Dear reader – thanks for your enquiry. As with many readers who ask similar questions, recovery from surgery does not keep to a timetable, so what fits one person does not fit another. Gravity is a big one and takes a while to overcome this unpleasant sensation. It affects hands as well, so elevation is essential for the first 3-4 weeks but on a declining basis.
Pain at rest is the clue hosting a concern, so it sounds as though all is most likely just down to the normal inflammatory process. Codydramol contains codeine, and yes it can have side effects. Naproxen is a curious drug that works for some but not everyone. Ibuprofen 400mg is often a better drug used together with x2 paracetamol following the dosage recommended on the packet. These 2 drugs have the better pain management hit for routine cover and used with ice, and elevation can make a huge difference. Try not to walk before you run. Don’t listen to others as everyone is different. Good luck and let us know how it goes so consultingfootpain can share your experience further – David
I had bunion surgery plus two hammer toes fixed and also the two smallest toes so they would not stick up six weeks ago. Other then numbness and tingling, which I expected, I have had no pain. However when I put my foot down, it gets very red and a bit uncomfortable and my toes are still swollen. Is there anything I can do to help relieve the redness and swelling?
Dear Carol, you have had quite an amount of surgery, and even at six weeks, the symptoms you describe are not unusual. Be prepared for this to take 12 weeks. David
Thank you. I will remain positive. I have tiny little blister looking things on the bottom of my foot right behind the toes. They do not break open. My doctor did not seem concerned so as long as they don’t change, I will not worry. One more week and he said I can try walking a bit. He suggested crocs.
Thanks for your reply, I am pleased you have had some further advice. David
Hi I had bunionectomy surgery on both feet 4 days ago. A nurse said there were screws but no pins. The surgeon had told me he would cut a wedge of bone out to straighten the toe. I brought Darco post op bunion shoes with me but after surgery the nurse said they wouldn’t fit because of the bandages and had me walk on my heels to the bathroom. It caused a lot of pain and the floor was very slippery along with the bandages and the bandages are much thicker around the front of the foot and thinner at the heel making me tilt backwards when walking. Because of no shoes on I had to step onto the dirty ground at the hospital to get into the car from the wheelchair. I’ve had a very painful time trying to get off my bed and onto the commode and into a wheelchair and back on the bed again because of the heels being padded less. Last night I had someone bring the post op shoes for me to look at and the Velcro could have been adjusted so the shoes could have fit onto my feet even with all the padding. My left foot is in a lot more pain especially the big toe. Could I have torn the stitches or done damage because of this. It felt like a huge strain on my toes with a lot of burning pain everytime I had to get up. Your article has been very helpful and informative as all I’ve been told is to get my family doctor to remove the stitches in two weeks and see the surgeon in 4-6 weeks as he is in another town. I was told I wouldn’t need the walking boot but your article says otherwise. Can I use the walking boot on both feet. Do you have any advise you can give me after having both feet done. Do I need the bandages changed between now and having the stitches removed in two weeks. Can I rotate my ankles now or do any other leg exercises at this point. I have inflammatory osteoarthritis all over and my ankles are sore from not moving. I usually rotate and stretch my ankles before getting out of bed to lessen my usual foot pain before surgery. Any advise would be greatly appreciated. So many articles I’ve read say not to walk on the foot with surgery for a period of time as it can cause damage but i was made to walk right after the surgery and it did put a lot of strain on the toes. I don’t want to have gone through all this and then need to repair damage. Do you have any thoughts on this as well. Thank you in advance. I am in Canada. I read so many helpful medical articles from the UK even the US and I’m told France has a lot but here not so much so I really appreciate yours as I’m sure a lot of people do. I unfortunately am not the only one needing advise after this surgery. It is also nice to read an article from a surgeon that has had this surgery and knows how it feels.
Dear Gail – it sounds as though you did have a large dressing application, and naturally, any aid supplied won’t fit if this is bulky. I don’t know the type of stitches used, but I doubt they have torn, as most skin closures are sound. I have not found using 2 walking boots easy, while one is fine. It does depend on the design, though i.e shape of the sole.
I agree you need to have the dressing changed and made smaller so you can use the post-operative shoes for both feet. As far as exercises go, ensure the calf and thigh muscles are moved every few hours. Cycling movement with lying on your back is good. 10 pumps each leg every waking hour. An A-Z drawing motion around the ankle is good for the movement. Use exercises until you are mobile again.
Generally, the aim is rest (elevation & cool packs) to reduce swelling and discomfort. Still, if the pain is no longer an issue, some gentle movement is valuable for recovery and recirculates blood, aiding healing. There is no one rule for everyone. Don’t be afraid to ask your surgeon/nurse for advice as they have a duty to provide close care following surgery. Best wishes, David
Thank you so much for your reply. I can only imagine how busy you must be so it really means a lot to me. I had a ten minute appointment with my surgeon initially then he booked my surgery. I’ve tried to call him before my surgery to ask questions but I can’t get past the receptionist who is mostly unhelpful or goes wrong information. I had to get my family doctor to write perscriptions for things I would need like a wheelchair and commode etc. but I tried calling him the day after surgery about the amount of pain I was having and was told by his receptionist to go to emergency as he is too busy this week. Emergency will be a 4-8 hour wait. Patients with covid and other viruses are in the same waiting area. I was told at the hospital if I have any issues to call 811 that is where anyone can call a nurse for advise but a person can’t see anyone that way. I’m thinking I may have to go to emergency. I had severe bunions equally in both feet but my left foot was hurt more while trying to get up and down and across my bed and the left foot is extremely painful when I try to stand on the heel. The right foot is doing pretty good and feels like it is healing on schedule but the left foot is in much more pain and this morning it is more painful than yesterday. It feels heavy and much more swollen than the right foot. I cringe at the thought of touching that foot to the floor with the pain I’m having from it. The nurse at the hospital that told me the post op bunion shoes wouldn’t fit was mistaken. The day before yesterday I looked at them and saw they are fully adjustable because of the Velcro and I’ve had no problem getting them on since then. Do you think I should get the left foot checked or is this normal for one to be more painful and swollen than the other. I have the most intense pain on top of the big toe around the joint area. My family doctor was setting up home care but I haven’t received a call yet. I think they could change bandages if needed. I know it’s probably difficult for you to assess my foot but you have been the most helpful with your article and your reply to me so far. I would feel so lucky to have a surgeon as caring and helpful as you are. Your patients must be so grateful. I will work with what you think about my left foot, if you think it should be checked or if this is normal. I have an appointment on Feb. 14 with my family doctor to have the stitches out but I don’t see the surgeon until the six week mark I believe which is when the nurse said he’ll decide when I can walk again. Again I want to thank you for your help. I feel very lucky to be able to just contact you for advise and appreciate it very much.
Hi this is Gail again. I’m having a problem with my recovery and would appreciate your opinion on it. My surgery for both bunions was Jan 31. I went to emergency three days ago because my left foot was in so much pain. I could feel a clicking in the big toe. They took the bandages off and did an x ray and said everything looks ok and the screws are in place but the clicking now feels like dislocated bones when I put pressure on my heel to stand and it burns. The right foot is healing much better. Even though
the x rays showed everything is in place it doesn’t feel that way. Could something be wrong or is this something that is normal and will go away. I sure don’t want to wait six weeks to see the surgeon then find out I need surgery again. I have left messages at the surgeons office but I haven’t gotten a call back and don’t expect one as the nurse in emergency told me good luck with that when I told her I’ve been waiting for a call from him. My foot sure looked a lot better with the bunion gone even though the stitches and swelling are still there and I pray I can heal with no further surgery.
Gail, I understand the concern in your message. Assurance is important to you, and from what you have said, x-rays are as expected, and an emergency nurse believes there is no problem. It is always difficult to make statements about the lack of responses from surgeons, although I believe my professional colleagues would reply, cynically perhaps, more so after private surgery. I recalled having expensive dental surgery and was given an emergency number, and had no reply forcing me to speak to a receptionist. Equality of care is never transparent, yet my dental surgeon was caring and communicative when I attended. Bilateral foot surgery is an odd one. That one foot does better than the other is common, so we focus on the side with more concern. If your surgery appears sound, I doubt you will face more surgery. I am sorry to sound like an old record. Foot surgery takes 3-4 months in the first place, which was one reason I often suggested to my patients that they should have one foot done at a time. In the end, there is no right or wrong decision. Try to have lower expectations and build up gently but remain confident. By all means, ask your surgeon what he might expect at the next appointment. However, if you are concerned, ask for an earlier appointment explaining your concern and need his assurance. I do hope this might offer some additional assurance. Kindly, David
Thank you again for your reply. I know I do have high expectations and have waited a long time to find a surgeon that would do the surgery and I want so badly for this to work so I can walk with less pain. I know it won’t all be gone as I have arthritis in my feet and ankles as well and was told I need full reconstructive surgery but I believe the bunions surgery alone will help tremendously. I will lower my expectations and raise them slowly, as you said it does take quite awhile to heal. This feeling of something like two bones moving when I step off the bed or wheelchair really threw me and made me nervous as it began a few days after the surgery but I messaged you again as I feel I you were a remarkable surgeon from what I’ve read on your site and I trust your advise. I love the collection of books you wrote and have ordered two to start. I hope everyone goes through your site to see what you have written. I’d like to add one more thing for other readers here, if I had to do this surgery all over again I’d only do one foot at a time unless you are able to stay in bed and have someone at home to look after everything else so you can focus only on your recovery. Two feet done makes it so much more difficult to move around. In my opinion I don’t think two should be done at the same time. It’s like doing carpal tunnel on both hands at once and you have no hands to use. Again thank you.
I had bilateral SCARF and AKIN osteotomies 6 weeks ago today.
My surgeon was very clear this was my choice and he did not recommend having both feet done together.
However I had done my research and planned ahead. I have two very good friends who have taken on the dog walking duties.
I ensured the cupboards and freezer were full of simple meals that my ( 76 year old) husband could prepare .
I spent the first two weeks in bed with my feet elevated on a very comfortable foam wedge, that I purchased from Amazon in advance.
I only left my bed to use the bathroom. My husband brought my meals on a tray, and for that time only I sat up in my bed. The rest of the time my toes were above my nose as I’d been advised.
I was provided with crutches and special shoes preoperatively , had their use demonstrated by a physiotherapist and given the opportunity to walk about on them. They even demonstrated how to adjust the Velcro according to the bulk of dressings.
At two weeks I attended the practice nurse who removed the dressings and sutures. I had purchased extra wide socks to wear once the dressings came off and these have been very comfortable in my special shoes ( my toes would be cold otherwise!) Three days after sutures out I had a planned telephone appointment with my surgeon, giving me the opportunity to discuss any concerns.
After that first two weeks I started pottering around the house, always using the shoes and crutches. It was certainly uncomfortable initially as my feet swelled after just a short time, but that has improved dramatically.
I planned seated activities for the entire period. Tv, audiobooks, telephone messages and calls, needlework, using my laptop, friends round for coffee and board games and good old fashioned letter writing!
Today, to celebrate the six week mark my husband is taking me out to lunch. My first trip out. On Thursday we have the appointment with the surgeon for X-rays and hopefully to be advised I can return the crutches and ditch the special shoes.
I’m sharing all this because I sensed the despair in Gail’s posts that she didn’t know how difficult it would be. That is sad. In contrast I have had a very positive experience and I should add that my care has been in Scotland and entirely with the NHS.
Thank you from Scotland, Gill. It is always lovely to have positive feedback. Surgery varies so much for everyone. David
Hi Gill, this is Gail. I just read your post and it touched my heart. I am so very happy everything turned out well for you. I have not been so lucky. The aftercare has been almost non existent with my surgeons office only returning a call when the receptionist thought I said my foot was black on a message. She was mistaken but it got her attention. When the surgeon looked at my x rays from the emergency he said he did see something wrong even though the emergency room doctor didn’t see it. The bone in my left foot had shifted. I have been given almost no instruction on what to do and my family doctor and health nurses don’t know either as the surgeon has not given anyone notes. My partner at home has not been very helpful so I’ve had to do a lot of things I shouldn’t be doing according to articles I’ve read. Bless your husband for being so wonderful. I wish I would have prepared meals ahead of time as you did but my partner reassured me he would look after everything including the dogs and cats but hasn’t done so. This has been an experience I wouldn’t want to repeat unless I was sure I would have the help I needed and a surgeon that provided proper post op care. I did have a phone appointment with him last week and I was told I could weightbear on my right foot now but not for another two weeks on my left and I could wear normal shoes in a month. I called back to ask a question and the receptionist informed me the notes she was given were that everything was two weeks later than what I was told so I’m playing it safe and waiting. It was quite difficult not having proper instruction. I am so grateful to Dr. Tollafield for his help, this site and his books. I purchased his book Behind The Scenes which has been very informative. At this point my big toes are leaning in towards my other toes and are turned a bit sideways even though I kept putting rolled up gauze between the toes to keep the big toes straight. At least the big bunions are gone. I don’t know where things will go from here but it sure does my heart good to know that you are doing good. All my best to you and your husband.
Thanks, Gail, for your reply and for Gill for sharing. The idea is to offer a support network even though we may not have all the answers.
I have to say I am so grateful to you for putting up this website and to everyone else for their posts and questions. It really helps when we have questions and to read everyone else’s issues that might be similar to our own. Also learning of your books that have so much helpful information was awesome. I wasn’t sure if it was ok to reply to someone else but it would be nice to receive replies from other people on their experiences. It made my day to hear from Gill about her experience.
Hello Dr. Tollafield in a reply above I saw that you had given or recommended toe splints to your patients. Can you tell me what kind to look for. I am now doubling up gel spacers which don’t seem to be working very good but the balled up gauze I was using was causing pain in my toes. My family doctor gave me a prescription for toe splints but doesn’t know which kind I should get. Thank you.
Hi Gail, toe splints form an interesting subject, and I am pleased to direct you to my link on toe splints
However, as a cautionary tale, the splint will not correct failed surgery, correct a bunion, or make it straight if it is no longer aligned. I used splints only to help with healing and reduce joint pain. If the bone moved after surgery, the chance of meeting the original objective would likely be poor. I am sorry if this sounds negative. However some bunion corrections while less than ideal can satisfy some patients but not all. David
Hi
I had the Skarf and Akin procedure carried out on my left foot 7 months ago. I am struggling with extreme heat pain and discolouration. My foot is either freezing cold and purple or extremely hot, swollen and red. Elevation helps the heat/redness. I can only walk very short distances as this seems to be a trigger. I have had nerve conduction tests and an ultrasound which have all came back as normal. I’m really at the end of my tether as it is preventing me from carrying on with my normal activities. I would really appreciate any advice you can give me. It is the burning pain that is making this so unbearable. Thank you in advance.
Hello, Ms/Mr? McClean. I am sorry to hear about your problem. Seven months should be plenty of time for the foot to settle, and your description suggests an unusual pain response often called complex regional pain syndrome (CRPS) — freezing, hot & cold and burning pain are the giveaway triggers. Your treatment should have started, but my advice is to seek a pain specialist (anaesthetist or rheumatologist). Ultrasound and nerve conduction tests are not conclusive. I am sorry to advise that if this is CRPS, then the journey is not clear or predictable. The are a wide range of strategies available to try with specific medicines to calm the nerve-related problem, but you ideally want to avoid drugs that cause a dependency. I am assuming you are a USA person. If you Google the internet for the condition, I believe there is a US help site for patients. I would also advise against assuming that surgery went wrong or was inappropriate, although I assume you might have had information before surgery on risks. The condition strikes women more than men, and any age makes it open season. Surgery and injury set the symptoms off, but predicting who will experience this is almost impossible. We do not know the true incidence, but I suspect it is less than 1%, and plenty of Scarf surgery is undertaken without this arising.
If you search for pain on my site, there is more information on pain and CRPS. If you are UK-based, ‘Burning Nights’ is a site you can use for this condition. Try and get a diagnosis ASAP and get some professional treatment as the longer this is left the more difficult it is to subdue. David
Hi! I am one of the unfortunate people who ended up with CRPS after bunion surgery. I am thirteen months out of surgery and I will say it is a little better… but my foot will never be the same. I still suffer with pain, swelling and discoloration but it is better than it was. I came close to losing my foot so I am happy that I still have it and that I can do some of the things I used to do. I was on gabapentin for about six months but I made the choice to go off it. It’s a long road and it will improve but definitely get into see a specialist because it is likely something you will always have to deal with at some level. I am so sorry…
Thank you, Emily. It is good to have a patient perspective and valuable for readers. Of course, the most important part of managing CRPS is ensuring a correct diagnosis. David
I had bunion and hammer toe surgery 11 weeks ago. After severe pain in my foot and ankle after 4 weeks ( & first wearing a trainer) an X-ray showed arthritis in the foot and ankle. Am now having physio & my surgeon says everything looks good but it will be a slow recovery. I’ve been trying to walk daily – up to 1.5 or 2 miles, which I can manage but have pain afterwards. When I ask how far I should walk I just get told ” as far as you feel able” Is this too much too soon? My husband and I used to walk miles so I think I’m pushing myself to get back to this level quickly. Anyone else had this issue? Thanks
Debbie, there is no absolute right period before full activity. I would tell my patients 12-16 weeks for most resolution to occur and allow activity, including walking and dancing and playing sports.
Some people do better earlier, and some take 6 months. The difference is the type of surgery (extent), age, organic make-up, healing power, attitude, weight and determination. The advice is broadly correct from your surgeon. I should add your feelings of frustration, of course, not least because your husband is free to walk and wants you back. Don’t be too hard on yourself I am sure you are nearly there, but do build up with positive and yet realistic expectations. David
Thank you so much for your reply David which has really reassured me. I think I have been putting too much pressure on myself tbh. I need to listen to my body ( which is what I would say to someone else as I am a nurse!) I’ve backed off walking for 2 days and had my 1st swim yesterday, which was great as it’s one of my favourite activities. I also sat in the jacuzzi for 5 minutes & the heat really seemed to help. My mood really lifted too. I think you’re right. Positive but realistic expectations! Thanks so much again. Your support has really helped me
Thanks for your response and glad to be of assistance Debbi
Hi I’m 6 weeks post metatarsal osteotomy & aiken osteotomy lateral release and excision of morton neuroma removal between 3/4 toe, all on right foot. Healing well, still can’t fully weight bare on foot. Toes still stiff and swelling occurs when standing for too long. Wearimg shoe outside but bare heal indoors.
However my big toe and 2nd toe seem to have quite a gap. Will this eventually close, if so when? Also is there anything I can purchase to help the gap close any sooner?
Hi Javell – I can only offer a general comment as I don’t know all your details. The surgeries combined are fairly intensive and swelling can be sustained for 12-16 weeks so you have some way to go. The gap usually reduces with the swelling and walking but I would expect you to be loading the foot at six weeks as part of rehab. The time that the foot will take weight can be slow. You can send me a picture to busypencilcasecfp@gmail if you like so I can check. In 2-5% of cases over correction of the first toe can arise and leaves a permanent gap. In thirty years of doing surgery I think I have only correct one such case but that decision should only be made later on. David