Frances Clare’s* congenital bunion got progressively worse until she was in her mid-40s, when she could no longer tolerate the pain or even walk her beloved dog, Freda. As a last resort, she opted for surgery.
I’ve had a bunion on my left foot since birth. As a child, I didn’t like the way it made the side of my foot near my big toe look very wide, but it didn’t hurt too much as long as I wore the right (ie sensible) shoes.
I couldn’t wear fashionable shoesDuring my teenage years, I resented the fact I couldn’t wear the shoes I wanted to. I always had to be careful buying shoes: it was a right pain because there weren’t many styles I liked in my wide ‘EE’ fitting, especially as my other foot is a normal ‘D’ fitting.
As a young adult I went skiing, which turned into a bit of an ordeal because the ski boot hurt my left foot so much. The tight, rigid fit was agony and ruined my holiday. On my return home, I sought medical advice for the first time and my foot was X-rayed, but the doctor said my bunion wasn’t bad enough to need treatment.
In my 20s I was embarrassed about the way my foot looked so I was careful to keep it covered as best I could and tried to buy shoes that camouflaged the bulge. Sandals in particular were difficult to find.
What is a bunion?A bunion is a deformity of the joint at the base of the big toe, which results in the big toe pointing towards the second toe. Symptoms include swelling, inflammation and pain, which may be eased by wearing wide, comfortable shoes. In severe cases, surgery may be necessary.
I was discouraged from having surgeryThe pain was gradually getting worse so in my 30s I went back to the doctor, but again I was told the problem wasn’t serious enough for anything to be done about it. What the doctor said discouraged me from having surgery: I was told that correcting a bunion is a major operation that involves a long and sometimes painful recovery period.
Over the years my bunion got progressively worse. During the past decade, the angle at which the bunion protruded became much more pronounced, with a bigger ‘bulge’ and it began to hurt more.
Despite being in almost permanent discomfort, I rarely took anything for the pain. As it was localised I felt I should be able to handle it, although even normal, everyday movements such as changing gear when driving were quite uncomfortable. The pain also began to feel ‘arthritic’ and during cold weather almost every step hurt.
My foot was worse than I’d realisedIn 2008 I adopted a dog – a lively golden retriever called Freda – but taking her for walks wasn’t as much fun as it should have been because I was in so much pain.
By the time I was 45, driving and walking the dog, the two things I do every day, were a real problem. I do a lot of driving for work and I have to walk Freda daily. Spurred on by stories I’d read about people who’ve had a bunion operation carried out with minimal invasion, under a local anaesthetic, I got my GP to refer me back to the hospital. The consultant barely refrained from laughing when I asked about this: he said my bunion was severe and the ‘minimal invasion techniques’ were only suitable for people with minor bunions.
I was very upset by the consultant’s response and couldn’t hide my dismay. He suggested doing an MRI [magnetic resonance imaging] scan. I’d never had one of these before and the combination of the scan and further X-rays revealed one broken bone and two very small dislocated bones in my foot. What’s more, half my big toe joint had eroded away. It was no wonder I was in pain.
The consultant explained that as the bone became forced into more and more of an angle, it caused pressure on the rest of my foot, which exacerbated the pain.
Suddenly, contrary to what I had been told previously, he advised surgery, saying: “Why didn’t you come earlier?” He said it was so bad there was barely any toe joint left and I needed an operation to ‘fuse’ the bones in my foot [called arthrodesis, where the ends of the two bones in the big toe are permanently joined] without delay.
Having the bunion operationBefore the operation I was a bit anxious because everything I read online suggested that it’s a dreadful experience, especially the recovery period, because your foot has to take all your weight. Most of the people on the forums I visited counselled against having the operation unless it was absolutely essential because it’s so unpleasant.
In the event, it wasn’t too bad. I had the operation done on the NHS but at a private Nuffield hospital. This meant it was carried out by a consultant orthopaedic surgeon and I got a private room. (I was advised by staff that the NHS have contracted out all bunion operations, so if you want your bunion fixed and don’t have private health insurance, it’s worth asking if this is the situation in your area.)
I had to have a general anaesthetic and stay in hospital overnight because they wanted to give me intravenous antibiotics to reduce the risk of infection. I also had an ankle block, which stops the pain for 24 hours; plus morphine.
It was a good thing I did stay in overnight because when the physiotherapist checked my plaster (a ‘slipper’ plaster) the next morning, she said it was too loose. The plasterer and I bonded over 25 photos of his golden retriever, but he explained that it might be counter-productive to re-do the plaster so soon as it might disrupt the healing process.
Early days of my recoveryI was relieved to discover that my foot didn’t hurt nearly as much as I’d feared. The worst time was the day after the operation, once the painkillers had worn off. They sent me home with drugs (including tramadol, diclofenac and codeine) but I didn’t take any of them: I didn’t need to.
Within 48 hours of the operation my foot hurt less than it had before I had it done.
I did what I was told. For the first four days, I tried to keep my foot higher than my heart for most of the time. My parents live nearby and I stayed at their house because I don’t have a downstairs loo and I didn’t want to have to go up and down the stairs during the day. They were wonderful and looked after me and walked Freda.
When I went home, I kept my foot up for 80-90 per cent of the time. Over the next fortnight, I was careful not to put my foot under any strain. I didn’t walk at all other than to go to the loo and get food and drinks, leaning on elbow crutches. Once the post-operative swelling had subsided, the plaster was very loose so I went back to see the plasterer again. By this time, everything had settled down, so he was happy to re-do my cast.
Rest and recuperationI stayed off work for three weeks and my foot was in plaster for six weeks. I had 10 stitches, which didn’t come out until the plaster was removed; the scar is barely visible.
The consultant recommended that I buy a pair of MBT shoes, which are a suitable shape for feet following a bunion operation, but I couldn’t find any in my size. Luckily, I unearthed some ancient Skechers I’d bought during a fitness fad years ago, and they happened to provide the support my foot needed: a rigid sole with a rocker to avoid stressing the joint.
I didn’t have any physiotherapy. Eight weeks on from the operation, my toe’s still stiff but it doesn’t hurt. It sometimes feels slightly tender if I walk for more than about 30 minutes but I can walk around the house and I’m fine at work. I’m still wearing the Skechers every day (except for the odd day when I put them in the washing machine) and am planning to carry on wearing them when I exercise for the next couple of months.
There are several different bunion operations and the one I had was the most radical because my big toe joint had almost completely eroded away. As there wasn’t any of it left, I had no choice but to have the big toe fused.
Advantages and disadvantages of surgeryI wish I’d had the operation done sooner, because I did experience chronic pain for many years. However, it’s unclear whether if I’d had surgery 10, 15 or even 20 years ago, I might have had a less serious operation and got away without having it fused. Or might I then have needed a second operation later in life?
Long-term, the advantage of having the bones fused is that you then don’t have to have anything else done. If you have a lesser operation, then sometimes the problem reoccurs. And then you end up having another operation to have the toe fused, so you have to spend two, three-month periods recovering.
The advantage of going for the more dramatic operation is that once it’s done, that’s it. Once the big toe has been fused, you can’t wear high heels – certainly not higher than an inch or an inch and a half – but I couldn’t wear them before the operation anyway because they hurt too much, so that’s not much of a hardship.
There are risks associated with bunion operations, such as infection and DVT (deep vein thrombosis). Also, in rare cases the bones fail to fuse properly. Some people find walking still hurts after the op, but I’m hopeful I’ll be able to walk normally again once I’m fully recovered.
My feet match!I’m gradually increasing the distance I walk so I don’t put my newly-healed foot under too much strain. I don’t want to run a marathon – which is fortunate because it might not be possible – but within six months or so I should be able to walk for 10 miles. Freda will be happy!
I’m really pleased with the outcome. Now, my left foot matches my right foot: they’re exactly the same width for the first time and I’m looking forward to treating myself to some nice new shoes.
*Name has been changed.
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