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Bunion surgery

A bunion surgery is considered when conservative measures are no longer effective and the pain persists. This guide provides a clear overview of when it makes sense to operate on a bunion, which new surgical methods are available for bunions, and when they are used.

Fact about bunions

Bunions are one of the most common foot deformities. Bunions generally affects more women than men. The Shark Screw® offers patients a natural surgical method without any metals in the body.

When should a bunion be operated?

The decision to operate a bunion depends on various factors and should be made in close consultation with an orthopedic surgeon. In general, bunion surgery is considered if conservative measures are not sufficient to alleviate the symptoms and the bunion continues to cause pain or impair the quality of life. Some indications for bunion surgery may be


If pain, especially in connection with activities such as walking or standing, persists despite conservative treatments such as orthopaedic insoles or physiotherapy exercises.

Deformity & restriction of movement

If the bunion leads to a significant deformity of the foot and the normal movement of the big toe is impaired.

Inflammation & swelling

For recurrent inflammation and swelling in the area of the big toe.

Limited quality of life

If the bunion significantly impairs the quality of life, for example, due to difficulties in wearing shoes or social restrictions.

It is advisable to consult a specialist at an early stage if you are experiencing pain and to find out about the available treatment options. Patients who prefer a natural surgical method to metals and their risks in the body should find out more about “screws made of bone”.

How long are you on sick leave / in hospital after bunion surgery?

The duration of incapacity to work after bunion surgery depends on various factors. In general, it depends on what kind of occupational activities are carried out and how quickly the individual healing process takes place. In the case of activities with low foot strain or sedentary work, the incapacity to work often lasts only a few days to a week. However, people who have to stand a lot at work may be on sick leave for two to six weeks or longer.

The time in hospital after bunion surgery is usually relatively short. The inpatient stay usually lasts one day or possibly two, depending on the complexity of the procedure and the individual healing process. The overall duration of illness after bunion surgery also varies. In the first few days after the procedure, it is important to rest the foot. Depending on the healing process, sick leave may last several weeks. It is advisable to follow the surgeon’s post-operative instructions exactly and to undergo regular check-ups to monitor the progress of healing.

What are the chances of success with bunion surgery?

The chances of success at a bunion surgery are generally very good, especially if the procedure is performed by experienced and qualified surgeons who choose a biological e.g. with Shark Screw®. The decision to have surgery is usually made when conservative treatment methods do not provide sufficient relief of symptoms and the bunion causes significant discomfort.

Here are some factors that can influence the chances of success:

Surgical experience

The surgeon’s experience and qualifications are crucial. An experienced foot surgeon can select the optimal surgical method and perform the procedure with precision.

Choosing the right surgical method

There are various techniques for correcting bunions, and the choice of the appropriate method depends on the patient’s situation. An experienced surgeon will select the appropriate method according to the severity of the deformity and other individual factors.

Aftercare & rehabilitation

Aftercare and rehabilitation after the operation play an important role in the success of the operation. The patient should follow the post-operative instructions exactly, take advantage of physiotherapy and attend regular check-ups.

Health status of the patient

The patient’s general state of health can influence recovery. Healing may be delayed in people with pre-existing conditions.

How long does a bunion surgery take?

The duration of hallux valgus surgery varies depending on the type of procedure, the complexity of the case and the surgeon’s experience. As a rule, the actual operation takes around 30 to 100 minutes. If you suffer from severe bunions, the operation usually takes a little longer than for a mild deformity. The operation can be performed either on an outpatient or inpatient basis. Whether an operation is performed on an inpatient or outpatient basis, under general or local anesthesia, can only be decided in consultation with your doctor.

The severity of bunions

The aim of bunion surgery is to relieve the patient’s pain as quickly as possible. A large bunion angle (how much the toe is bent) is often also an indication of more severe pain. However, this does not have to be the case. Patients often have severe pain even though the hallux valgus is not yet very pronounced

Severity level I

Mild form

Intermetatarsal angle (IM) less than 15°

Severity level II

Moderate form

Intermetatarsal angle (IM) between 15° and 20°

Severity level III

Severe form

Intermetatarsal angle (IM) over 20°

The pain caused by bunions does not always depend on the severity of the hallux valgus angle. Hallux valgus pain is always a purely subjective sensation and varies from patient to patient!

Dr. Klaus Pastl

Expert for bunion surgery

Whether mild, moderate or severe bunions, Shark Screw® offers patients a biological treatment for hallux valgus.

What is meant by intermetatarsal angle (IMA) & hallux valgus angle (HVA)?
The intermetatarsal angle, or IM angle for short, is the angle formed by two metatarsal bones. This usually refers to the angle between the first and second metatarsal bones. To correct a hallux valgus deformity, the surgeon selects the appropriate surgical method based on the intermetatarsal angle. The hallux valgus angle, abbreviated to HV angle, describes the angle between the extended axis of the first metatarsal bone and the proximal phalanx of the big toe.

Overview of hallux valgus surgery methods

Mild form

In a mild form, the angle between the first and second metatarsal bones deviates from the normal alignment. The big toe tends to lean outwards towards the neighboring second toe. In addition, bony deposits appear on the first metatarsal head. This leads to irritation, swelling and pain in the area of the ball of the big toe. The misalignment also causes premature signs of wear on the metatarsophalangeal joint.

normal foot

mild form

Possible treatment

In many cases, it is not enough to simply remove the bone protrusion. Instead, a more complex measure is required, namely a rearrangement of the metatarsal bone, as is also necessary for moderate and severe forms of hallux valgus. Saw cuts are made on the bone to change the alignment of the bone axis. This procedure, also known as an “osteotomy”, enables targeted correction of the deformity and is particularly important for advanced forms of hallux valgus.

Austin / Chevron Osteotomy

In the Austin / Chevron osteotomy, the bone is repositioned in the area of the head and then fixed with a screw. Every year, many patients opt for a biological fixation without any metal in the body. This is possible with bone screws.

Surgery according to Austin/Chevron

Surgery according to Austin/Chevron – lateral


Recovery takes several weeks, so it is necessary to wear a special shoe (forefoot relief shoe) for about 4-6 weeks. Within this period, it is permitted to put weight on the foot in the shoe.

Moderate form

The spread of the foot increases with an increased angle between the first and second metatarsal bones.m Mobility in the metatarsophalangeal joint of the big toe is often painful and restricted. The area of the “bunion” can be prone to inflammation and causes pain even at rest, while the big toe increasingly affects the neighboring second toe.

normal foot

Moderate form

Possible treatment - Operation according to Meyer-Scarf

The Meyer-Scarf operation involves a Z-shaped transection and correction of the position of the shaft of the first metatarsal bone.

Surgery according to Meyer/Scarf

Surgery according to Meyer/Scarf – lateral


Healing takes place over a period of 6-8 weeks.

Severe form

Due to a considerably enlarged angle between the first and second metatarsal bones, the ball of the big toe protrudes significantly outwards. As a result, the big toe can either push itself over or under the second toe or push it outwards. This change can lead to pain, swelling, callus formation and incorrect loading, which can be exacerbated by wearing tight shoes.

normal foot

Severe form

Possible treatments

It is necessary to reposition the first metatarsal bone at its base. Alternatively, a fusion operation between the first metatarsal bone and the first tarsal bone may be necessary. This measure does not impair the rolling process in the metatarsophalangeal joint.

Surgical technique 1: Repositioning osteotomy at the base of the 1st metatarsal bone

The bone is repositioned in the area of the base of the metatarsal bone. Either a small bone wedge can be removed and the resulting gap closed or the bone is “bent open” (opened) in the area where it was cut and corrected to its correct axis. During the healing process, the severed bone is usually fixed in place with bone screws or a metal plate. Depending on the pain, this plate will be removed again after half a year. If screws made of bone are used, this operation to remove metal is not necessary.


Healing normally takes 6-8 weeks.

Surgical technique 2: Stiffening between the 1st metatarsal bone and the tarsus (Lapidus surgery)

Abnormal mobility in the joint between the first metatarsal bone and the tarsus can also lead to malalignment. In such cases, a fusion operation is required between the first metatarsal bone and the first tarsal bone in the corrected position, known as “Lapidus arthrodesis”. The bones are connected using screws and/or a special titanium plate. These metals are removed at the patient’s request after about a year. The use of bone screws eliminates this second operation and the associated risks.

Severe form

Surgery according to Lapidus


In the initial phase after the operation, only partial weight-bearing on the foot is permitted. The foot and ankle are often initially immobilized in a removable plastic boot or a plastic cast. Bone healing takes longer, on average the foot can be fully loaded again after 8-12 weeks.

What is a forefoot relief shoe?

A forefoot relief shoe is a special shoe that has been developed to relieve the forefoot. It is often used after a bunion surgery where relief of the front part of the foot is required.

What new surgical methods are available for bunions?

New bunion surgery method: surgery with screws made out of bones

However, patients often ask what new hallux valgus surgery method is available – the answer: a natural treatment, free of foreign bodies such as metals etc., with a screw made from pure human donor bone. We are talking about the so-called Shark Screw. The Shark Screw is used in orthopaedics and trauma surgery and offers patients enormous advantages. In conventional hallux valgus operations, metal screws and plates are often used, but these have the disadvantage that they have to be removed again in the event of complications or allergic reactions, meaning that patients may have to undergo a second operation. However, there is also the case where these metals remain in the body without any function.

Leading surgeons rely on the bunion surgery method with bone screws. As already mentioned, patients who have been treated with the Shark Screw bone screw are spared a possible second operation to remove the metal. It also offers excellent tolerance, especially for allergy sufferers or diabetics. But the best thing is that the Shark Screw is completely remodeled into the patient’s own bone and is therefore no longer visible on the X-ray after a few months.

Hallux valgus surgery: Before - After

What does the foot look like after bunion surgery? Many patients are concerned about how the foot changes after bunion surgery. For this reason, in the following section, we present you with an informative gallery that illustrates the direct difference before and after bunion surgery.

The right preparation for bunion surgery

What you can do before bunion surgery

Bunion surgery begins long before the incision is made on the operating table, namely with the preparation for the operation. But how do you prepare properly for a surgery? As movement is always restricted for a few weeks after the operation, it is advisable to prepare for the time afterward. This includes activities such as rescheduling appointments, completing important tasks at work, planning physiotherapy or even lymphatic drainage.

Bunion surgery experience reports / bunion surgery experience

These were the experiences of patients after bunion surgery

Before surgery, patients often want to know what experiences other patients who have already had bunion surgery. The following people opted for bunion surgery and were willing to share their personal experiences afterward.


Mild bunion

“Longer walks were already difficult, even when cycling I often had to stop after 15 minutes because it hurt. To summarize: taping and massaging helped in the short term, but not in the long term. After the bunion surgery I had no complaints at all. The decisive factor for me was that my doctor used bone screws instead of metal screws because I didn’t want to have a foreign body inside me.”


Moderate bunion

“I tried to get the pain under control with insoles and sports shoes, but that didn’t really help. I did a lot of research on the Internet and thought: 1 surgery is enough. All other screws except the Shark Screw® must or can be removed. That was the deciding factor for me to save myself the 2nd operation. With the Shark Screw®, you save yourself the risk of a second operation. If you were to have a metal screw or plate, some patients don’t feel it. But many patients feel the metal material in their bodies – I wanted to avoid that at all costs.”


Severe bunions

It was made clear to me that if a plate was inserted during my hallux valgus operation, I would have to take it out again – but I wanted to avoid this additional procedure. My doctor then told me that there was another option, namely hallux valgus surgery with Shark Screw® – the screw no longer needs to be removed. I think that’s an extremely big advantage, especially at a young age.”

The best bunion doctors near you

New bunion surgery method: surgery with screws made out of bones

To guarantee that bunion surgery is successful, it is crucial to choose the right surgeon and biological surgical material. We have made it our mission to bring together specialists in the field of hallux valgus surgery on one platform to guarantee you, the patient, an optimal overview. All doctors can look back on many years of experience in the field of foot surgery and are familiar with modern and biological surgical methods for bunion surgery.


In principle, it is possible to perform bunion surgery on both feet at the same time. However, this approach is not recommended as it can lead to a complete restriction of the patient’s mobility. It is advisable to schedule the procedures one after the other in order to give the patient a certain freedom of movement and to better manage the recovery time.

After bunion surgery, comfortable, wide shoes with adjustable closures are recommended. Look for low heels, cushioning, arch support, and light weight. In consultation with your doctor, orthopedic insoles may be helpful. Choose closed shoes made of breathable materials for protection and comfort during recovery. However, you should consult your doctor before purchasing to ensure that the shoes meet your individual recovery needs.

The decision between outpatient or inpatient hallux valgus surgery depends on various factors, including the individual’s health condition, the complexity of the procedure and the patient’s preferences. It is important to discuss all options with the doctor to make the best choice for each case.

  1. Outpatient surgery:
  • Outpatient procedures are usually performed without an overnight stay in hospital.
  • Suitable for less complex bunion cases.
  • The patient returns home on the same day.
  • Requires assistance from a companion, as the patient should not drive home after the operation.
  1. Inpatient surgery:
  • Inpatient procedures require hospitalization for one or more nights.
  • Suitable for more complex cases or when additional medical monitoring is required.
  • The patient remains in hospital until he or she has recovered sufficiently.

Physiotherapy after bunion surgery usually begins immediately after the operation and initially focuses on pain relief, swelling control, and promoting blood circulation. Techniques such as cold therapy, gentle movement exercises, and other methods are used. The exact time and type of exercises are determined by the podiatrist and can vary depending on the individual healing process.

It is challenging to identify a single “best” clinic for hallux valgus surgery, as this depends largely on individual requirements, location preferences, and personal circumstances.

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