This is a general overview of issues that are important as you decide whether to have surgery for a toe deformity. It is designed to help you learn about your choices and options and to prepare you to work with your doctor to make the best decision for you. For more information about the risks, benefits, and outcomes of this surgery, please follow the links.

You may find it helpful to keep track of information that is most important to you on a sheet of paper as you read. This may help you organize your thoughts and questions for your doctor.
 

Medical Information

What are you trying to decide?

This information will be helpful if you are trying to decide whether to have surgery for your bunion and/or for another toe deformity (hammer, mallet, or claw toes).

In general, your choices are:

1. Choose conservative treatments, such as wearing roomy footwear, using pads to cushion the painful area, limiting activities that cause pain, and taking anti-inflammatories.
2. Choose surgery.

If you have toe deformities caused by rheumatoid arthritis or other conditions, such as nervous system problems, this information may not apply to you. Some diseases cause severe joint deformities that are best treated with surgery.

Get the facts: Things you should know about bunions and hammer toes

Bunions, hammer toes, and other toe problems are common, especially in women. Although they are not caused by improper footwear, these toe problems are made worse by wearing shoes that are too short or too narrow, have high heels, or don't have enough room in the toe box. Sometimes toe deformities are related to problems such as loose ligaments in the foot or a foot that rolls inward (pronation) when you walk.

Bunions and other toe deformities can cause discomfort and pain and may make it difficult to walk. Shoes may rub on the toes, causing pain, blisters, calluses, or sores. In some people, the toes may become misshapen, and the people may feel that their feet are unsightly.

If you take steps to treat a bunion or other toe deformity when you first notice symptoms, you can often avoid surgery. However, in some cases, surgery may be the most appropriate treatment.

How do you know if bunion or hammer toe surgery is right for you?

Surgery for a toe problem, such as a bunion, hammer toe, or other toe deformity, is generally appropriate in the following situations:

• You have severe pain in the toe that interferes with your daily activities, and conservative treatments (roomier footwear, anti-inflammatory medications) have not helped.
• You have a severely deformed foot.
• You have a fixed hammer toe that causes pain that cannot be managed with home treatment.

Surgery is generally not done only to improve the appearance of the foot in a person who does not have pain.

What does the research show?

Surgery for bunions, hammer toes, and other toe deformities usually relieves pain and allows you to walk and wear properly fitted shoes more easily and comfortably. In many cases, the foot will look more normal, but pain relief is usually the primary goal of surgery.

How effective is surgery for bunions and hammer toes?

There are over 100 different types of bunion surgery, and many types of surgery for the various other toe deformities. The specific outcomes and risks vary depending on the type of surgery, the surgeon's experience, and how severely the toe is deformed.

• Most people (about 80%) are satisfied with the results of bunion surgery.
• About 10% feel the results are okay, and about 10% are dissatisfied.
• About 70% to 95% of people have less pain, depending on the surgeon and the type of surgery.
• About 40% to 60% of people are able to wear their normal footwear again after they recover fully from surgery. However, it is not possible to return to wearing high-heeled and poorly fitted shoes again, as the bunion may return.
• If you want surgery to improve the way your foot looks and not to relieve pain, you may be less satisfied with the outcome.

Because there are many different kinds of toe deformities and types of surgery to correct them, it is difficult to report how many people are satisfied with the results of surgery. You may expect that surgery will give you a particular outcome. Ask your surgeon how likely it is that surgery will give you the outcome you want most, such as less pain, a more normal-looking foot, or the ability to wear certain types of shoes or do certain activities.

What new problems could develop if you have bunion or hammer toe surgery?

About 10% of people are dissatisfied with the results of bunion surgery, and about 5% to up to 30% may still have some pain even after surgery.

Bunions may come back after surgery. This happens 10% to over 20% of the time, depending on the type of surgery and the severity of the bunion. Hammer toes, claw toes, and other toe deformities may also come back after surgery. Sometimes this happens because there is a problem with loose ligaments in the foot or a foot that rolls inward (pronation) when you walk.

Toe problems are especially likely to recur if you keep wearing the kind of shoes that contributed to the problem in the first place. If a toe deformity recurs and becomes severe again, you may need another surgery.

Because there are so many different kinds of toe deformities and types of surgery to correct them, it is difficult to report how many people have complications or are not satisfied with the results of surgery. Ask your surgeon how likely you are to have complications that concern you, such as infection, recurrence of the bunion or other toe problem, or persistent pain. Also, ask if you will need to avoid certain types of shoes or activities after surgery.

What are the risks of not having surgery?

Depending on what other type of conservative treatment you try, the risks of not having bunion or other toe surgery vary. If conservative treatment (such as wearing roomier, low-heeled shoes) helps relieve your toe pain, there is little risk in not having surgery. Many people can control bunion and other toe pain by wearing roomy footwear, avoiding or limiting activities that cause pain, and taking anti-inflammatories. Although the toe problem may continue to get worse, it may do so more slowly and it may not cause as much pain.

You may continue to have pain and difficulty walking, standing for long periods, or finding shoes that fit (if your foot is very deformed).

If you have diabetes or peripheral vascular disease, avoid getting blisters and sores on the skin over a toe deformity. People with these conditions are more likely to develop infections. Some doctors may not recommend surgery if you have one of these problems, because your risk of infection or slow healing after surgery is also higher.

Your Information

What do you think?

• How do you feel about surgery in general? Some people prefer to avoid surgery if possible. Other people are willing to have surgery if it is an option.
• What is the main reason you are considering surgery? Do you want to relieve pain and make it easier to walk and find shoes that fit? Do you want to improve the way your foot looks? Ask your doctor how likely it is that surgery will give you the specific result you want. It is important that you have reasonable expectations about how surgery may help you. Surgery will usually relieve pain, make it easier for you to walk, and make it easier for you to find shoes that fit. However, it may not make your foot look completely normal or allow you to wear any kind of shoes you want or wear a smaller size shoe. The main goal is to relieve pain and ease severe deformities.
• Have you tried home treatment? Many people find that wearing shoes with more room in the toe box helps relieve pain. However, some people may need to wear certain shoes in the workplace or do not like the way shoes with a wider toe box or a lower heel look. Several companies make fashionable and comfortable dress shoes for women that have wider toe boxes and lower heels. Keep in mind that even if you have surgery, you still need to wear shoes that give your toes plenty of room to keep the toe problem from coming back. If these kinds of shoes relieve your pain, you do not need surgery.
• Are you an athlete? How does your bunion or hammer toe affect your participation in sports? If you can manage the pain, most experts will recommend delaying surgery as long as possible.
• What other factors may influence your decision?

Try on a decision

Some people may find it helpful to try the following exercise to see what they think about a particular option:

• Pick one of your options, and pretend that you have chosen to try that option. For example: "I will have bunion surgery."
• Write down what you think or expect will happen if you make that choice. For example: "I understand that there is a risk of complications but that the surgery has a good chance of relieving my pain."
• Check with your doctor to see if your expectations are accurate.
• What do you think about that decision?

Best decision

Before making a decision to have surgery, consider your feelings and concerns and your medical condition. Talk with your doctor after considering these and any other factors that may be important to you.

Make an action plan

Now that you and your doctor have made a decision, find out what you can do to make sure you have the best possible outcome. Write down the steps you need to take next. Think positively about your decision, and do your part to ensure success by following your doctor's advice. When you share in making a decision, you also share responsibility for how things turn out.