Is Physical Therapy Needed After Bunion Surgery?

A bunion is a bony prominence, or bump, that can form on the inner border of the foot, near the base of your big toe. This condition (also known as hallux valgus) occurs when the first metatarsal bone starts to move away from the second metatarsal bone in the forefoot. The separation that occurs between the first and second toes causes the big toe to angle outward towards the other toes and a bony bump to form.

While bunions are often asymptomatic, occasionally they can cause pain and significantly impact your ability to walk or wear shoes. In these situations, surgery and postoperative physical therapy (PT) are often needed to address your symptoms.

This article will review what bunion surgery is and when physical therapy may be necessary after the procedure.

What Is Bunion Surgery?

While bunions may cause your foot to look deformed, this usually is not reason enough to have surgery. Instead, surgical procedures are typically reserved for people whose bunions are causing significant symptoms that do not improve with conservative measures.

Common complaints associated with bunions include:

• Pain over the bony prominence or on the bottom of the foot, near the base of the first and second toes
• Chronic warmth, redness, or swelling near the base of the big toe
• Difficulty walking normally or fitting into shoes due to pain
• Stiffness in the big toe

If an operation is needed, you will have several options, depending on the condition of your foot and your surgeon’s preference. Common surgical techniques are:

• Osteotomy: This technique involves improving the alignment of the great toe by making one (or several) cuts in the bones of the foot and stabilizing the area with pins or screws. Adjustments to the soft tissue in the surrounding area are also frequently required to maintain the toe position.
• Arthrodesis: This surgery fuses one (or more) joints together with pins, plates, or screws to achieve a better toe position and relieve your pain. This option is usually performed on people with severe bunions, advanced osteoarthritis (wearing down of the joint cartilage that protects bones), or a previous failed toe surgery.
• Exostectomy: This intervention removes or shaves off the bony bump on the inner border of the foot. Because it doesn't improve the alignment of the big toe, exostectomy surgery is usually performed along with another surgical treatment.

Postoperative Physical Therapy

Regardless of which surgery you get, your surgeon will likely recommend you to outpatient physical therapy.

While individual situations will vary, PT typically focuses on several goals for rehab. These typically include the following:

Pain and Swelling (Edema) Control

Bunion surgery can meaningfully reduce pain, but this can take time. In some cases, it may take up to two years for your foot symptoms to completely resolve.

In the meantime, your physical therapist can help jump-start this process by focusing on improving the pain and inflammation that occurs immediately after surgery.

To do this, cryotherapy (cold therapy) and vasopneumatic compression (inflatable sleeve that uses air to create pressure around an area of the body) may be used to decrease the soreness and swelling in the foot and leg.

Other modalities, such as electrical stimulation (electrical pulses applied to muscles), may also be applied to the area in an attempt to diminish any postoperative edema (swelling).

Finally, manual massage techniques are sometimes performed by your PT in an effort to move any fluid that has developed out of the foot or lower leg.

Gait Training

Avoiding bearing weight on your affected foot is usually required after bunion surgery. While the timeline differs depending on the procedure, this protective period can last for six weeks or longer.

During this time, your physical therapist will work with you to ensure you can safely and efficiently move around your home and community on crutches.

When your surgeon allows you to begin putting weight on your foot, your physical therapist will help you regain a normal walking pattern, or gait. It is not uncommon to limp after a bunion surgery or to develop a tendency to roll your foot outward in an effort to avoid rolling off the affected big toe.

Because of this, your therapist will provide you with instructions and exercises to aid in correcting these common compensations.

Range of Motion

After your big toe alignment is improved with surgery, regaining your range of motion (how much you can move a part of the body) is an important focus. Increasing the movement will help you obtain a more normal walking pattern and can also help improve your balance as you begin to move around again.

To improve the movement in your big toe, your therapist will perform passive stretching techniques (in which an outside agent, such as the therapist or a resistance band, is used to create the force for the stretch) and may also include gentle joint mobilizations (in which the therapist manually moves the joint) to the foot.

A home stretching program typically is recommended to improve your progress between therapy sessions. It is important to remember that if you've had an arthrodesis (joint fusion surgery), you should avoid stretching your fused joint, since the affected area is now permanently restricted.  

Balance and Strengthening

After a lengthy period of non-weight-bearing, the muscles in the lower leg atrophy (decrease in size and become weak) and your balance reactions are frequently diminished. This weakness can impact your ability to walk, negotiate stairs, or navigate uneven terrains.

Physical therapy helps you improve the strength in your toe, ankle, and lower leg muscles by focusing on resistance training exercises that target these important areas. Proprioceptive (balance) training is also used to help increase your stability when you begin to move around more.

Typically, a home exercise program is created for you. Activities will progress and become more challenging as your strength and balance improve from week to week.

As time goes on, your therapist may also incorporate more sport-specific conditioning drills and exercises into your rehab if getting back to running, jumping, or exercising is a goal of yours.

Summary

Recovery after bunion surgery can be a lengthy process, and physical therapy can be critical to regaining mobility as your foot heals. Physical therapy after bunion surgery involves pain and swelling management and gait training early on. It eventually will include stretches to improve range of motion and exercises for balance and strength.

A Word From Verywell

While a painful bunion can make every step you take seem challenging, surgery can be helpful in resolving your symptoms. It is important to remember, however, that surgery is only the first step in your recovery. The physical therapy you receive after your procedure is often critical to helping you regain your independence and return to the activities you love.

If you’d like help finding an experienced therapist or have questions about the PT you will need, be sure to speak to your surgeon before your bunion operation.