When can I drive after bunion surgery or big toe fusion?

You must be able to walk comfortably, perform an emergency stop and be out of the post-operative shoe — usually around six to eight weeks. If it is left foot surgery and you drive an automatic car, Mr Welck will advise you can return to driving at 2 weeks, but it is essential the insurance company are informed.

Patient Guide for Forefoot Surgery with Mr Welck — What to Expect Before, During and After Your Surgery

Home / Patient Guide for Forefoot Surgery with Mr Welck — What to Expect Before, During and After Your Surgery

Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Forefoot Surgery Guide (Bunions & Big Toe Fusion)

By Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon (RNOH Stanmore) — London & North London. This patient guide explains what to expect from forefoot surgery, focusing on the two most common procedures: bunion correction (hallux valgus surgery) and big toe fusion (first MTP joint fusion, or arthrodesis, for big toe arthritis). Mr Welck treats the full range of foot and ankle conditions — from bunions and big toe arthritis to sports injuries and total ankle replacement — across London, North London and Hertfordshire, and as a senior NHS consultant at the Royal National Orthopaedic Hospital (RNOH), Stanmore.

Why Have the Surgery? (The Benefits)

Bunions and big toe arthritis are progressive conditions that cause pain, swelling and deformity, making footwear uncomfortable and limiting walking, work and sport. When simple measures — wider shoes, insoles, padding and pain relief — no longer control your symptoms, surgery is usually the most reliable way to resolve the problem.

The main benefits of forefoot surgery include:

Lasting pain relief — correcting the bunion or removing the worn-out arthritic joint addresses the underlying cause of the pain.
Improved alignment and appearance — the big toe is straightened and the bony prominence reduced, giving a more normal-looking foot.
Better-fitting footwear — most patients can return to comfortable, normal-width shoes and trainers once healed.
Stopping progression — surgery prevents the deformity worsening and protects the smaller toes from being pushed out of position.

Mr Welck will only recommend surgery once non-surgical options have been considered, and will discuss whether a bunion correction or a big toe fusion is the right operation for your particular foot, and whether any additional procedures are necessary to fully correct your foot.

Preparing for the Surgery

Good preparation helps recovery go smoothly. Beforehand you will usually have a pre-operative assessment and weight-bearing X-rays so Mr Welck can plan the procedure precisely. If you smoke, stopping well before surgery significantly improves bone healing and reduces wound problems. Follow any fasting instructions and arrange for someone to help you at home for the first couple of weeks.

A few simple items, bought in advance, make the early recovery far more comfortable and Mr Welck will recommend you get them to make the recovery more simple for you:

A foam leg elevator — keeping the foot raised above heart level is the single best way to control swelling and pain in the first two weeks, and is far more effective and straightforward than stacking pillows.
A waterproof cast and dressing protector — such as a ‘Limbo’ — lets you shower without wetting the dressing, keeping the wound clean and dry while it heals. Multiple plastic bags never work!
Comfortable, wide-fitting trainers or shoes — ready for when you progress out of the post-operative shoe.

For more detailed advice, please read these patient leaflets prepared by Mr Welck’s team:

Download: Preparing for Foot Surgery (PDF)
Download: Foot Surgery Product Guide (PDF)

What Does the Surgery Involve?

Forefoot surgery is carried out under either a general anaesthetic (you are asleep) or a regional anaesthetic (the leg is numbed), often the two combined. This means you wake up in no pain as the foot is numb for the first 24–48 hours. Most forefoot operations take around 45 to 90 minutes.

Bunion surgery (hallux valgus correction): A small cut is made on the inside of the big toe. The surgeon shaves away the bony bump and then carefully cuts and re-aligns the bone of the big toe (an osteotomy), moving it back into a straighter position. The bone is held securely in its new position with two small screws for the metatarsal bone, and often a small surgical staple for the bone in the toe itself. These usually stay in permanently and can’t be felt.

Big toe fusion (first MTP joint fusion / arthrodesis): When the big toe joint is worn out with arthritis, the aim is to remove the painful joint completely. The worn surfaces are cleaned away and the two bones joined with a small plate and screws. Over the following weeks they heal into one solid piece of bone, permanently removing the arthritic pain. The toe is fused in a comfortable position that allows normal walking and a wide range of shoes.

In both operations the skin is closed with dissolvable stitches and a supportive bandage is applied. You will be placed in a special stiff-soled post-operative shoe to protect the foot.

How Long Will You Be in Hospital?

Forefoot surgery is usually carried out as a day case, which means you come in and go home on the same day. Occasionally, depending on your general health, the type of anaesthetic or how far you have travelled, or the time of surgery, an overnight stay is advised. Before you leave, the team will control your pain, fit your post-operative shoe, show you how to use crutches, and give you written aftercare instructions.

You cannot drive yourself home, so please arrange transport and someone to stay with you for the first 24 hours. Please be reassured you will never be discharged home until you are fully comfortable and safe to go home.

What Does the Recovery Look Like?

Recovery from forefoot surgery is staged. The timeline below is a typical guide — your own progress depends on the procedure, how well the bone heals and your general health. Keeping the foot elevated in the early weeks is the most important thing you can do to aid healing and reduce swelling.

Early Recovery (First 2 Weeks)

For the first two weeks, rest at home with the leg elevated as much as possible to control swelling. Walk only short distances always in your stiff-soled post-operative shoe, using crutches for support, and keep the dressing clean and dry. You will be given regular pain killers to take and clear instructions of how to take them. At around two weeks you return to the clinic for a bandage change and wound check. Pain is rarely an issue patients mention.

Midterm Recovery (2 to 6 Weeks)

After the wound check you will spend a further four weeks walking in the flat post-operative shoe, gradually increasing how much you are on your feet. After the first 2 weeks you rarely require the crutches, although you can use them for balance if you like. Most patients are back into comfortable, wide-fitting trainers by around six weeks. Swelling is still normal at this stage, so continue to elevate the foot when resting.

Long-Term Recovery (6 Weeks to 6 Months)

From six weeks onwards your walking steadily improves, and most people are walking completely normally by around twelve weeks. Swelling and the final shape and comfort of the foot continue to settle over several months, with full recovery taking up to six months. Return to higher-impact exercise and sport is gradual and guided by Mr Welck at your follow-up appointments; it is normal for the foot to stay a little swollen for several months.

What Are the Risks?

Forefoot surgery is very commonly performed and the great majority of patients do well, but as with any operation there are risks. The most relevant procedure-specific risks for bunion correction and big toe fusion are:

Delayed healing or non-union — occasionally the cut or fused bone is slow to heal, or does not fully join. This is more likely in smokers and may rarely require further surgery.
Infection — usually superficial and treated with antibiotics; deep infection is uncommon.
Recurrence of the bunion — a bunion can, in a minority of cases, gradually return over the years.
Stiffness — some stiffness of the big toe is expected, and after a fusion the joint is deliberately and permanently stiff (it no longer bends).
Nerve irritation or numbness — a small area of numbness or tingling near the scar is common and usually settles.
Prominent or irritating metalwork — the screws or plate occasionally need to be removed later if they cause discomfort.
Ongoing swelling and altered loading — the foot can stay swollen for some months, and rarely pressure can transfer to the lesser toes.

Mr Welck will discuss the risks that are most relevant to your operation at your consultation. A full written list of the minor common and more major less common general risks of surgery is provided in the detailed risk leaflets below — please read the one that matches your procedure:

Guide to the Risks of Forefoot Surgery — Bunion & Toe Deformity (PDF)
Guide to the Risks of Hindfoot Surgery (PDF)

Frequently Asked Questions

How long will I need off work?

If you have a desk job and can keep your foot elevated, you may return after about two weeks. A job that involves standing, walking or manual work usually needs around six weeks off.

When can I drive again?

You must be able to walk comfortably, perform an emergency stop and be out of the post-operative shoe — usually around six to eight weeks, and never while taking strong painkillers. Always check with your insurer. If it is left foot surgery and you drive an automatic car, Mr Welck will advise you can return back to driving at 2 weeks, but it is essential the insurance company are informed to ensure you remain insured in case of any accident that may happen anyway.

When can I return to exercise and sport?

Gentle activity such as cycling and swimming can often resume once the wound has healed and bone healing is confirmed. Higher-impact sport is typically from around three months and is guided by Mr Welck.

Will the screws or plate need to be removed?

Usually not — the metalwork is designed to stay in permanently. It is only removed in the minority of cases where it becomes prominent or causes irritation.

Can both feet be operated on at the same time?

It is usually best to treat one foot at a time so you can stay mobile during recovery. Mr Welck will advise on the right approach for you. Both feet can be done at the same time if it suits your lifestyle better.

Will my big toe still bend after a fusion?

No — a fusion deliberately stiffens the big toe joint to remove arthritic pain. Most patients walk normally and wear a wide range of shoes, but very high heels are not possible.

About the Surgeon

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon and one of London’s leading specialists in foot and ankle conditions. He is a senior NHS consultant at the Royal National Orthopaedic Hospital (RNOH), Stanmore, an Honorary Associate Clinical Professor at University College London (UCL), and is double fellowship-trained in foot and ankle surgery, including at the Foot and Ankle Institute in Baltimore, USA. He treats bunions, big toe arthritis, sports injuries and the full range of foot and ankle conditions across London, North London and Hertfordshire. To arrange a consultation, please visit matthewwelck.com.

Medical disclaimer: This guide is for general patient information only and does not replace individual medical advice. Every patient is different, and the benefits, risks and recovery described here may not apply to your particular case. Always discuss your diagnosis and treatment options with a qualified foot and ankle surgeon before making any decisions about surgery.