Recovery Comparison: Unilateral vs. Bilateral Bunion Surgery

Comparing recovery for unilateral (one side) and bilateral (both sides) bunion surgery at the same time.

Minimal invasive bunion surgery can be performed on both feet at the same time or one foot at a time depending on the patient’s needs and the type of deformity. The patient’s ability to recover is also a factor.

Preoperative considerations

The preoperative conditions as to whether to perform one foot operation or both feet at the same time will very much depend on the medical history and health status. If the patient is fit and healthy and can mobilise well unaided, then both feet can be considered to be operated on at the same time. If the risk of any infection due to concomitant disease or wound problems is not a concern, then both feet could be operated on at the same time.

Usually with newer techniques with minimally invasive surgery, there is minimal post-operative pain, and this is usually not a significant consideration as to whether both feet can be operated on at a time.

The concern may well be that if the patient wishes to return to work after five to seven days, then having both feet operated on at the same time may not be considered a reasonable decision. In those patient groups, I would recommend that they have one foot operated on at a time so that they can remain very mobile on the other foot without any implications. However, should the patient be able to rest significantly for the first two weeks, then both feet could be operated on.

Typically, if you have one foot operated, then for the first five to seven days you will be very limited to five to 10 minutes an hour of walking and then you can return to outdoor activity and commuting to work after a week provided you are in a protective boot. If you have both feet operated on, it will be two weeks of complete rest, but it may be three or four weeks before you feel comfortable to get into a trainer and to mobilise and commute to work.

In terms of expectations, when it comes to bunion surgery, you may find that one foot is always a bit more sore than the other post-operatively during the healing stage, and this is because we generally try to favour one foot over another.

Also, in terms of having both feet operating at the same time, you may have to spend a lot more time indoors and the patients who find it difficult to stay indoors, it may prove difficult, and in those patients I tend to advise that they split the recovery by having one foot operated on but remain mobile and then have the second foot operated on.

Surgical procedure overview

Whether you have one foot done or both feet, both can be performed under local anaesthetic with or without sedation, some people require general anaesthetic. In terms of the techniques of surgery, they are exactly the same. The only difference is that you may need to use crutches more often during the initial post-op recovery of two weeks if you have both feet operated on. You will require a bit more help at home in terms of cooking, cleaning, if you have both feet operated on, especially for the first seven to ten days, whereas with one foot at a time you remain quite mobile.

Recovery comparison unilateral versus bilateral

Overall, the total recovery of bone healing will take six to eight weeks regardless whether you have one foot at a time operated on both. Swelling will subside for over three to four month period. However, the main advantages of one foot operated on versus both is that you are more mobile after the first five to seven days, whereas with both feet the initial recovery may be that you are limited for a three to four week period.

In terms of pain, swelling and rehabilitation, the recovery is very similar, although you may find that you’ll have a bit more swelling with both feet operated on at the same time due to not being able to have a one healthy foot to rehabilitate and walk on.

Pros and cons

The pros of having one foot at a time are quite easy in that you have a recovery that is much less likely to have post-operative pain, you are mobile after five to seven days, whereas if you have both feet operated on, you may have a bit more discomfort and require painkillers for a bit longer. For one foot you may only require painkillers for 48 hours, whereas both feet you may require for four to five days.

Patient considerations

The lifestyle and daily demands are the main considerations, in particular when it comes to work. If you work from home, then both feet operated on at the same time may suit you well. If you have to commute, then you may wish to have one foot operated on. Having good support in terms of friends and family is more essential with both feet operating versus one foot.

Frequently asked questions

Q. What is the recovery time for bunion surgery on both feet?

A. The recovery time for bunion surgery on both feet remains six to eight weeks of initial recovery for bone healing, although you will be much less mobile for the first three to four weeks. I expect that swelling can take three to four months to settle.

Q. Which bunion surgery is better?

A. Minimally invasive bunion surgery has improved outcomes in terms of less risks and allows both feet to be operated on at the same time.

Q. Is bunion surgery done on both feet at the same time?

A. It depends on patient requirements. If the patient needs to have one episode, then both feet can be operated on, they will need extra support at home and be able to work from home for three to four weeks, whereas if they have one foot operated on at a time they can be mobile after five to seven days.

Q. Will my foot ever be the same after bunion surgery?

A. The idea would be to return the foot to improved function and structure stability after surgery.