The first night is the one to plan for
If you had a nerve block, the first night is the one that catches people out.
A popliteal or ankle block leaves the foot completely numb, and it wears off somewhere between twelve and twenty four hours after surgery, which for most day case lists lands in the middle of the first night. It does not fade gently. People describe waking suddenly to severe pain in a foot that felt perfectly fine when they went to bed.
The way through this is simple and it needs to be decided before you fall asleep, not afterward. Take your pain relief on the schedule you were given from the moment you get home, even while the foot feels fine and you are convinced you do not need it. Set an alarm for the middle of the night and take the next dose on time. Getting ahead of that pain is far easier than catching up with it.
Have water, your medication, your phone, and a small light within reach of the bed before you settle. A bedside caddy or a small table beside the mattress saves you getting up for any of it.
Elevate the leg properly in bed
The rule during the day is that the foot should be above the level of your heart. At night the aim is the same, but it needs to survive you falling asleep.
Support the whole calf, from just below the knee to the ankle, and let the heel hang free at the end rather than resting on anything hard. Pressure on the heel for hours is a real problem after foot surgery, and a sore heel is a miserable thing to add to a sore forefoot.
A firm leg elevation wedge does this far better than pillows. A pillow stack feels fine when you build it and has slid into a flat, useless heap by two in the morning, usually taking the elevation with it. A shaped foam wedge holds its angle all night and stops your leg rolling outward.
If you are using pillows, use firm ones, build a long ramp rather than a single mound under the ankle, and put one more pillow along the outside of the leg to stop it drifting sideways.
Do not elevate so aggressively that your back suffers. A comfortable angle you can hold for eight hours beats a perfect angle you abandon after an hour. Our guide on swelling after bunion surgery explains why the overnight hours matter so much for getting fluid out of the foot.
Which position to sleep in
On your back is the easiest position for the first two weeks, because it is the only one that keeps the leg elevated and straight without effort. Most people who normally sleep on their side end up on their back for the first fortnight whether they like it or not.
If you are a committed side sleeper, lying on the same side as the operated foot, with the leg supported on a wedge or a long pillow in front of you, is usually the first side position that works. Lying on the opposite side means the operated leg is on top and tends to drop forward across the body, which pulls on the foot.
A pillow between the knees helps in either side position, and stops the operated foot resting directly against the other leg.
Face down is generally the worst option early on, because it forces the foot to point and presses the toes into the mattress.
By around six weeks, once you are out of the boot and the wound is well healed, most people are back to their usual sleeping position without thinking about it.
The dressing is bulkier than you expect, and the toe is more sensitive than you expect. Two small things prevent most of the trouble.
Keep the weight of the covers off the foot. A duvet pressing down on a freshly operated big toe is surprisingly painful. A blanket lifter or bed cradle solves this properly. A cheap alternative is to fold the duvet back so it covers you to mid-calf and use a separate light throw over your upper body, or to prop a pillow either side of the foot so the covers bridge across.
Ask about the boot at night. Whether you sleep in your boot or post-operative shoe depends entirely on your surgeon. Some want it worn day and night for the first weeks, some are happy for it to come off in bed as long as it goes on before your foot touches the floor. Do not guess. If the boot comes off, put it directly beside the bed where you will step into it, not across the room.
Getting up in the night
The walk to the bathroom at three in the morning is the highest risk thing you will do in the first six weeks. It is dark, you are half asleep, and you are on crutches or in a boot.
Leave a lamp within reach or plug in a motion-activated night light along the route. Clear the floor between the bed and the bathroom completely before your operation and keep it clear. Put the boot or post-operative shoe on for every single trip, however short, and put your crutches somewhere you can reach them lying down rather than leaning against a far wall.
If you are non weight bearing, consider whether a knee scooter or crutches works better for you half asleep, and practise the route once in daylight. Our guide on how to prevent falls after surgery covers preparing the rest of the house.
Some people keep a bottle or a commode beside the bed for the first week rather than making the trip at all. It is not glamorous, and it is a lot safer than a night-time crutch journey.
Managing pain at night
Foot pain is often worse lying down than sitting up, partly because there is nothing to distract you and partly because a foot that has been down all day is at its most swollen by bedtime.
Take a proper elevation break in the hour before bed rather than going straight from the sofa to the mattress. Time your last dose of pain relief so it is working as you settle rather than wearing off. If you are icing, doing it in the evening rather than the morning tends to buy a more comfortable night, as long as you keep it off the wound and off unhealed skin.
If you are consistently waking in pain despite doing all of this, tell your team. Pain relief after foot surgery can usually be adjusted, and a fortnight of broken sleep slows down everything else about recovery. Our guide on how to reduce pain at night after surgery has more on the general problem.
It gets easier faster than the rest of it
Sleep is one of the parts of bunion recovery that improves quickly. The first week is genuinely disrupted, the second is better, and by three or four weeks most people are sleeping through the night again even though the foot is still swollen and still in a boot.
Get the first night right by staying ahead of the block wearing off, prop the leg on something that will still be holding its shape at four in the morning, keep the duvet off the toe, and make the route to the bathroom safe before you need it. Those four things cover almost everything.