Surgery For Bunions
Bunions or hallux valgus is a common condition that results in a deformity of the great toe.
The prominence of the bump or bunion is what causes rubbing and pain with shoe wear. Bunions are more common in:
- Women (ten times more than men)
- Those with a family history of bunions
There is no doubt that narrow and high heeled shoes contribute to the problem. Eventually the deformity worsens and results in arthritis and/or causes problems of overcrowding of the lesser toes. Occasionally a bunion may ulcerate and develop infection, which can have serious consequences.
Treatment of Bunions
Not all bunions require treatment. Only those that cause pain and/or problems with shoes need to be treated. There is no need to straighten a bunion to prevent problems in the future. This can be done at any time the bunion causes problems.
Treatment options are simple. Either make the foot fit the shoe (surgery) or make the shoe fit the foot (non operative treatment).
Non Operative Treatment
Bunions hurt because of rubbing within a shoe. Changing to a wide shoe with a deep toe box will often accommodate the foot and relieve symptoms.
Occasionally an insole or orthotic may be necessary. If this does not work or is not appropriate, then surgery is indicated.
The aim of surgery is to relieve pain and improve the function of the forefoot. The cosmetic appearance of the bunion is not a reason to operate. This is because all surgery has the potential to make the foot worse if a complication develops. This is very unlikely but is possible, therefore concern about appearance alone is not a good reason for surgery.
I usually perform surgery as a day case procedure under a general anaesthetic (GA) in combination with a local anaesthetic ankle block, which allows for a light GA.
You can stay in hospital if desired, or if you live in the country or live alone.
There are a number of different procedures used to correct a bunion so the operation is individualised for your particular problem.
In most cases it is necessary to perform a bony and a soft tissue procedure to fully correct the deformity. It is important to remove the deforming forces acting on the great toe to reduce the risk of the bunion coming back.
Metal screws and/or staples are used in the operation. These can stay in the bone forever and do not need to be removed, and do not set off metal detectors.
With modern surgery, severe postoperative pain is not a common problem and is easily controlled with medication.
There are two methods I use to correct a bunion:
- Scarf and Akin osteotomies (open procedure)
- Minimally invasive Chevron and Akin osteotomies (keyhole procedure)
The Scarf and Akin osteotomies are performed through a single incision on the inside of the foot. The tight soft tissues are released; the bone cut and repositioned to reduce deformity; finally then the toe is straightened. A closing wedge cut is made (Akin) to improve the correction.
Minimally invasive Chevron and Akin osteotomies offer similar correction, but through five tiny incisions instead of one large incision. This has the advantages of less pain, scarring and swelling, but not all patients are suitable for this procedure.
It is important not to underestimate the time taken to recover from bunion surgery.
As the foot is the most dependent part of the body, swelling is always a problem. Swelling causes pain and delays recovery.
It is important to allow two weeks off work as a minimum for clerical duties and at least six weeks for any form of work that requires long periods of standing or walking.
It is necessary to wear a special postoperative shoe day and night for the first four to six weeks.
Most patients take at least three months to fit their foot into a regular shoe. In some, swelling can persist up to twelve months.
Complications of Surgery
You should be aware that all surgery has a risk of complications and bunion surgery is no different.
There are medical complications such as heart attack, stroke, drug reaction, blood clots in the legs or lungs and even death in very rare circumstances.
The chance of one of these happening is very small but is real and can happen.
Surgical complications include:
- Infection: antibiotics are given before and after surgery to reduce the chance of infection, but cannot eliminate it.
- Nerve injury: can result from the small sensory nerves being caught up in scar tissue and may leave an area of numbness over the toe or occasionally an area of sensitivity.
- Bone healing: may be delayed or fail in rare cases and require further surgery.
- Stiffness of the joint: it is common for slight stiffness after surgery. This is a trade-off for correction of the deformity and does not cause any difficulty in most.
- Recurrence of the deformity: this happens in one in ten patients and is more likely if you wear narrow, high heeled shoes. It tends to happen in those patients with loose ligaments and the tightened tissues stretch out again in time.
- Overcorrection of the joint: this can happen and even worsen over time, nearly always requires further surgery if it develops.
- Wound healing: problems are rare and tend to happen in diabetics and smokers. If you do smoke you should stop smoking for at least four weeks around the operation.
Bunion surgery is very effective in the vast majority of patients with at least nine out of ten being happy with the result.
However it is possible, although very unlikely, to be made worse by surgery if a complication develops that cannot be easily fixed.
A more detailed discussion of your individual case will be made at the consultation.