Bunion Surgery

This page describes the condition of Bunions and the approach to this condition adopted by Mr Bowyer, at the Wessex Nuffield Hospital. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.

Description

A bunion is a bony lump at the base of the big (first) toe, caused by angulation of the big toe as it drifts sideways. The big toe then points toward the smaller toes, this is called Hallux Valgus. Pain is often due to footwear rubbing, crowding of the smaller toes, and sometimes from the joint itself.

Common Signs and Symptoms

• An outward - turned big toe that may overlap the second toe or cause the 2nd toe to claw
• Thickened skin over the bony protrusion at the base of the big toe (callus)
• Occasionally, fluid accumulation under the thickened skin (called bursitis); skin may become red, tender, and swollen with constant irritation or pressure
• Foot pain and stiffness.

Causes

• Genetics (you are born with or predisposed to it, with others in your family having it)
• Bunions are associated with wearing shoes with a narrow toe box (pointy shoes), but certainly not in all cases – your family genetics are more likely to be to blame than your mother’s choice of shoe when you were a child

Preventive/Non-operative Measures

• Wear wide-toed shoes that fit well. Avoid shoes with high heels
• Wear a small pad between the big toe and second toe
• Wear a bunion pad (like a large felt polo mint) over the bony prominence at the base of the first toe
• Shoes may be made or adapted to accommodate the bunion
• Some bunions are caused by “flat feet” and can therefore be helped by specially made insoles / arch supports
• Once the big toe is pushing on the second toe, or the big toe starts to twist around, then non-operative measures are not likely to bring about a lasting improvement in the condition. Surgery should only be undertaken if you have significant symptoms, and appropriate non-operative management has been considered

Surgical Treatment

Surgery may be necessary to remove the overgrown tissue (bunion) and correct the position of the first toe by realigning the bones. This is usually performed on a short-stay basis (you go home the same day or next morning). The surgery may involve cutting bone at and around the first toe joint, (called an osteotomy, often with names such as Scarf, Chevron, Akin) and reconstructing (cutting and repairing) the ligaments and soft tissues around the first toe. The bone cuts are usually secured using small screws or staples which are buried in the bone and stay in place forever, unless they begin to cause a problem.

Just as feet are of different shapes and sizes, so it is important to adopt a “tailor-made” approach to correcting the problem rather than saying “bunions need an x or y procedure”. Your doctor will be able to give you a more detailed description of which surgery he intends to carry out on your foot, and its implications for return to normal walking and activities.

A typical bony bunion deformity and the corrective surgery are shown below.

Surgical Aftercare and Recovery

It is now very rarely necessary to put the foot into any type of plaster after the operation, and there are seldom wires sticking out of the foot. You get up and walk with a “post op shoe” (a type of firm soled sandal which fits over the dressings) and crutches for a period of usually about 4- 6 weeks.

In the first week or so after surgery it is important to keep the foot up as much as possible, to reduce the swelling of the foot, lessen the chances of problems with the wound and reduce the need for pain-killers.

At around 2 weeks you will return to clinic for removal of stitches, and will be shown how to begin to exercise the foot and toe.

You will usually be able to return to walking without crutches or a special shoe at about 6 weeks, but no running, jumping or similar activities are allowed for the first 3 months after the operation. The swelling of the foot usually continues to improve for several months after the operation, so don’t rush straight out to by new shoes! In some cases your doctor may refer you to a physiotherapist who will help you to regain movement in your toe, and help you regain the mobility you had before your operation. If you are slower than these times do not panic as they are only guidelines, but do let your surgeon know when you attend clinic.

Possible complications/risks

• Failure to improve the position or symptoms
• Recurrent bunion, over-correction (toe points inward), or stiffness of the big toe
• Infection
• Injury to nerves (numb or hypersensitive toe)
• Weight transfer to the 2nd toe, causing pain elsewhere in the foot
• Bone not healing, or screws becoming prominent and requiring removal
• General surgical / anaesthetic complications such as blood clots
• If you are at particular risk of complication, this will be discussed with you. If you have any specific worries, you should discuss these with the doctor treating you

How do I know if I have a complication?

• Many of the problems become obvious with time (i.e. recurrence etc), however you should notify a doctor if you get an increase in your pain or swelling after you go home which does not settle with rest, elevation and mild pain killers, as this may indicate an infection
• You will be seen in an outpatient clinic in the weeks following your surgery to enable your doctor to monitor your progress