Bunion Surgery - Bunionectomy

When is surgery indicated?

In early or mild cases, surgery can usually be avoided. In general, the majority of symptoms from a minor deformity can be controlled by correctly fitting shoes or insoles.

If the correct shoes and / or insoles do not control the pain, then surgery is indicated. There is normally no need to rush ahead with surgery and it can be organised to fit in with schedules and timetables. This is true, as long as there is no sudden change in symptoms or deformity.

If the hallux valgus becomes unstable, with a rapid increase in the deformity or there are signs of clawing at the second toe, then I would recommend earlier surgery. This is because severe deformities are harder to correct, the surgery becomes more complex and does not achieve the best results.

In more severe cases, shoes and insoles will still help with the pain, but surgery is usually necessary to achieve maximal relief.

When should I have surgery?

The recovery from bunion surgery is more prolonged than one might expect. This is due to the swelling which takes months to dissipate. Often the foot remains too swollen to fit into normal shoes for 9-12 weeks. It will be 4-6 months before you are walking long distances in comfort. Therefore, it is sensible to leave 4-5 months before any special or major occasions.

What does the operation involve?

There are over 100 operations for bunions. The principles behind the surgery are to realign the bones (osteotomy) and to tighten up the stretched tissues. Prior to surgery, the foot deformities and xrays need precise assessment. No bunion is the same, and there is a complex interplay between the bone deformities and tendon contractures. This needs careful assessment to decide upon the correct operation and to achieve the goal of a comfortable straight foot. No single operation caters for all bunions and the results will be below standard if the wrong procedure is used.

Pre op                                                                    Post op   

Are there any risks of surgery?

Of course there are risks with any operation.

Risks of surgery

Stiffness & swelling

Initially the foot will be very swollen and needs elevating. The swelling will disperse over the following weeks & months but will still be apparent at 6-9 months. The toe will be stiff but will normally regain its original movement.

Infection

There is always a risk of infection with surgery. You will be given 1 dose of intravenous antibiotics during surgery. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for 10 days. If there is an infection, it normally resolves with a course of oral antibiotics.

Nerve damage

A nerve supplying the side of the toe lies beneath the incision. This is at risk of damage. Usually it is just bruised and will recover. If the damage is permanent, it will leave a small patch of numbness. This does not normally cause any disability.

Undercorrection

Occasionally, the deformity of the toe is not wholly corrected. This is more common in severe cases. Rarely, this is problematic and requires further surgery.

Overcorrection

Very rarely, the toe can be over straightened so that it angles away from the foot (hallux varus). This is a rare complication and usually requires further surgery.

Sick leave

In general

• 4 weeks off work is required for sedentary posts,
• 6 weeks for standing or walking posts
• 8 weeks for manual / labour posts.

We will provide a sick note for the first 2 weeks; further notes can be obtained from the GP.

Post operative instructions for the ward

• Elevate
• Check Xray
• Discharge when safe and comfortable (daycase / 1night)
• Mobilise fully weight bearing in post op shoe for 6 weeks
• Dressing to remain undisturbed for 2 weeks.

Follow up

• 2 weeks for removal of sutures
• 6 weeks in clinic - weight bearing Xray
• 3 months for final review

Severe Hallux Valgus                                                Post op 6 months

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