Bunion Surgery

What is Bunion Surgery?

Bunion Surgery involves a procedure called an osteotomy, meaning ‘bone cut’. There are many variations on the choice of osteotomy carried out, but modern forefoot surgery usually involves the procedure known as a Scarf Osteotomy. An incision (cut) is made along the inside of the bunion. The bone cut is made in the first metatarsal and the fragments displaced into a more ‘normal’ position. The bone is held in position by two small surgical screws. The screws are buried in the bone so usually do not need to be removed. The ‘fix’ is stable and there is usually no need for a plaster cast post operatively. The bony protrusion (bump) is trimmed at the same time as the cut is made. The soft tissues attaching to the outside of the big toe are often tight and may be released to allow correction of the toe. This may be done through a small second incision on top of the foot. Ankle arthroscopy is usually carried out under general anaesthesia, either as a day case or in some instances as an overnight stay in hospital.

What is an Akin Osteotomy?

A further procedure known as an Akin Osteotomy may be carried out on the big toe (phalanx) at the same time. This involves removing a wedge of bone from the big toe; the aim of this is to achieve a better correction of the sideways deviation of the big toe. The bone is ‘fixed’ in position using a staple or stitch.

Benefits of Bunion Surgery

The purpose/benefits of this surgery are to straighten the toe/toes, narrow the forefoot and correct deformity in order to reduce pain. The exact procedures performed are individualised for each patient; the exact benefits also vary.

Important Post-Operative Advice for Bunion Surgery

Wound site – you will either have stitches or steri strips with a dressing covering the wounds. A padded bandage will be in place. If you have undergone surgery to correct deformities of the lesser toes you may also have K wire(s) protruding from the toe(s). If you need to walk you will take your weight through your heel. It is extremely important to keep the affected foot elevated above groin level as much as possible for the first two weeks following your operation. This is important to avoid swelling and help wound healing. You will find that when your foot is lowered it will throb and swell. This results in elevated levels of pain. Pain relief will be prescribed by your doctor. The wounds should be kept clean and dry until they are fully healed.

A Special Shoe

Often called a ‘wedge’ shoe will usually be provided for you to wear following your operation. The shoe is designed so that all weight is taken through the rear of the foot. This shoe should usually be worn for 6 weeks after your surgery. Crutches will be provided and instructions on the safe use of them will be given to you by the physiotherapist. You should be able to walk to the toilet and will be shown how to manage stairs. You can gradually increase your walking distance.

Exercises

Patients are encouraged to move the toe after a Scarf osteotomy or a Weil osteotomy but may be advised not to move the toes after some other types of surgery. Check with your surgeon.

Appointment

You will be given an outpatient department appointment two weeks following your procedure. The bandage will be removed and your wound site will be inspected at this visit. If the wounds are sufficiently healed (following review at 2 weeks) then it will be possible to bathe. If wounds have not healed then the area must be kept dry.

Returning to work

This depends on your individual circumstances and your
type of employment. If you have a sedentary type employment and are able to elevate your affected foot then you may return to work from 2 weeks following the surgery but it may take 3 months for someone to return to a physically demanding job.

Driving

If surgery is to your left foot and you have an automatic car you can usually drive at around 3 weeks following your operation. Otherwise, it should take 6 to 8 weeks. You must be able to perform an emergency stop. Notify your insurance company of the type of procedure that you have undergone to ensure that cover is valid.

Sport

You can usually return to sports between three to six months from the date of operation; recreational walking or light sporting activities may be resumed earlier.

Possible Complications of Surgery

Modern forefoot surgery has a success rate of over 90% but, as with all surgery, complications can occur. You should not contemplate surgery for cosmetic reasons only.

Recurrence of the deformity – This happens very rarely and further surgery may be required.
Over correction – This again happens very rarely and may require further surgery.
Infection – An infection can sometimes occur in a small percentage of patients. If this is the case, it is possible that further surgery may be required to remove infected bone or screws. Minor infections normally settle after a short course of antibiotics.
Numbness and tingling – This can occur at the surgical site, as a result of minor nerve damage. Numbness or sensitised areas are usually temporary but may be permanent.
Non union – The bones occasionally fail to unite (join). If you smoke your risk of non union or major complications are greatly increased. It is essential that you stop smoking before surgery and refrain from smoking until all bones have healed.
Screws – Occasionally, screws become prominent, these may be removed at a later stage.
Scarring – Any type of surgery will leave a scar; occasionally this causes pain and irritation.
Stiffness – Stiffness and pain in the toe(s) can occur following surgery.
Pressure transfer –A callous can develop under the second toe caused by weight transfer to the second toe (this applies to bunion surgery only).
Blood clots – A deep vein thrombosis (DVT) or Pulmonary Embolus (PE) is rare. Please inform the team if you have had a DVT or PE before, or if you have a family history of clotting disorders.

Kent’s Holistic Foot & Ankle specialists

The Sajid Shariff clinic is a private orthopaedic clinic based in SE London and Kent that specialises in surgical and non-surgical treatment of foot and ankle conditions including bunion surgery.

Keep an eye on the shape of your feet; if you see changes see a doctor to find out if there are any recommendations to prevent hallux valgus from forming

Use a variety of exercises to stretch your feet and calves

Try to avoid shoes that have a heel or pointed toe

What is Bunion Surgery?

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