The Foot and Ankle Clinic

Bunion or Hallux valgus

Hallux valgus (bunion) | How does a bunion or hallux valgus occur? (explain my condition to me?) | Where, why and when might I expect to get bunion or hallux valgus pain? | Why do bunions occur? | Do bunions or hallux valgus get worse? | What treatments are available for bunions or hallux valgus? | If I have a bunion or hallux valgus is the best treatment surgery? | Bunion surgery - when and what? | Bunion surgery | Bunion surgery at the clinic | Additional procedures may be necessary | Can the big toe joint(mtp) always be left mobile? | If I leave my bunion for now and it gets much worse will you still be able to do something? | My bunion is not so painful now but I don't want to end with feet like my grandma's | Minimising symptoms after bunion or hallux valgus surgery | Bunion operations - the scarf osteotomy | The scarf osteotomy-animation | Operative stills- the scarf osteotomy | Operative stills-the Arthrex Basal plate | Pre and post operative images of bunion surgery | After the bunion or hallux valgus operation | Complications of bunion or hallux valgus surgery


Bunion Surgery

Having read the "How does it occur section" you are now in a position to understand the principles of surgical correction of the deformity. To give a high chance of satisfactory outcome the (mechanical) factors driving the deformity should be overcome. This means replacing the first metatarsal next to the second metatarsal, thus realigning the tendons and reducing their deforming forces. This is well demonstrated by the following x-rays which shows how a scarf osteotomy has achieved this aim.

hallux valgus surgery - preop

hallux valgus surgery - postop

The tissues on the second toe side of the deformity may become shortened and contracted and require a releasing operation(known as a lateral release) at the same sitting.

There are many different operations available. At the Foot and Ankle Clinic we use three main corrective operations, depending upon the degree of deformity, for the pure bunion. In order of increasing deformity :

1. The Chevron osteotomy (3MB) Download movie (2.8MB) scarf osteotomy mpg The Scarf osteotomy(3.8MB) Download movie(3.5MB)

Bunion surgery at the clinic

At the Foot and Ankle Clinic bunion surgery can be carried out either as a day case procedure or overnight stay. Bunion surgery is most comfortably done under a general anaesthetic which is supplemented with nerve blocks whilst the patient is asleep, providing a high degree of post-operative pain relief.

Bunion surgery - before and after

Most discomfort after bunion or hallux valgus surgery is in the first twenty-four to thirty-six hours, and this is the time which is critical for pain relief. As well as having a nerve block under general anaesthetic (which will keep your foot completely numb for between twelve and eighteen hours) you will be on a regular cocktail of three different oral painkillers. Using this combination after bunion or hallux valgus surgery most patients have mild to moderate discomfort which is short-lived.

Post-operatively your foot will have a heavy bandage for five weeks but no plaster cast. The purpose of this is to hold the soft tissues in a corrected position as they heel after the operative repair performed during bunion surgery. This bandage after bunion surgery is changed at two weeks following the operation.

You will be able to weight bear on your foot immediately after bunion surgery. This is initially using a pair of crutches combined with a Donjoy Podulux shoe.

A patient may come completely off the crutches after bunion surgery as soon as they feel comfortable enough. Usually this will take seven to fourteen days approximately. You may return to driving after bunion surgery at best after one week if you have an automatic car and have your left foot operated upon. If your right foot has been operated upon for a bunion then you will need to wait five weeks before returning to driving. You may return to work at between one to two weeks after bunion surgery if you are involved in lighter occupation and are able to take breaks as needed. If your occupation is not standing for protracted periods of time or any heavy type duties then you will need to wait for five weeks after your bunion surgery. After bunion surgery you will fit into a softer, wider fitting normal shoe at approximately five weeks. You will get into narrower shoes three to four months after bunion surgery approximately.

Additional procedures may be necessary

Despite directly reversing the pathology with the surgery detailed occasionally the big toe can retain an element of deformity at the end of the operation. Under these circumstances an additional osteotomy at the tip of the toe is performed which can correct the residual deformity. This is known as an Akin osteotomy and involves removing a small segment of bone from the inner side of the big toe itself.

Can the big toe joint (MTP) always be left mobile?

If there is significant arthritic change associated with the deformity then an 'arthritis' operation such as a fusion may be more appropriate (see Hallux rigidus).
For very large (and generally fixed ) deformities again a fusion may be more appropriate (see Hallux rigidus).

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