dev
mahadevan
consultant foot and ankle surgeon
What is a bunion?
A bunion, also known as hallux valgus is a bony bump that forms on the joint at the base of the big toe. It is due to malalignment of the bones in the front of the foot. This causes the big toe to deviate toward the smaller toes and forces the joint at the base of your big toe to stick out. A bunion deformity can cause redness, swelling and pain at the base of your big toe. You may also form hard skin (callus) in areas with increased pressure or rubbing. When severe, the smaller toes may also deform. Over time, footwear can become increasingly difficult.
What are the treatment options?
Bunion symptoms can be managed using wider fitting shoes with a low heel and bunion pads/sleeves. These measures do not change the shape of your bunion but aim to reduce your pain.
If non-surgical treatment does not help, I may recommend surgery if you are symptomatic. Surgery entails removing part of the bunion and realigning the toe through bone cuts (osteotomies). The most frequently undertaken procedure for this condition is the Scarf / Modified Chevron and Akin osteotomy.
In some patients with severe bunion deformity and hyper mobility of joints, a more complex bunion correction (Lapidus procedure) may be recommended in order to achieve and maintain the desired correction. The recovery following this procedure is slightly longer than the Scarf and Akin osteotomy.
What does surgery involve?
This procedure is usually performed as a day case. It is normally performed under general anaesthetic combined with a local anaesthetic block for pain relief.
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Scarf / Modified Chevron and Akin osteotomy
A small incision (cut) is made between the big toe and second toe to release the tight soft-tissue. Then a further incision is made over the bunion. Part of the bunion is removed and bone cuts (osteotomy) are made to the metatarsal (Scarf / modified Chevron) and proximal phalanx (Akin) to realign the big toe (see X-rays below). The bones are secured in its new position using small screws and staples. The skin is closed using dissolvable stitches and a bulky dressing is applied. Your foot will be protected in an orthopaedic shoe for 6 weeks. You will be allowed to walk on the operated foot but taking most of your weight through the heel.
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Lapidus procedure
3 small incisions are made around the bunion and midfoot. Part of the bunion is removed. Deformity correction is achieved by preparing and fusing a joint (1st TMTJ) in the midfoot using a plate and screws. You will still be able to move your bunion joint. Occasionally an Akin osteotomy (as described above) will be added to improve the correction (see X-rays below). After surgery, your foot will be protected in a plaster for 2 weeks followed by a boot for 6 weeks. You will not be weight-bearing on the operated leg for 2 weeks.
Scarf & Akin osteotomy for bunion
Lapidus & Akin procedure for bunion
Aftercare and FAQs
It is important to keep the foot elevated as much as possible especially for the first 3 days. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Wound care – The bulky dressing should be kept on until your first clinic appointment 12-14 days after surgery.
Walking - You will be able to walk on the day of your surgery unless advised otherwise. You may mobilise freely around the house but long walks or standing for long periods should be avoided. Very rarely you may need to use a stick or crutches for a few days.
Work - If you have a sedentary job you should be able to return to work within 2 weeks. If your job is physical, you may need to stay off work for at least 6 to 8 weeks.
Driving - You will not be able to drive for 6 to 8 weeks following surgery. However, if you drive an Automatic and it was your LEFT foot that was operated on; then you may start short drives 2 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
What are the surgical risks?
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Infection - there is a small risk of infection with all surgery.
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Swelling - this is quite common. In some people the swelling reduces within a matter of weeks and in others could take a few months.
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Deep Vein Thrombosis - also known as Thromboembolism (VTE), this is a rare complication of foot surgery.
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Nerve damage – this may leave you with numbness or a sensitive scar
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Tendon damage
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Non / Delayed union
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Toe stiffness
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Persistent or recurrent deformity
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.
Research Article on Bunion correction by Dev Mahadevan
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Extended Plantar Limb (modified) Chevron osteotomy versus Scarf osteotomy for hallux valgus correction: a randomised controlled trial. Foot and Ankle Surgery. 2016 Jun;22(2):109-13
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Foot and Ankle Surgery Best Paper Award 2016
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