Orthopaedic Surgery - Bunion Surgery (Hallux Valgus)

What is Hallux Valgus?

In hallux valgus the big toe (hallux) moves towards the other toes and a lump (bunion) can be felt on the side of the big toe. The bunion is not usually due to extra bone formation, but due to the bone of the first metatarsal becoming prominent.

What are the causes?

Around 15-30% of people develop a bunion at some stage of their life.

They can run in families, but just because you have a bunion doesn't mean your children will inevitably have one. Wearing tight or badly fitting shoes can make the problem worse by putting extra pressure on the big toe joint, causing friction on the overlying skin.
In some cases bunions are associated with a joint problem such as osteoarthritis or rheumatoid arthritis, injury or muscle imbalance.

What are the symptoms?

Not all bunions are painful; the main problem is caused by the pressure of the shoe over the bony prominence.

This causes discomfort or pain as the skin over the lump becomes red, blistered or infected. Sometimes a fluid-filled sac, called a bursa, develops over the joint.

The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place, resulting in the second toe becoming deformed (hammer toe) and it presses on the shoe.

Also the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot (transfer metatarsalgia).

The lesser toe joints can also become contracted and corns or ulcers may develop from pressure of your show on the skin. Sometimes arthritis develops in the deformed joint, causing pain in the joint.

How are bunions treated?

Non-surgical treatment

Comfortable well-fitting shoes can be all that is needed to ease symptoms. High heels tend to squeeze the foot into the front of the shoe and should be avoided. A small pad over the bony prominance, which can be bought from a chemist, can take the pressure of the shoe off the bunion preventing the development of pressure sores and ulcers.

Surgical treatment

An operation to correct the deformity is an option if footwear modifications do not relieve your symptoms. Surgery is performed to realign and re-balance the first toe to restore normal function through a combination of soft tissue releases and bony cuts (scarf osteotomy) in the first metatersal bone. The purpose is to relieve pain and not for cosmetic reasons. The operation is performed under a general anaesthetic, which is supplemented with a local anaesthetic block, providing a high degree of post-operative pain relief.

What is a Scarf and Akin osteotomy?

An Akin osteotomy involves breaking the side of the big toe bone then fixing it with a screw. It is not always necessary to perform the Akin osteotomy.

A Scarf osteotomy involves breaking the big toe bone to improve the alignment, removing the bunion then fixing the bones back together with screws.

The screws are buried within the bone and are not palpable under the skin. They do not usually need to be removed following surgery. Severe deformities and arthritic joints can be treated with a fusion operation. Surgery can also be combined with shortening and straightening of the lesser toes to deal with deformities.

Can I walk after the operation?

Following the operation you will be able to walk with the special shoe and crutches, however, you should not walk for more than 10-15 minutes in the hour for 6 weeks.

At all other times it is imperative that your foot is elevated above the level of you heart to control the swelling in your foot. After 6 weeks, stiff soled shoes or trainers will need to be worn for another 6 weeks.

What are the risks?

There are general risks relating to all surgery to the foot which includes infection, scarring, swelling, numbness and blood clots.

The main specific risks are failure of the bones to fuse. This risk is increased in patients who are diabetic, have rheumatoid arthritis and in those who smoke. It is therefore important to stop smoking prior to the operation and during recovery.

Will I be able to wear normal shoes?

Once your foot has fully healed, you will be able to wear normal shoes. It is recommended that you wear stiff soled shoes for support.

For Further information

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