Hallux Valgus (Bunion) Surgery

What is a bunion?

A bunion is a condition which affects your big toe joint. As a result, your big toe points inwards towards the second toe. This makes your foot wider causing difficulties with shoe fitting and often pain within your big toe joint.

What are the benefits of bunion surgery?

These include:

• your big toe will be straighter

• the pain in your big toe joint will be reduced or will have stopped completely

• your foot will be more comfortable in your shoes.

What does it involve?

Your operation will be performed as day case surgery. This means you will be able to go home the same day. However, you must have a responsible adult to take you home and stay with you for the first 48 hours.

Your operation will be carried out under local anaesthetic. Injections are given around your ankle or behind your knee to numb the skin and deeper nerves. You will be awake during the operation but will not be able to see your operation or feel any pain.

The operation takes about 1 hour, although you should expect to be in the clinic for around 3 hours. This is to allow time before your operation to give you your local anaesthetic and time after your operation, to allow you to rest and recover before going home.

During your operation an incision (cut) is made to the side of your big toe joint down to the bone. Cuts are then made in the bone to straighten your big toe.  Small screws or wires are used to make sure your bones heal in the correct position.  You will not normally notice these screws or wires and they do not usually need to be removed. The incision is closed using sutures (stitches) and covered with a large dressing for two weeks.

What happens after my operation?

You will be taken to the recovery area, given a special shoe to wear and shown how to use your crutches. The painkillers you have been given should help, if taken regularly. You should always follow the instructions provided in the leaflet supplied with your tablets. You will be given a leaflet, ‘Foot Surgery – Discharge Advice’, giving advice on how to look after yourself and your foot. You will then be able to go home.

What are the risks and possible complications?

There are risks you need to consider before you agree to the procedure.

You should be aware that all of these complications are rare. Complications can usually be treated and need not result in you having a permanent disability or pain.

These can include:

• recurrence of your bunion. This can happen to 6 patients in every 100¹

• pain under the ball of your foot. This is due to a slight change in the way you walk after the operation

• a stiff big toe joint. You will be given exercises to do after your operation to help prevent this happening
  
• slightly elevated (raised) big toe

• Deep Vein Thrombosis – DVT (blood clots in the leg veins) or Pulmonary Embolism – PE (blood clots in the lungs).

All adult patients will have their risk of developing a blood clot assessed at their pre-assessment visit. The healthcare professional who carries out the risk assessment will discuss your risk factors with you and advise on treatment to reduce your risk.

You will be given information, ‘Your personal advice for the prevention of venous thromboembolism (blood clots)’, advising you how to reduce your risk of developing a blood clot.

• infection of your skin. This can happen to 1 patient in every 83¹. Infection of your skin can be easily treated with antibiotics

• infection of your bone. This is rare and can happen to about 1 patient in every 2,000. This is a more serious complication; you may need another operation to remove the infected bone, a stay in hospital and long courses of antibiotics

• delayed healing of the skin or bone in your foot. Although you will be told how long your foot should take to heal, delays in healing the skin and bone can occur. The information on healing times is given to you as a guide only and you should allow for this when planning your recovery

• prolonged swelling in your foot. Swelling is always present after surgery as it is part of the normal healing process. Swelling lasting longer than expected can happen to about 1 patient in every 500¹

• haematoma. This is a painful collection of blood within your foot at the operation site. This occurs very rarely and generally settles without any problems

• thick or sensitive scarring of the incision

• loosening or movement of the screws or wires that have been put in to hold the bone in your foot. Normally these are left in place, however you may get irritation or pain meaning the screws or wires have to be removed once the bone has healed. This can happen to 1 patient in every 60¹

• fracture to the bone. This can happen to 8 patients in every 1,000²

• problems with local anaesthetic. A reaction to the local anaesthetic used to numb your foot is rare and can happen to less than 1 patient in every 10,000¹

• nerve damage. This is usually temporary but can be permanent. Great care is taken to avoid damage to the nerves in your foot during the local anaesthetic and your operation

• more pain after surgery. The majority of patients who have foot surgery have less pain after their operation. However, you may have no improvement in your symptoms or more pain after surgery

• avascular necrosis. This is a very rare complication. It is where part of the bone in your foot loses its blood supply. Your bone may then become weaker, change shape and become damaged resulting in problems such as arthritis in the joint

• Chronic Regional Pain Syndrome. This is a very rare condition where pain develop in your foot after your operation and does not settle down. If this happens you would need to be referred to a pain specialist.

How long will it take my foot to get back to normal after my operation?

Between 4-6 weeks after your operation your foot will begin to return to normal and you should be able to wear your shoes again. Trainers or flat, loose fitting lace up shoes are the type you should wear. Your foot will still be quite swollen, especially at the end of the day.

At 6 weeks you may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again. Your healthcare professional will also advise when you can drive again.

After 6 weeks you can return to work but if you have an active job you may need a longer time off to recover. Your healthcare professional will advise when you can return to work.

You should avoid taking part in sport until you are advised by your healthcare professional.

6 months after your operation you will be given an appointment for a final review of your foot. You should now only have slight swelling in your foot and you should be getting the full benefit of your operation.

12 months after your operation your foot should be completely healed.

What other treatments are available?

Other treatments can include:

• changing your style of shoe
• wearing insoles inside your shoes to correct the position of your foot

• wearing bunion shields and padding

• no treatment

Contact numbers

If you need advice or have any problems, please contact the Podiatric Surgery Team

North Tees and Hartlepool NHS Foundation Trust

Podiatric Surgery Team
One Life
Park Road
Hartlepool
TS24 7PW
Central booking office: 01429 522471
Monday – Friday, 8:30am – 4:30pm

Further information is available from

The Society of Chiropodist and Podiatrists
1 Fellmonger’s Path
Tower Bridge Road
London
SE1 3LY
telephone: 0207234 8620
or via the website at www.feetforlife.org

NHS Choices
telephone: 111 (when it is less urgent than 999)
Calls to this number are free from landlines and mobile phones or via the website at www.nhs.uk

References

1. Kilmartin TE (2006) Critical Review: The Surgical Management of Hallux Valgus. British Journal of Podiatry, Vol 9, no. 1, pages 4-24
   
2. Naismith AR. And Pavier JCS (2008) Fracture patterns following Scarf & Akin osteotomies. Podiatry Now, August 2008, pages 24-30.

Information used in the development of this leaflet

Gudas CJ. Scarf Z-Osteotmy. In: McGlamry ED, Banks AS, Downey MS, Martin DE, Miller SJ eds. (2004). Forefoot Surgery. Baltimore: Wilkins and Williams, pages 299-315.

Yu GV, Schnirring-Judge M, Shook J. Complications of Hallux Abducto Valgus Surgery. In:McGlamry ED, Banks AS, Downey MS Martin DE. Miller SJ eds (2004). Forefoot Surgery. Baltimore: Wilkins and Williams, pages 391-413.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

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Leaflet feedback

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Email: [email protected]