Bunion Surgery

There are many types of bunion surgery but the most common are ‘scarf osteotomy’ and ‘chevron osteotomy’, both of which are carried out at the Fortius Clinic.

What does it involve?

Bunion surgery is usually carried out as a day case procedure under a general anaesthetic along with an injection into the foot to numb it and reduce pain after the operation.

During the procedure the surgeon will usually make two incisions (cuts) around the big toe and remove the bony bump on the side of the foot, realigning your toe. The metatarsal bone is then cut (known as an osteotomy ) to reposition the bones and effectively narrow your foot. The osteotomy is held in place with small metal screws that remain in the foot.

Recovery

Immediately after surgery:

• Your foot will be bandaged, numb and pain free
• Your specialist will be able refer you to a physiotherapist to advise on exercises and walking in the padded stiff shoe supplied
• Before you go home, you will have an X-ray and you will be discharged only when you are comfortable, with a follow-up appointment and painkillers if required

During the first few weeks:

• Elevate your foot (above the level of your heart) as much as possible to reduce swelling
• Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
• Some blood ooze can be expected in the bandage. If you are worried, contact the Fortius Clinic for advice
• Take painkillers as prescribed by your doctor
• Avoid smoking

Follow-up appointments:

Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:

• 2 weeks - your bandage will be removed and you will be given a toe splint and special shoe to support your toe
• 6 weeks - your hospital shoe and toe splint will be removed and you will have an X-ray
• 12 weeks - final appointment and discharge

When can I start to walk?

Your surgeon will be able to advise you about this, as every case is different. However, below is a guide to what may be advised:

• 0-6 weeks - you will be able to weight bear in a hospital shoe
•  After 6 weeks - you will be able weight bear in your own shoes

How do I wash and shower?

For the first two weeks after surgery, it’s important to keep the bandaging totally dry although you can shower with a waterproof cover over the plaster. After two weeks, you can remove the cover if the wound is healed, but gently dab the wound dry and then re-apply your toe splint.

How should I look after the wound?

Once out of bandaging, don’t pull at your scabs but let them fall away naturally. If your wound becomes red, swollen or sore, contact the Fortius Clinic and arrange to see your consultant to check it’s not infected.

Physiotherapy and rehabilitation

You will be referred to a physiotherapist who can guide you through the stages of rehabilitation including gait re-education (learning to walk correctly again), toe mobilisation exercises, swelling reduction and reducing muscle tightness.

When can I start to drive again?

The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car during an emergency stop. Being able to do this can take at least six weeks.

Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

When can I return to work?

This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time, you should be able to return to work after four weeks; if it involves manual work, you may need to have up to eight weeks off.

What long-term outcome can I expect after surgery?

This is a very successful procedure, with 90% patient satisfaction rates. You can expect:

• Excellent pain relief once the toe has healed, which can take up to six weeks
• A good level of activity by three months
• To have fully recovered by six to 12 months and be able to carry on with your normal sports and other activities, although you may experience some swelling in the foot for up to a year

What are the risks?

Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:

• Infection
• The risk of infection is around 1% although this can usually be effectively treated with antibiotics. Serious problems caused by infection are very rare and can be treated
• Nerve damage
• Nerves that supply feeling to the skin are near the incision site. Permanent damage is rare (around 5%) but if your toe stays numb after surgery, it may be because the nerve is bruised but it will usually recover
• Under-correction or recurrence of symptoms
• The risk of this is around 5% and it’s more common in severe cases. Although under-correction does not usually cause symptoms to return, it can cause a mild cosmetic deformity, in which case you may be able to have further surgery
• Over-correction
• In rare cases (around 1%) the toe can be straightened too much so that it bends towards the other foot (hallux varus). Although this is a very rare complication, it usually requires further surgery
• Deep Vein Thrombosis (DVT)
• You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). However, DVT is fairly unusual after this type of procedure (less than 3% of cases)

Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery