Surgery for hallux valgus has been transformed in recent years. The experience of surgery, the recovery and the long term outcomes have been transformed with introduction of modern techniques.
An operation may be considered if simple treatments do not improve the pain in your foot. An operation is always optional. How much pain you have in your foot will help you decide whether you need an operation.
The most common operation to correct a Hallux Valgus is called a Scarf and Akin Osteotomy. There may be the option of keyhole surgery (Minimally Invasive Chevron Akin Osteotomy – MICA). Occasionally other types of operation are considered and we will discuss these with you in the clinic.
Modern bunion surgery is carried out using fine precision instruments. Rigid fixation of the realigned bones allows early mobilisation without requirement for plasters or crutches. Buried headless screws are used to minimise the chance of needing further surgery to take the implants out. Metal pins (K-wires) are not required for correction of the big toe.
You will require an anaesthetic and you will meet the anaesthetist before the operation. They will discuss with you which type of anaesthetic you prefer in your circumstances. The operation is usually done under general anaesthetic. A nerve block to numb the toes helps greatly with pain relief immediately after the operation.
There is normally a cut of about 3cm on the top of the foot on the skin between the first and second toes. The tight tendons and ligaments which are pulling the toes out of line are released.
A longer cut is made on the inside border of the foot. This is used to remove the bump, then realign the bones of the foot and the big toe. The bones are fixed in place with screws and sometimes a small staple.
If there are problems with other toes in the foot these may be corrected at the same time.
The screws and staples will remain in the foot and only occasionally need to be taken out later if they are prominent causing problems.
For most people there is the option of having surgery on both feet at once should you prefer. Most people having an operation on one foot can be treated as a day case. People having an operation on both feet may need to stay in hospital overnight.
Minimally Invasive Chevron Akin (MICA) is a new technique for bunion correction. This is carried out with a series of cuts of about 5mm, leaving shorter scars.
X-rays are used during the operation to ensure the correct positioning of the bones. The bones are reset and heal in a similar way to the open operation. The bones are fixed using buried screws – there are no wires to be removed. You would have the same protective shoe during the recovery.
There are advantages and disadvantages of minimally invasive surgery compared with scarf and akin osteotomy. Our surgeons have extensive experience of both techniques and can discuss with you which is the more suitable option for your foot.
Modern surgical and anaesthetic techniques have transformed patients’ experience of hallux valgus surgery. You may have a local nerve block to relieve pain immediately after the operation – this means you wake with the foot feeling numb but with very little or no pain.
You will have a bandage on your foot for about two weeks
You are provided with either a blue shoe (figure 2) or a forefoot off-loading shoe (figure 3) to walk.
For most people the shoe is only required for two weeks or until you can wear a wider fitting shoe comfortably. In some situations it can be needed for six weeks.
It is more comfortable if you elevate your foot as much as possible on a footstool, recliner chair or sofa.
You can walk around your house and garden or short distances beyond for the first two weeks
You do not have to use sticks or crutches but some people find them comfortable in the early stages.
A physiotherapist will see you on the ward either before or after your operation. They will show you how to use crutches and advise you how to do stairs when wearing the blue shoe or off-loading shoe.
You can return to desk work at around 1- 4 weeks after your operation. Remember to sit with your foot propped up. If you are on your feet for longer periods it may be 2-3 months before you are comfortable enough to get back to work.
It will take 4-6 weeks before you are able to safely use the foot pedals in your car.
You will have a clinic appointment about 2 weeks after your operation. Dressings will be changed and the wound checked. Stitches are usually dissolvable and so only need trimming back in clinic. Some people will require a further appointment. You will have x-rays taken at one of the follow up appointments – this allows you to see what has been done!
Any operation has risks. These risks are higher in patients who smoke, are on steroid medication or have diabetes. After this operation problems can be:
X-rays of a foot before and after a Scarf / Akin osteotomy. This shows the successful removal of the bone lump and straightening of the big toe.