Bunion/Hallux Valgus

What is a bunion?

A bunion is a bony deformity of the joint at the base of the big toe. The medical name is hallux valgus.
The main sign of a bunion is the big toe pointing towards the other toes on the same foot, which may force the foot bone attached to it (the first metatarsal) to stick outwards.

What causes bunions?

The exact cause of bunions is unknown, but they tend to run in families. Wearing badly fitting shoes is thought to make bunions worse. It's also thought that bunions are more likely to occur in people with unusually flexible joints.

What is a bunion surgery?

Surgery is the only way to correct a bunion. A bunion will usually get worse over time, so if it's left untreated it's likely to get bigger and become more painful.

If your bunion is causing a significant amount of pain and affecting your quality of life, your GP may refer you to be assessed for bunion surgery.

The aim of surgery is to relieve pain and improve the alignment of your big toe. Surgery isn't usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.

Left in your foot or removed later on. Some of the surgical procedures for bunions are described below.

How long will I stay in hospital?

Bunion surgery is carried out as a day procedure, which means you won't have to stay in hospital overnight. The procedure will either be carried out under general or spinal anaesthetic

Osteotomy (open or mini invasive)

Osteotomy is the most commonly used and proven type of bunion surgery. Although there are many different types of osteotomy, they generally involve cutting and realigning the bone in your toe.
The tendons and joint will also be realigned. Sometimes the lesser toes will be corrected as well. If the bunion is modest and flexible a mini invasive correction may be offered.

Fusion

If the deformity is very large or there is arthritis in the joint it may not be possible to realign or inappropriate to do so. In this case a fusion of the joint will be offered. This will sacrifice the movement in the joint.

What happens after the operation?

After bunion surgery, your foot and ankle may be swollen for up to a year. While you're recovering, you'll need to keep your foot raised to reduce swelling. You will be given a protective shoe to walk in.
It's likely that you'll be unable to wear all of your normal shoes for at least six months after surgery. You will have a bandage and postoperative shoes (shoes specially designed to allow heel walking and protect the bony cuts) before you can start wearing regular footwear. This will keep the bones and soft tissues in place while they heal.

What happens before the operation?

Prior to admission you will need to have a pre‐ operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. The pre‐operative assessment nurses are there to help you with any worries or concerns that you have, and can give you advice on any preparation needed for your surgery.

Before the date of your admission, please read very closely the instructions given to you. If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery.

What does the surgery involve?

There are a number of different surgical procedures used to treat bunions. The type of surgery recommended for you will depend on the severity of the deformity.

Your surgeon will use screws to hold the bones in place while they heal. Depending on the type of surgery you have, these may be;

• A deep vein thrombosis, very rare
• stiffness in your toe joints
• a delay or failure of the bone to heal,
  or the bone healing in the wrong
  position (1%)
• pain under the ball of your foot (2%)
• damage to the nerves in your foot (2%)
• prolonged swelling and continued pain
  (common)
• the need for further surgery
• thickened scar tissue
• Recurrence

Speak to your GP or surgeon if you have any concerns after surgery, or if you experience any of these complications. They can advise you on how to deal with these complications, including further treatment options.