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Mr Matthew Morris, Consultant Orthopaedic Surgeon
Claremont Clinics: Mondays, Tuesday EVE & Friday PM
What is a Bunion?
A bunion is a lump on the inside of the foot at the base of the big toe mostly caused by deformity of the joint between the big toe and foot or 'Hallux Valgus', meaning 'big toe turning out'. However, sometimes they are caused by arthritis of this joint or 'Hallux Rigidus' meaning 'stiff big toe'.
Most people and doctors think of a bunion as the lump on the foot and the big toe crossing over towards the other toes. Anyone can get a bunion, but they are more common in women. There is also a strong trend within families, shoes can worsen bunion deformity and pointed high heels are the worst culprits for this.
Why Does the Bunion Hurt?
A bunion can be present for many years without causing any pain and the pain is not always related to the size of the bunion. The reasons bunions start to hurt is because they start to rub on footwear, become mechanically compromised or there is arthritis in the joint.
Most people try different shoes to accommodate the bump, but even then the bunion can rub or cause overcrowding and deformity of the lesser toes. The pain can be caused by the mechanics of the joint being stressed, even in relatively small bunions.
In about a third of cases, the pain is felt under the base of the second toe and not in the bunion itself, this is due to overloading as the big toe fails to take its share of the weight.
What Treatments are There for Bunions?
Modification and compromises in shoes are the first treatments. This does not mean you cannot wear your best shoes, but high heels and pointed shoes should be saved for special occasions. There are lots of toe spacers and splints on the market which can help. Simple painkillers can also be taken.
Unfortunately, bunions tend to worsen over time despite these measures as the mechanics of the foot are very powerful. Surgery is often indicated to correct a painful bunion and an x-ray is required to plan the surgery, although this decision can sometimes be made without an x-ray.
What Does Bunion Surgery Involve?
There are lots of people who have heard terrible stories about bunion surgery, this is because in the past, the mechanics of the foot were poorly understood and the surgery undertaken by non-specialists.
Now, specialist trained Foot & Ankle Surgeons are able to correct bunions with a much better understanding of the mechanics of the foot, using modern techniques resulting in improved recovery.
The surgery involves dividing the bone in the foot and sometimes toe as well, then moving the bone and fixing them in the corrected position with screws. This can be done through a cut on the inside of the foot or some surgeons are now offering minimally invasive bunion corrections (keyhole surgery). This has an advantage of earlier comfort and recovery. Both techniques involve dividing a bone in the foot and this takes time to heal, we can't rush nature! This means the foot aches and swells for a number of months after surgery.
The surgery is usually done under a general or epidural anaesthetic and takes about 30 minutes to perform, usually as a daycase procedure. The surgeon or anaethetist will put local anaesthetic around your ankle whilst you are asleep to help with post-operative pain relief. 90% of the patients I asked over a 6 month period said the pain was not nearly as bad as they had been expecting. However, some pain is unavoidable after orthopaedic surgery. Patients are discharged home fully weight bearing in a special protective shoe and bandage a few hours after the surgery.
If the arthritis in the joint is severe, the surgery can be different but this would all be discussed prior to theatre.
What is the Recovery Period After Bunion Surgery?
After surgery, patients will recover for a few hours in hospital until ready to go home and will usually be given something to eat and some painkillers. The physiotherapists will check for safety walking in the special shoe and that the patient has fully recovered from the anaesthetic.
For the first 2 weeks after surgery, I ask my patients to rest the foot as much as possible. They are allowed to walk to the toilet, up and down to bed and of course to make a cup of tea! The message is to do many little trips but not stand for long periods of time. The rest of the time they can put their feet up, ideally higher than their bottom to help with swelling. Painkillers will be provided.
After 2 weeks, I will see them again in clinic and take down the surgical bandages. Leaving the foot wrapped up for 2 weeks after surgery reduces the chance of infection and patients will be able to shower after this point.
Between 2 and 6 weeks, patients remain in the post-operative shoe for protection, but can start to be a little more active, resting the foot as aching and swelling dictate.
I will usually see the patient at 6 weeks when they are allowed to return to normal shoes, driving and work if it is a sit down job. Standing all day or carrying will take a few more weeks.
By 3 months, nearly all patients are pleased with the outcome of surgery, 95%. The foot however does not completely recover until 1 year after surgery.
Are There Any Risks From Bunion Surgery?
Yes. Unfortunately, all surgery including bunion corrections carry a risk of complications or problems. The good news is that 95% of people are pleased with the outcome of their bunion correction, the remaining 5% have usually had a problem in the post-operative period.
1 in 100 people have an infection in the wound which requires antibiotics and rarely a washout back in theatre.
1 in 50 people have some numbness on the big toe after surgery due to nerve injury, some of these have it before surgery as well.
Bunions can recur over a life time, so the younger you are when you have it corrected, the higher the risk of recurrance.
Over or under correction can also occur. It is the surgeons job to get the toe well aligned, but we do this with the patient lying down and when weight bearing, rarely, it can be over or under corrected possibly requiring repeat surgery.
Blood clots or DVTs are associated with all surgery, but the risk after bunion correction is relatively low. Patients would not usually be required to take blood thinning drugs unless other risk factors were present.
Should I Have my Bunions Operated on?
It is always the patient who decides if they would like to go ahead with surgery. I see my role as the surgeon to listen to the history from the patient and explain the treatment options, risks and recovery expectations. I will of course advise if I do not think that surgery is the right option or the risks too high. I will happily answer any questions which help the patient make their decision.
The main reasons to operate on a bunion are pain despite an acceptable compromise in footwear, deformity causing the lesser toes to displace and pain under the second toe.
Private bunion surgery at Claremont with Mr Morris starts at £2,560 plus an initial consultation fee of £200 if you don't have health insurance. For more information or to book an appointment with Mr Morris, just call our friendly Private Patient Team on 0114 263 2114 or email firstname.lastname@example.org. You will need a referral letter from your GP or you can see one of our Private GPs if you prefer.
Copyright Matthew Morris, 2016.