Bunions - Patient Information

Vale Healthcare's Foot and Ankle specialists treat a full range of Foot & Ankle conditions including Bunions.

Find out more about our surgeons: Mr Rhys Thomas | Mr Sandeep Hemmadi

What is a Bunion?
What causes a Bunion?
Symptoms of a Bunion
Diagnosis of a Bunion
Treatment of a Bunion
Post-Bunion Surgery
Are there risks to Bunion Surgery?

A bunion is a lump on the inside of the big toe joint. The bunion is usually associated with a big toe that leans outwards towards the other toes. This condition is known as hallux valgus.

The deformity of the big toe gives less space for the other toes, especially when shoes are worn. This, in turn, may cause problems with the other toes of the foot.

What causes a Bunion?

Bunions are more common in women and may also run in families. However in certain people tight or ill-fitting shoewear may cause the big toe to deform. Some bunions are associated with arthritis or occur because of a previous injury.

Symptoms of a Bunion?

Some bunions may cause no problems at all. Even large bunions may not cause any significant symptoms.

When bunions do become problematic they may cause pain and further swelling. They may also cause difficulty with shoewear due to rubbing and large bunions may even deform a shoe! The deviated big toe may push on the second toe, sometimes making the two toes cross-over.

Diagnosis of Bunions…

The diagnosis is easily confirmed by the appearance of the foot. An X-ray is taken to assess the complete extent of the deformity and the condition of the joints.

Treatment of a Bunion

Symptoms of related to bunions may be treated with or without surgery.

Non-surgical Treatment

Non-operative treatments involve alterations in shoewear and local supports which can be provided by our podiatrists. These will aim to relieve the discomfort and provide pressure relief but will not correct the condition or improve the appearance.

Our physiotherapists may help to address any underlying biomechanical issues that relate to the condition.

Surgical treatment

Bunion surgery aims to correct the deformity and to restore normal function to the foot.

Many different types of operation are available to treat a bunion. Each surgery must be tailored to the individual patient and depends on the type of bunion deformity and the lifestyle and expectations of the person. An experienced Foot and Ankle Surgeon will take all these considerations into account when deciding on the optimum procedure and will discuss this with you.

Corrective surgery involves removal of the lump on the inside of the foot (bunionectomy). This needs to be combined with a bone cut (osteotomy) of one or more bones of the big toe to straighten out the toe. Tight tendons and ligaments may also need to be addressed.

One of the most common and modern ways of bunion correction is with a ‘scarf osteotomy’ of the 1st metatarsal bone. This is often combined with an ‘Akin osteotomy’ of the proximal phalanx of the big toe. The bone cuts are held with screws and staples to maintain the corrected position. The use of strong screws helps prevent any further movement between the bone cuts and causes less pain and swelling after the operation. As the bone is rigidly fixed with screws you do not have to go into a plaster cast and the toe can be moved early to prevent stiffness. It is not usually necessary to remove the metalwork at a later date.

Some bunions are appropriate for treatment using the new technique of minimally invasive surgery. Rhys Thomas was the first surgeon in Wales to perform this technique and is one of only a number of surgeons in the UK to offer this technique.

Dissolvable stitches are used to close the wound and a soft bandage is applied.
Many patients will be able to go home the same day as their operation. You will be allowed to put weight through the foot in a special ‘post-operative shoe’.

Post-bunion surgery

Both before and after your surgery you will be seen by a physiotherapist. This will help you to get used to walking your ‘post-op shoe’.

The physiotherapist plays an important role in mobilizing the big toe after surgery to prevent stiffness developing and in helping to reduce swelling. These factors will help speed recovery after your operation.

You will be reviewed by your surgeon in 2 weeks when the wound will be inspected. It is usually ok to shower after this. In 6 weeks you will have an xray of your foot to ensure good healing and will be able to come out of the ‘post-op shoe’. A final check-up is usually made at 3 months.

What about returning to work after Bunion Surgery?

Generally, it will take approx. 2-4 weeks for sedentary work, 6 weeks for jobs involving standing or walking, and 8 weeks for manual workers.

Are there any risks to Bunion Surgery?

Unfortunately no surgery is guaranteed to be risk free. By picking an experienced Orthopaedic Foot Surgeon to perform your surgery using modern techniques, these risks should be minimized

Infection

You will be given antibiotics at the time of your surgery. If an infection should develop after your bunion surgery it should settle with a course of antibiotic tablets.

Swelling

The foot needs to be elevated initially to prevent swelling. Swelling will settle with time but may take up to 6-9 months to settle fully.

Stiffness

Any operation around a joint may cause stiffness afterwards. Mobilizing the big toe after the operation will lessen the chance of stiffness developing.

Nerve Damage

Damage to small nerves around the scar may occur. This will usually recover but if it doesn’t may leave a small patch of numbness that doe not usually cause any problems.

Fracture

As the cut bones start to heal they are weak and and may break (fracture). This can be painful and cause more swelling. Rarely a further procedure is needed.

Blood Clots/DVT

The risk of symptomatic blood clots following bunion surgery is low. Mr. Thomas follows the guidelines issued by the British Foot and Ankle Society. Your risk factors will be discussed with you prior to your surgery.

Undercorrection

With severe deformity the big toe may not be completely straight after bunion surgery. Very rarely the deformity may recur despite fixation. However the toe does not usually cause the problems that it did before the operation.

Overcorrection

Rarely the toe is corrected too much and starts pointing inwards rather than outwards (a condition known as hallux varus). This condition may need further surgery.