Hallux Valgus (Bunions) Surgery

What is hallux valgus?

Hallux valgus is often referred to as a bunion deformity. The big toe drifts outwards towards the smaller toes and a small bump appears on the inner aspect of the foot along with a red swelling in the region of the big toe joint.

How is it caused?

It is common for bunion problems to run in families. Wearing inappropriate shoes and laxity of joints have also been implicated as factors that may cause the development of a bunion.

What are the symptoms?

Most people have no symptoms but some develop pain over the bunion, difficulty with wearing shoes and, in severe cases, difficulty with walking.

What can be done about a bunion?

Conservative management: A lot of people with bunion problems can be managed with the use of appropriate footwear and in some cases with the use of orthotics (inserts used in the shoes). If conservative measures fail to improve the situation patients with continued symptoms, difficulty with wearing shoes and increasing deformities can be helped with appropriate operative procedures. Surgery will correct the deformity, narrow the foot and give better biomechanics (structure and movement) to the foot. The operative procedure chosen will be discussed in greater detail with you by your surgeon.

What does the operation involve?

The operation to the forefoot can be performed either under general anaesthesia or regional anaesthesia. This decision can be made after discussion with the anaesthetist. The operation itself involves making an incision over the affected toe, cutting and shaping the bones, realigning the bones and fixing them using small screws and staples (if appropriate) to achieve a better alignment and biomechanics. There are different techniques, and your surgeon will discuss which is appropriate for you.

What about pain?

Whilst you are in hospital you will be monitored and the medical staff will give you pain killers as required and prescribed. When you are at home you may find Paracetamol or Ibuprofen (if tolerated) useful for controlling any pain. Instructions on management of pain will be given by the nursing staff before you leave the hospital.

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How long does recovery take?

Most patients undergoing hallux valgus surgery will stay in hospital for one night. The majority of patients have only a padded dressing and bandage to the wound but some patients may require the use of a plaster cast to the forefoot after surgery. You will be given a special shoe, which helps to off-load the forefoot. The physiotherapist will give instructions on how to wear the shoe as well as the use of elbow crutches if necessary. For the first two weeks you are advised to restrict your walking distance to within the house and garden and to limit the extent of your walking.

Your wound dressing will be changed at 7-14 days and the stitches removed or trimmed between two and three weeks. In general most of the dressings are removed by about six weeks postoperatively. You are advised to keep the dressing clean and dry until the stitches are removed. You will need to wear the special shoe for between 4 and 8 weeks, depending on the operation performed, and your surgeon will be able to advise you on this. Following this it is advisable to wear loose-fitting shoes (Ecco, Hotter or sports shoes). Normal footwear (which is well-fitting) can be worn about three months after the operation.

Swelling is quite common after foot surgery and this is best managed by elevating the foot at regular intervals. You are advised to elevate the operated foot on a pillow every night and during the day to elevate the affected leg/foot on three different occasions i.e. 11am, 3pm and 6pm for about one hour each time. The above measures will help to reduce swelling of the foot. These instructions should be followed for at least 10-14 days.

People vary in how quickly the swelling disappears after surgery and three months is not unusual. Provided you are not having undue pain or inflammation there is probably nothing to worry about and you can afford to give it time.

Patients having had only the left foot operated on will be able to drive an automatic car within two weeks. Those who have had an operation on the right side will be able to drive after about 6-8 weeks.

You are advised not to fly after surgery for about 6 weeks. Swimming will be possible once the sutures are removed and the wound is healing satisfactorily.

When can I go back to work?

This will depend on the type of work you do. For example if you have a desk job and can do your work with your foot up and in a special shoe you may be able to return to work after 2-4 weeks. If on the other hand you do manual work where there would be a lot of pressure on the foot then you may need 8-12 weeks off work.

What can go wrong?

All operative interventions have an inbuilt risk and complication rate. The risks following hallux valgus surgery are as follows:

  • Infection (the wound may become infected and inflamed)
  • Neuroma (injury to a nerve)
  • Deep vein thrombosis (clot in the vein)
  • Prolonged swelling of the foot
  • Recurrence of the deformity
  • Metal breakage (screws used in the operation)
  • Stiffness of the joint
  • Non union
  • The above complications are rare but can occur.