Hallux Valgus (Bunion)

What is a bunion?
A bunion is a lump at the base of the big toe, caused by sideways drifting and angulation of the big toe. A bunion is not a ‘bump’ on the bone, it is caused by angulation of the bones in the foot. Sometimes it is painful in itself, but more commonly it causes symptoms by pressure on shoe-wear or, on occasions, by crowding or crossing the smaller (lesser) toes. The second toe can become so crowded that it becomes ‘clawed,’ and crosses over the big toe.

Is surgery the only way to treat bunions?
Early and mild bunions may respond to the application of splints or braces, although the effects are often short-lived. Wearing ‘corn plasters’ or ‘pads’ may relieve local pressure symptoms. Shoes may be made or adapted to accommodate the bunion within a broad front (toe-box).

Some bunions are caused by flat foot and collapse of the arches. These can be helped by arch supports.

More severe bunions can only be corrected by surgery. Surgery should only be undertaken if the symptoms are significant and appropriate non-operative management has been considered. The surgery is usually carried out under a general anaesthetic, with local anaesthetic being used to reduce the amount of general anaesthetic required. Surgery is usually performed either as a day-case (where you do not have to stay in hospital over night at all), or with an overnight stay in hospital.

What can I expect after the operation?
After the operation, you will wake up with your foot in a bandage.
The foot is always painful, but painkilling tablets usually control this. 
In order to minimise swelling, you will need to keep your foot up after the operation. You will be given a special shoe to wear after surgery. This should be worn at all times, including in bed at night.

What can I do once I am discharged?
To start with you will need to rest your foot up (above heart level) most of the time. When the foot is lowered it will throb and swell. This should be avoided. With time, the period you can keep the foot down will increase. After two to three weeks after the operation you should be able to keep it down most of the time.

At around two weeks after surgery, you will return to the clinic for removal of stitches. It is important to exercise, or mobilise the toe. This can be started after surgery, and you will be advised of the exercises. Failure to undertake these exercises increases the risk of developing stiffness of the toe after surgery.

Are there any risks or complications?
Although the operation produces good results in most cases, complications do occur. Although great care is taken with the operation and aftercare, a small number of people (up to 10%) may have a less than perfect results due to problems such as:

Recurrence of the bunion
Over-correction of the bunion, so that the big toe points inwards.
Sensitisation and pain in the foot due to damage to the small nerves or blood vessels in the foot.
Non-healing of the bone.
Stiffness of the big toe.
The screws become prominent and require removal at a later date.
Weight transfer to the second toe (a corn under the second toe).
Infection of the skin, and rarely of the bone.
The complications of any surgery such as thrombosis (a blood clot) and anaesthetic problems.