Bunion (hallux valgus) surgery
The skin over the bunion might be red and sore. Wearing tight, narrow shoes might cause bunions or make them worse.
The best approach
In Australia, there are three main approaches currently used by orthopaedic surgeons:
- First metatarsal and proximal phalanx bone cuts to correct the deformity.
- Fusion of the first metatarsophalangeal (MTP) joint.
- Fusion of the first tarsometatarsal (TMT) joint.
With an open bunion correction, an incision is made on the inside of the foot over the bunion, and a special z-shaped cut of the first metatarsal bone is made – this is called a Scarf osteotomy and it's actually a carpentry principle. This osteotomy allows the surgeon to rotate and translate the distal part of the bone (i.e. the part with the metatarsal head and MTP joint) into a corrected position, which is then held with small compression screws.
If necessary, a small wedge of bone can also be taken from the first proximal phalanx in order to pull the toe even straighter. This bone cut is usually held with a small staple.
In addition to the bone cuts, the tight soft tissues on the lateral side of the big toe joint are lengthened, and the loose soft tissues over the bunion prominence are tightened up.
Fusion of the big toe
An incision is made over the inside aspect of the foot. and the TMT joint is cut and prepared to allow the first metatarsal to be rotated back into the correct position. A special Lapidus plate is then inserted to hold the joint in the new position. A second cut is usually needed around the MTP joint in order to shave the bunion prominence and tighten the stretched medial capsule.
Care after surgery
Two weeks after surgery, the wounds are checked. Range of motion exercises and rehabilitation are started once the wound has healed. A simple exercise of gently manually moving the great toe up and down is important to prevent stiffness.
Patients need to wear a surgical shoe for up to 6 weeks. If it is the right foot they won't be able to drive for this period. Office and desk-job workers can go back to work after 2 weeks, but those doing manual jobs on their feet often need a full 6 weeks off. Most patients can wear supportive sneakers from 6 weeks post-op, and after this time they can usually swim and use an exercise bike or an elliptical trainer.
The bone cuts take 8–12 weeks to fully heal, and most of the swelling diminishes by 3 months. By 6 months most patients have returned to their normal activities without pain or discomfort.
Fusion of the big toe
What should patients know before considering bunion surgery?
Recurrence of the bunion is possible and depends on both the severity of the patient's preoperative deformity, the surgical technique employed, as well as their age. Infection rates are generally very low, as are the risks of nerve damage, stiffness. or problems with bone healing.
Conditions like diabetes, peripheral vascular disease or long-term use of immunosuppressant drugs are possible contraindications to surgery, and patients with these conditions require careful evaluation by an orthopaedic surgeon.
Bunion surgery is covered by both Medicare and private health funds only when performed by an orthopaedic surgeon.
- Pathway for total hip replacement and resurfacing hip replacement
- Bearings for hip replacement
- Hip replacement in the young