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Bunion Surgery

This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case. The procedure takes approximately 30-60 minutes. The aim of surgery is to improve pain and function as well as the appearance of the toe.

The Operation

A 4cm incision is made on the top of the foot between big and second toes to release the tight structures on that side.

An 8cm incision is made on the inner aspect of the foot over the bunion. Some of the underlying bony prominence is shaved off then the bone is divided so that it may be re-aligned. The bone is stabilized with 1 or 2 screws that are completely embedded within the bone. Because the screws are embedded you will not be able to feel them, and they should not require removal at a later date.

The tissues are then stitched, and a wool and crepe bandage applied.

Risks

Risks include

  • Infection – 1-2 % in our unit.The risk of blood clot is low since you will be mobil
  • Blood clots (thrombosis) – The risk of blood clot is low since you will be mobile. The treatment to reduce this risk will be provided if required
  • Numbness - on the top of big toe usually gets better with time.
  • Pain, swelling, and bruising - This can occur after any foot and ankle surgery. You have to keep the limb elevated for 48 hours to avoid Swelling.
  • Scar sensitivity – do scar massage .it usually improves with time.
  • Incomplete improvement - occasionally symptoms will be improved but remain present to a small degree.
  • Recurrence - deformities can recur, and there is a higher risk in the younger patents.
  • Stiffness - this improves over time and helped by physiotherapy.

Discharge advice following bunion surgery

Dressings

Your foot has been dressed in a wool and crepe bandage. You will have to keep the wound clean and dry.You will be given a special shoes which offloads the forefoot for 6 weeks

Elevation

You have to keep the limb elevated to reduce the swelling. It will occur to some degree following all foot and ankle surgery. Try not to hang your leg down for two weeks after surgery. The swelling can sometime last for 6 months. In bed, put the foot on a pillow.

Analgesia

You will receive a prescription for pain medication on discharge. Pain is often due to swelling, and rest and elevation of the foot ease this.

Walking

We advice heel walking for first two weeks with crutches which physiotherapists will train you before discharge. A special shoe has been supplied for you wear over your dressings that should be worn during the day for 6 weeks. It is necessary for you to walk by taking the weight on your heel so that you don’t put pressure on the big toe. It is not necessary to wear this shoe in bed.

Follow-up

You will be reviewed approximately 2 weeks following surgery, and the dressings and sutures will be removed. At this stage you will be placed in a removable splint. You will still need to continue wearing the special shoe for 6 weeks. You will be reviewed again after 6 weeks at which time you will have an X-Ray. If all is well, you will be referred to the physiotherapists and you can discard the post- operative shoe. The foot is often slightly swollen at this stage and so a comfortable pair of loose-fitting shoes or trainers will need to be worn and should be brought to the clinic. You will then be reviewed, hopefully for a final check, at about 3 months after the surgery.

Driving and work

You should not drive a manual car for 6 weeks following surgery. After this you should start driving gradually, to check that you are comfortable. It normally takes a few days to feel confident.

If you have an office-based job, then it may be possible for you to return after 2 weeks however it is more advisable to return after 6 weeks. If you have a more physical job, then it may take 8-12 weeks.

Recovery

It often takes 6 months for all the stiffness and swelling to resolve following bunion surgery, and minor swelling late in the day is not unusual and should not be a cause for concern.