The term ‘bunion’ is used to describe a swelling or deformity on the inner side of the big toe. The toe tends to deviate. The problem tends to run in families and can be made worse by ill-fitting shoes.
Symptoms consist of pain on the inside of the big toe, particularly when wearing shoes. The toe may look deviated. The problem gets worse over time.
Non-operative treatment consists of using wide fitting shoe wear. Insoles or orthotics may sometimes be of help.
Surgical treatment consists of realigning the metatarsal bone of the big toe. The goal of surgery is to straighten the toe and to narrow the foot.
Mr. Samarji, a specialist in treating Bunions in Manchester, uses modern techniques of surgery to reduce the pain that is traditionally associated with this procedure. A plaster is not usually needed following the operation. The patient will need to walk on the outer side of the foot or use a special shoe for a few weeks until the bone has healed.
The majority of patients will get an extremely good result following surgery for a painful bunion.
Richard will examine your foot examining the bunion and the great toe joints. In fact the whole of the foot is examined as quite often there may be other conditions present that may need to be addressed (for example metatarsalgia or lesser toe problems). If you have any insoles these may also need to be examined. Comparison with the other foot is also made. For a painful bunion X-rays are also obtained to help measure the size of the bunion, which in turn will help determine what type of surgery is most appropriate for you.
The indication for an operation is to get rid of the pain associated with the bunion and hence surgery is indicated for a painful bunion rather than a painless deformity.
Following evaluation of your foot and the problems the you have been experiencing, and review of the X-rays an explanation of the nature of your problem/problems would take place. In addition the various treatment options for your problems would be outlined and explained.
Usually a joint decision between Richard and yourself about the most appropriate way to treat your foot problem is the purpose of the consultation. With regard to surgery it is important that you understand what is involved including the chance of success and any risks attached with surgery so that you can make an informed decision about how you wish to proceed. It is very important in the consultation that you are aware of the different treatment options and the pros and cons of the options open to you.
The operation generally takes between thirty to sixty minutes. The operation involves dividing the bone and realigning it into the corrected position, correcting the deformity that is present. The bone is fixed with one or two small bone screws. The screws usually give very solid fixation and a plaster cast is therefore not needed. After the operation a bulky bandage is applied to the foot. At twelve to fourteen days following the operation the stitches are trimmed. Usually dissolvable stitches are used. For small to moderate sized bunions a small incision can be used which helps with the cosmetic effect. Even for larger bunions the incision and scar is placed on the inside of the foot. It tends to heal very well here and it is very difficult to see any scar particularly when looking from the top and hence it is quite a cosmetically acceptable scar in that it is very difficult to see. Richard uses this approach rather than using incisions on the top of the foot that may not produce such a good cosmetic result.
Following surgery to correct a hallux valgus / painful bunion, this type of surgery is usually carried out as a day case. If the operation is carried out in the afternoon you will need to have nothing to eat or drink following a light early breakfast six hours prior to the operation.
If the operation is in the morning then having nothing to eat or drink from 2am in the morning prior to the procedure would be the usual requirement.
Following surgery to correct a painful bunion / hallux valgus, it is important to walk on the heel or on the outside of the foot for six weeks to allow the bones to heal. The small bone screws are not designed to take your full body weight. In this regard particularly for the right foot it is not advisable to drive for at least six weeks until the bone has healed. With regard to returning to work, it is possible to return to work after two weeks particularly if doing a sedentary type job.
With regard to playing sports, it is usual to be able to return to playing sports three to four months after the operation. Usually at six weeks you will be able to start putting weight through the operated area and get back to walking normally as soon as is comfortable thereafter.
Normally physiotherapy is not needed following surgery for a painful bunion.
All surgery carries the risk of complications. These include infection, clots, bones not knitting, and development of arthritis or complex pain. The risks however are very small with the risk of deep infection in the bone being less than 1%.
Occasionally a bone may not knit, but this tends to be a problem for patients who smoke as this can inhibit bone healing.