Mr Tristan Barton, Consultant Orthopaedic Surgeon at Circle Bath, talks us through the process of having bunion surgery.
What is a bunion?
A bunion is a prominence on the inside of your foot at the base of the big toe, associated with the big toe pointing towards the other toes. It is also known medically as a ‘hallux valgus’ deformity. ‘Hallux’ is Latin for ‘big toe’, and ‘valgus’ describes the big toe pointing outwards. Bunions are far more common in females and can either be a problem you are born with, or develop as you get older.
Bunions are not always painful, and many people have bunions that do not cause them any problems. If the bunion does cause symptoms, it is usually a pain or ache within the bunion itself. This pain is often worse in certain shoes, and during activities on your feet. The size of the bunion does not always correlate with the amount of pain it causes. Some people have large bunions with very little pain; others have a smaller bunion but a lot of pain. Sometimes bunions do get larger over time and become increasingly uncomfortable. They do not always progress, however, and sometimes people have had bunions for many years that have not changed.
A frequent question I get asked is why someone has got a bunion. Bunions are strongly genetic, and frequently run in the family. People often know of someone in their family who also has a bunion. Other causes include certain types of shoe-wear. If someone has a bunion, symptoms will be made worse by either tight shoes or shoes with a high heel. A high heel places a quite a strain on the ball of the foot, and can make bunions bigger and more uncomfortable.
Bunions can also cause other problems. The shape of the bunion can make it difficult to find shoes that fit properly without rubbing. You may even have to buy shoes that are a size too big in order for them to fit. Another issue is that of the big toe pressing on the second toe causing pain and deformity. If the big toe has been pressing on the second toe for a long time, the second toe can become fixed in a bent position that itself can cause problems with shoe-wear. This deformity is called a hammer or claw toe.
At your initial consultation, I will ask you questions about your foot and what problems it is giving you. I will examine your foot and, if needed, get an x-ray to give me a clearer idea of the extent of the problem.
A number of treatment options need to be explored before surgery is considered necessary. The first port of call would be addressing your shoe-wear – finding comfortable shoes that give your toes enough room is key, and in some patients, this is enough to relieve symptoms. Other patients may find that wearing special insoles in your shoes provides support to your foot and makes the bunion more comfortable.
If all these options have been tried and the bunion remains painful, then surgery is an option for you. Other reasons to consider surgery are if the big toe is pressing on the second toe causing pain and deformity of the second toe.
Bunion surgery has progressed significantly over the last 10 years. Where once it was considered a painful operation, this is now rarely the case. This is due to improved surgical techniques, and better control of pain following surgery.
The main aims of surgery are to straighten the big toe, reduce the size of the prominence on the inside of your foot, and reduce the pain from your bunion. The surgery may be combined with surgery to the other toes of the foot if needed.
The surgery can be performed with you awake or asleep. If you are awake, you will have an anaesthetic ‘block’ so will feel no pain. The decision as to which anaesthetic you have is entirely yours. Surgery is performed as a day-case procedure, which means that you will have the operation and go home on the same day. If you need to stay overnight, this can be arranged.
The surgery typically takes about 1 hour and involves making a small 3cm incision on top of your foot, between the big and second toe, and a longer 8cm incision over the bunion on the inner side of your foot. Any bony prominence found there can be shaved off, and then I can cut across the big toe bone before repositioning it to correct the deformity. This will be held in its new position with small screws that will not need removing. The incisions are then stitched up, and a bandage applied.
After surgery, I will give you a special shoe that goes over the dressings, and our physiotherapy team will be on hand to help you learn to walk with crutches while the foot begins to heal. Keeping the foot elevated is very important, especially early on, as this helps combat swelling and further pain. You will need to walk on your heel on the side we have operated on for 6 weeks.
I will see you at 2 weeks following surgery. At this time your stitches will be removed, and the foot will be placed in a material splint. You will have to continue wearing the special shoe over the splint and walk on your heel for another 4 weeks. I will see you again at 6 weeks following surgery and we will get x-rays of your foot. If everything looks as we would expect, you will then be able to walk more normally in a loose-fitting pair of shoes.
It does take up to 6 months for all the swelling and stiffness to settle, and you have to be patient in your recovery.
Our dedicated foot and ankle unit at Circle Bath is the ideal facility for you if you have been struggling with a bunion deformity of your foot. Every patient has different needs, and I will tailor your surgery and recovery to your individual requirements.
Alongside a dedicated physiotherapy team to guide you through your recovery and rehabilitation, this level of personalised care extends right through your time with us at Circle Bath. Book a consultation with me today, and we can discuss and plan all options, both surgical and non-surgical, available to you.
- Ankle arthroscopy
- Ankle ligament repair
- Ankle replacement surgery
- Big toe cheilectomy
- Toe deformity correction
- Foot bunion removal surgery
- Ganglion removal (feet)
- Repair of tibialis posterior tendon
- Ankle fusion
- Subtalar fusion
- Triple fusion
- Midfoot fusions
- Rheumatoid foot reconstruction
- Ingrowing toenail treatment
- Bone spurs