Bunion Surgery

Minimally Invasive (Keyhole) Bunion Surgery

A bunion, also known as hallux valgus, is bony prominence at the base of the big toe, which often results in pain, redness and rubbing in footwear. The 1st metatarsal bone abnormally angles outward towards the other foot from its joint in the midfoot. A bunion can change the shape of your foot, make it difficult for you to find shoes that fit correctly and worsen the symptoms if left untreated.

Causes

Although it is not clearly understood why bunions occur, possible causes include:

• Family history and genetics
• Arthritis (inflammation of the joints) including rheumatoid arthritis, psoriatic arthritis and gout
• Neuromuscular conditions such as cerebral palsy (affects movement and co-ordination)
• Connective tissue disorders such as Marfan’s syndrome (affects the connective tissues)
• Tight fitting shoes that are too tight, narrow or high heeled.

Signs and symptoms

The main indication of a bunion is the pointing of the big toe towards the other toes of the foot. Other signs and symptoms include:

• Pain and swelling over the big toe that increases while wearing shoes
• Swelling with red, sore and calloused skin at the base of the big toe
• Inward turning of the big toe pushes the second toe out of place
• Bony bump at the base of the big toe
• Sore skin over the bony bump
• Difficulty walking and wearing shoes

Diagnosis

The diagnosis of a bunion by an orthopaedic surgeon includes taking a medical history, and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Your surgeon will usually order weight bearing X-rays (i.e. taken while standing) to access the severity of the bunion and deformity of the toe joints.

Treatment

Your GP may have already initially recommended conservative treatment measures with the goal of reducing or eliminating your foot pain.

Such measures can include:

• Medications for relieving pain and inflammation
• Wearing surgical shoes with a wide and high toe box, avoiding tight, pointed or high-heeled shoes.
• Use of orthotics to realign the bones of your foot and ease pain.
• Padding of bunions
• Ice applications several times a day

Conservative treatment measures can help relieve the discomfort of a bunion, however these measures will not prevent the bunion from becoming worse.

Surgery

Surgery is the only means of correcting a bunion. Surgery is also recommended when conservative measures fail to treat the symptoms of bunion.

There are many surgical options to treat a bunion. The common goal is to realign the bones in the foot, correct the deformity, and relieve pain and discomfort. The surgery is performed as a day procedure, under the effect of a light general anaesthetic and a regional nerve block. When you wake up, you will not be in pain and will be able to walk on your foot straight away.

Minimally Invasive Technique

This is a surgical technique where the operation is performed through very small incisions, only a few millimetres long. This is in contrast to traditional surgery performed through large incisions.

Advantages

Minimally Invasive Bunion Surgery has perceived advantages over open surgery, as smaller incisions are made. Much less soft tissue stripping is required to gain access to the bone in order to make the bony corrections. This may lead to:

• Reduced surgical time
• Less damage to tissues
• Less internal scarring
• Minimal external scarring (no stitches needed)
• Less joint stiffness
• Day case surgery
• Quicker recovery time
• Faster return to work and normal activities
• Possibly a better result

Procedure

The foot is numbed using an ankle block like traditional surgery and you can be awake or asleep, depending on your preference. Several 3 mm incisions are placed around the foot to allow access for the specialist instruments. An x-ray machine is integral to the operation to ensure the instruments are directed accurately, ensuring precise bony cuts and therefore an excellent correction.

A new range of surgical tools, not normally used in traditional open surgery are used and these require a new set of technical skills in order to master the different surgical techniques. This requires training and experience.

Risks and complications

As with any surgery, bunion surgery involves certain risks and complications. They include:

• infection
• recurrence of the bunion
• nerve damage
• unresolved pain and swelling
• Joint stiffness or restricted movement

Post-operative care

Patients should follow all instructions given by the surgeon following the surgery. These include:

• Keep your dressings dry and leave them in place until your next outpatient appointment.
• Minimise walking where possible.
• Elevate the foot to minimise swelling as much as possible for the first 6 weeks.
• You will have to wear specially designed post-operative shoes to protect the wounds and assist in walking
• You may not be able to wear regular shoes for 6 weeks