What is a bunion?
A bunion is a general term for a bump of bone. This is most commonly used to describe a bump of bone on the inside of the foot where the big toe meets the foot.
What causes a bunion?
Bunions are not generally caused by poor footwear. Bunions can be inherited and they are more common in women than men. The most common cause of bunions (the medical term for which is hallux abducto-valgus) is when the bone behind the big toe, called the first metatarsal, moves inwards and the big toe starts to move outwards so it is pointing towards the little toe. In effect instead of the toe being attached to the first metatarsal in a straight line the joint becomes deformed and forms an angle.
Are bunions painful?
In most cases the pain is caused by a bunion is from shoes rubbing on the bump of bone. Most people only experienced bunion pain when they wear a shoe that cannot accommodate the bunion. In some cases bunions are painful because the joint is also affected by arthritis which makes it stiff and painful to walk on.
What are the treatment options?
By simply wearing loose fitting shoes which can accommodate the bunion, the pain should stop. Pharmacists can also provide bunion shields or padding which protect the bump of bone. These devices would have to be accommodated in the shoes.
The most permanent treatment for the correction of bunions is by surgery. Over the years many types of operation have developed the majority of which involve either cutting the bone or the joint and realigning them back into their correct position.
The older types of surgery involve putting a foot in a plaster cast for six or more weeks after the operation to allow the bones to set. Modern surgical techniques now allow for the bones to be pinned or fixated using internal screws meaning that plaster casts are no longer necessary. This gives more predictable results to the surgery and allows the patient to be much more mobile far earlier in the post-operative period.
How long does the operation take?
The correction of a bunion by surgery, on one foot takes approximately one hour.
Do I need a general anaesthetic?
Approximately half of the bunion corrections we perform are carried out under local anaesthetic. This involves a series of injections around the ankle which keeps the foot numb during the operation and up to 8 hours after. The local anaesthetic technique may also be supplemented with sedation by administration of a drug which will relax you during the operation and make you feel sleepy. The drug also causes to have no memory of the operation.
Will I have pain after the operation?
The local anaesthetic used during the operation will keep your foot numb for the first few hours after the surgery. You’ll also be given painkillers and anti-inflammatory drugs to take for the first 2 to 5 days after surgery. Most people report that their discomfort is controlled by the medication and some people say they have no pain at all and did not need to take any medication. A small minority of people do have pain requiring stronger drugs which we will provide if needed.
Do I have to stay in hospital?
For the first 48 hours after surgery you will be asked to rest with your foot elevated only getting up to go to the toilet. If you have somebody at home to look after you it would be quite safe for you to go home. If however this is not possible or your house is unsuitable, for example you have lots of stairs, it may be a good idea to stay in hospital for the first post-operative night.
Will I have to have my stitches taken out?
You will leave hospital with a soft dressing around your foot and ankle and a nylon post-operative shoe to walk on. Most of the time we use dissolving sutures in the skin which do not need to be removed but you will come back after approximately one week to have the dressings removed.
When can I wear normal shoes?
After about two weeks post surgery you can expect to be able to wear a strong lace up shoe such as a trainer. You will be able to walk in this to a limited extent. You will also be provided with a set of exercises to undertake regularly to make your big toe joint more flexible. In most cases when internal bone screws are used it takes 6 to 10 weeks for the cuts that have been made in the bone of your forefoot (metatarsal osteotomies) to heal fully. Generally you can expect to be wearing fashionable shoes and returning to sports after approximately 3 months.
When can I go back to work?
This really depends on the type of work you do. If your work is sedentary, i.e. you are not on your feet all day, you may be able to return to work after a week or two. If however you have a job which requires you to stand for long periods you may need to be away from work for longer. Your surgeon will monitor your progress via consultations and x-rays to give you more specific advice tailored to your individual needs.
How many times will I need to come to the hospital?
You will have an initial consultation and clinical examination by the podiatric surgeon to plan your surgery. X-rays of your feet will be obtained to assist this process. Two weeks after you have had your operation you will see the surgeon for the first post- operative review to check your general progress and to have the dressings changed.
You will then be seen again a further four weeks later (six weeks after the operation) when you will have a further x-ray taken to confirm satisfactory progress in bone healing of the operated area.
Will I have to have the screws removed?
The internal bone screws are only useful to hold the bones in position while they are healing. After this they serve no purpose. The bone screws are made of an inert metal and are in most cases left inside the foot as it would require a second operation to remove them. In very rare cases the screws may need to be removed if they start to loosen or the bone around them becomes infected.
How much walking can I do after the operation?
You need to rest for the first two days after the operation and then walk as little as possible for the next two weeks. You will be given very specific instructions on how to look after your foot after the operation and a telephone number to ring if you have any questions. It is very important that you follow the instructions to prevent any complications. In most cases patients are able to walk short distances after two weeks and then gradually increase this over the next month.
Am I too old to have surgery?
Age is generally not a good guide to deciding whether an operation may take place. Your general state of health is a more important factor in deciding whether an operation may be indicated.
What if I need some advice after the operation?
You will be given contact telephone numbers to call if you need any information.