Bunion Operation


What is a Bunion Operation (Hallux Valgus correction)?

A bunion is a painful bony prominence on the inside (medial side) of the ball of the great toe joint associated with the great toe deviation and rotation. Hallux Valgus correction is performed to re-align the great toe and reduce the bunion prominence and narrow the foot. The surgery consists of osteotomies - cutting and resetting the bone - and is performed when the toe is chronically painful and interferes with everyday activities and shoe wear. The osteotomies are called SCARF and Aiken osteotomies, and when the bones are re-set one bone is held with two screws and the other with a staple. These are both very low profile and will not require later removal.

What are the risks of a Bunion operation?

The Hallux valgus correction surgery is a quick and effective operation. The majority of surgeries go very smoothly without any major complications.

There may be a degree of pain for approximately 2 weeks. Persisting pain is very uncommon.

Commonly, patients experience swelling around the osteotomies, which can take several weeks to settle. Occasionally patients can experience some transient numbness around the incision. Some stiffness of the great toe joint is common though the flexibility returns gradually after normal walking starts at six weeks. Physiotherapy following surgery is generally not required

  • Serious complications such as infection and blood clots are very rare.

  • Non- union or delay in healing is a very rare but a possible complication. It occurs more frequently in smokers and diabetics.

  • Recurrence of the hallux valgus or bunion is possible but generally not as severe as it was initially.

  • Pain may persist if there was also a degree of arthritis in the joint prior to surgery.

How long does the Hallux Valgus surgery take?

An uncomplicated stabilisation takes about 60 minutes to perform. There are 2 incisions – one on the inside of the foot and one in the 1st webspace.

Generally it is performed as Day Stay Surgery and you may go home the same day as your procedure.

You will need someone to drive you home, and a responsible adult to be with you overnight as you may still be sleepy and require oral pain medications.

What Happens on the day of surgery?

DO NOT EAT OR DRINK from midnight, unless otherwise instructed.

Dr Schluter will meet with you, answer any further questions, check the consent form and mark the operative leg. You will also meet the anaesthetist (specialist doctor) who will be providing the anaesthetic. In most cases the procedure is done under a general anaesthetic. An IV line (drip) will be inserted and you may be given some

What should I expect immediately after the operation?

After the operation you will go to the recovery room where nursing staff will monitor you until you are awake. You are likely to have a cast over your forefoot made of plaster of paris to keep the forefoot immobilised. You can put weight on the heel but do not put any pressure through the great toe. You will be supplied with crutches for balance.

As you wake up you will notice the foot is completely numb due to the local anaesthetic that is used for pain relief (ankle block). This will wear off after about 8-12 hours when the incision site will start becoming uncomfortable and this is when you start taking the prescribed pain relief. Once you are alert, you will be encouraged to get up and mobilise slowly. Once you can mobilise safely you will be ready for discharged home.

What follow up should I expect?

Dr Schluter will review you at a follow up appointment 1- 2 weeks after your surgery. He will review your wounds and remove any sutures that are not dissolvable. You will be able to discuss the procedure, update work certificates if required and get an estimate of the time to recovery.

How do I look after my ankle when I get home?

For the first 14 days it is very important to elevate the foot when you are resting. Rest is important to allow the swelling and inflammation to settle. Take the pain relief medication regularly as prescribed.

Because it is immobilised in the cast, the foot should not be too painful. You cannot get the cast wet so when showering, so you will need to cover it with a plastic bag and tape it securely. There may be some bruising and swelling and occasionally some bleeding visible though the cast. This will occur in the first 3 days and stops with elevation and will not require a cast change.

Generally you will have the cast removed, dressings changed, wound checked, strapped with a Coban bandage and fitted into a Darco surgical sandal at the first clinic appointment. You can continue to weight bear through the heel in the Darco sandal for 6 weeks after surgery. You can shower out of the sandal but continue to cover the foot with a plastic bag. The Coban bandage can be removed at 4 weeks after surgery and the wound can be left uncovered in the shower if it has healed well.

With the exception of showering, leave the Darco sandal on at all times (including in bed at night), until instructed to take it off at 6 weeks post op. An Xray is taken at this stage to check on the healing of the osteotomies.

You cannot drive with a Darco sandal on the right foot. You can drive with a Darco sandal on the left leg if you have an automatic car after 3-4 weeks post surgery, but it is not recommended for long trips. Avoid flying for the first 6 weeks if possible because of swelling and risks of blood clots.

My foot is still swollen, is this normal?

It is quite normal to have swelling for 12 weeks after the operation. This will slowly resolve with time.

If you are concerned about any of these symptoms please discuss them with Dr Schluter at the clinic visit.

What if I have concerns after my surgery?

Please do not hesitate to contact Dr Schluter’s rooms or your GP if you develop any of the following:

  • Heavy bleeding through the cast.

  • Sudden severe pain or tenderness at the wound site or in the joint.

  • Swelling in the calf or thigh, especially if associated with pain or heat

  • Redness around the incision that continues to spreads.

  • Temperature higher than 38.5 °C (fever) or chills.

  • Any concerns you may have regarding your recent surgery