A bunion is a bony and soft tissue prominence situated at the bottom of the great toe and associated with outward deviation of that great toe and is medically called a hallux valgus.
Over time, the deformity usually steadily increases, can cause secondary problems in the lesser toes and patient will start to also develop degenerative change in the great toe joint and between the ball of the great toe and the small underlying sesamoid bones which act like miniature knee caps beneath the big toe.
This is continually evolving and up to one hundred different types of operation for correcting bunions have been described, however most surgeons now carry out a Scarf or modified Scarf type osteotomy. This involves either a general or regional anaesthetic, a longitudinal cut along the inside of the great toe following which the bony soft tissue prominence is removed. Then a “Z” shaped cut is made through the neck and shaft of the bone which supports the great toe to allow the treating surgeon to slide the bone back into the correct anatomical position and then secure it with screws. Following this any further bony prominences are removed, a soft tissue correction to tighten the stretched structures on the inside of the great toe is performed and the wounds are closed.
A large pressure dressing is worn for two weeks, the operation is normally performed as a day case and patients are able to weight bear the day of surgery although for the first two to three days are recommended to maximally elevate the foot. Fourteen days from surgery, patients come to clinic for a wound check and suture removal, at that point switching over to loose footwear such as large trainers. At six weeks an X-rays is taken to make sure that union has occurred and at that point a gentle physiotherapy programme is commenced.