Bunions(HalluxValgus)Bunionsareacommonfootdeformityofthebigtoe.Theyareoftenaninheritedcondition.Footweardoesnotdirectlycausebunionsbutmaycontribute.Bunionscanoccurinadolescenceordevelopasyougetolder.Thedeformityofabuniontendstoworsenovertime.

Whatsymptomsdobunionscause?Bunionscancausepainfulrubbingoverthebonyprominenceinfootwear.Thismakesfindingfootweardifficultandmaylimitactivities.Theycanalsobeassociatedwithpainelsewhereinthefootduetoalteredweightbearingcausedbythebigtoedeformity.Whatisthenon-surgicaltreatment?Youcantryshoemodificationwithwidershoestolimittherubbing.Splintsandspacersmaybehelpfulwhenworntopreventrubbing.Theywillnotcorrectthedeformitypermanentlyorpreventprogression.Whatisthesurgicaltreatment?Surgeryisthemostreliableandpermanentwaytocorrectyourbunion.Therearemanyoperationsusedforbunioncorrection.TheoperationusedbyMr.CurryistheScarf-Akinosteotomy.ThisoperationthewidelyusedinEuropeandAustraliaandavoidsmanyoftheproblemsassociatedwithotherbunionoperations.

Theoperationcomprises5parts

• Anincisionovertheinsideofthebigtoeismade.Thetissuesholdingthebigtoearereleased.

• Thebonyprominencefromthemetatarsalisremoved.

• Themetatarsalboneiscut(Scarfosteotomy)torealignthejoint.Thisisfixedwith2screws.

• Theproximalphalanxboneisthencut(Akinosteotomy)tocompletethecorrection.Thisisheldwithastaple.

• Thefinalpartoftheoperationistorepairandtightenthecapsulewherethebunionhasstretchedit.Thishelpstopreventrecurrence.

Whatisthesuccessrate?90%ofpatientsachieveasuccessfuloutcomeafterbunionsurgery.

Whatdoestherehabilitationinvolve?

• Youareinhospital1nightforonebunion

• Forthefirst2weeksyoushouldkeepyourfeetelevatedasmuchaspossibletominimizeswelling

• Youareabletobeginweightbearingimmediatelyinastiffsoledshoe.Hisshoeistobewornfor4-6weeks.Thereisnoplasterrequired.

• By6weeksyoucanbeginwearingwideoropenshoesandshouldbecomfortablewalkingaroundyourhouse.

• By3monthsyoucanbeginwearingnormalshoesandshouldbebacktorecreationalwalking.

• Swellingcantake6-9monthstoresolveandtightshoesmaybedifficultforthisperiod.

WhatifIhavebothfeetcorrected?Recoverytimeis50%longerwhenyouhavebothbunionscorrectedatthesametime.Willtheoperationbepainful?Youroperationwillusuallybedoneundergeneralanaesthetic.Toprovideongoingpainreliefyouranaesthetistwillperformanerveblockwhilstyouareasleepwhichnumbsthefootfor8-16hours.Sowhenyouwakeupyouwillhaveminimalpain.Astheblockwearsoffyouwillbegivenoralpainrelief.HowlongwillIbeoffwork?Thisisdependentuponyouroccupation

• Seatedjob 3-4weeks• Standingjob 6-8weeks• Heavyliftingjob 8-12weeks

WhencanIdrive?• Manualcar

o Nodrivingfor6weeks• Automaticcar

o Leftfootnodrivingfor2weekso Rightfootnodrivingfor6weeks

Whataretherisksoftheprocedure?Generalrisksofsurgery• Infectionandwoundhealingproblems• Nerveinjuryandscarsensitivity• Bloodclotstotheleg• Anaestheticproblems• Incompleteresolutionofsymptoms

Specificrisksforbunionsurgery• Stiffness• Recurrenceofdeformity

o 1%chanceperyearo 10%overyourlifetimeo Recurrenceisneverasbadasthe

originaldeformityandoftendoesn'trequiresurgery.

• Underorovercorrectionofthetoe• Painifarthritisispresent• BonesnothealingThisinformationisanoverviewofthemanagementofbunionsandisnotallinclusive.IfyouhaveanyquestionsregardingthispleasecontactMr.Curry’sroomson(03)99286188.