The Goal of bunion surgery is to remove the painful bump, straighten the toe and prevent recurrence.
The principle is to mechanically align the bones appropriately. There are multiple different techniques to achieve this.
Not one procedure can effectively cover all Bunion types, whilst some are more suited to dealing with a particular deformity. Bunion surgery has been associated with a recurrence, and this is usually as the mechanics of the deformity have not been addressed.
Mr Shepherd utilises different surgery techniques for an individual patient.
- Minimally Invasive Bunion Surgery.
- Open Scarf – Akin Bunion surgery
- Fusion including a Lapidus fusion.
To asses this a CT scan may be required to determine the mechanical alignment and rotation of the foot. All of these procedures can be performed as day cases, and allow walking on the flat of the foot in a surgical shoe.
Minimally Invasive Bunion Surgery.
Essentially Minimally Invasive surgery involves 2-3 mm incisions and specialised ‘burrs’ to make cuts in bone ‘osteotomies’ that are performed under X-ray or Fluoroscopic guidance. Once the mechanical alignment has been achieved the construct is secured with screws.
Minimally invasive surgery has the benefits of small incisions, dealing with large deformities and bunions with rotation. They are inherently a less stable type of bone cut, that relies on the strength of the screws, and can shorten the 1st toe bone.
Scarf- Akin Procedure
This is an open procedure with an incision along the inside of the forefoot. A popular surgical technique worldwide, with precise open bone cuts, it is a very stable construct, that is particulary good at dealing with translation, and preventing shortening. They are less effective in dealing with large rotation. Once the bone alignement has been corrected the construct is fixed with small screws and a stabilisation of the soft tissues is performed.
1st Tarsometarsal Fusion – Lapidus procedure
This fuses the joint above the bunion in the Midfoot, the Tarso-Metatarsal joint. This is an open procedure, and very effective procedure for dealing with large deformities, large rotational deformities and in particular patients with ligament laxity or hypermobility in whom a Scarf-Akin or a Minimally Invasive procedure may have a high chance of bunion recurrence. It has the benefit of being a very powerful and stable way of dealing with deformity. Once performed the construct is held with a plate.
Surgery can be a day case or an overnight stay, and appropriate analgesia is provided to take home. Initially there is a 2 week period of elevation to allow swelling settle. Immediate weight bearing is possible in a post-operative stiff soled shoe. In general it is possible to move to a comfortable running shoe from 4 weeks, however swelling can take 6-8 weeks to settle, and up to 3 months before fully consolidated. Massage and range of motion activities and progressive mobilisation commence from the 2 week period.
The risks and complications will be assessed and discussed with you. There is a small risk of infection, wounds healing issues, and numbness or sensitivity in the skin or scar. Specifically for bunion surgery there is up to a 5% chance of recurrence of the deformity, overcorrection of the big toe, or problems with bone fixation or bone healing. Conversely, a successful outcome is achieved in more than 90% of patients.