Hallux Valgus (Bunion)

Hallux valgus is due to lateral deviation of the big toe leading to the development of a bunion- a bump on the side of the foot at the base of the big toe. The bump is made up of a prominent bone (the 1st metatarsal) and thickened skin and tissues around the prominent bone.


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Corns and calluses may develop over the bunion, the big toe and the second toe due to pressure from the footwear.


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Surgery for Bunions

Once a symptomatic hallux valgus fails to respond to conservative measures, surgical treatment is usually considered. In the past a ‘one-technique-fits-all’ approach was commonly used by many surgeons and the patients had to endure weeks on crutches and in casts. Not surprisingly the results of surgical correction have often been unpredictable with patients complaining of residual pain & deformity both in the hallux and the lesser toes, giving rise to a relatively poor reputation for bunion surgery.


Modern Surgery

Over the last decade foot & ankle surgery became more modern and reliable as increasingly these procedures are performed by surgeons that received subspecialty training. As a result, a more individualized surgical approach to the bunions has been developed, including the use of new techniques such as the ‘Scarf metatarsal osteotomy’ and ‘modified Chevron’s osteotomy’. These techniques provide opportunity to correct all degrees of deformities in all planes. It is possible to provide a more stable internal fixation allowing early and full mobilisation without casts possible in most cases. Additional operations such as a lateral soft tissue release or a phalangeal osteotomy (Akin) are now often used to improve the correction depending on the individual features of the deformity.


Anaesthesia

Depending on the patient’s preference anaesthetic techniques vary from general anaesthesia to regional blocks that also allow excellent postoperative pain relief. The procedure can be done as a day-case or overnight stay.


Post-operative management

  • The foot is wrapped in a bandage to control swelling and provide support.
  • It is necessary to elevate leg to reduce post-operative swelling.
  • Plaster immobilisation is not needed in most cases.
  • Most patients can commence immediate mobilisation.
  • A special hard-soled postoperative shoe is usually required for about 4-6 weeks.