Bunion surgery will be carried out under general anaesthetic. During the surgery your big toe will be straightened by breaking the bone and repositioning the toe. The medical term for this is an osteotomy. There are various ways of doing this but, in general, a cut is made over the abnormal toe joint and the bony lump on the side of the joint is removed. A bone in your foot is cut and your toe moved into a better position. The bones are generally held with a screw or special staple until they heal together. The skin wound is then closed with stitches. You may need a separate cut between your first and second toes to help the correction and if required the second toe will be straightened.
There are a number of different approaches to osteotomies. In the majority of cases, Mr McKinley uses a ‘scarf osteotomy’. This is an osteotomy first used in the 1980s and popularised in France by Mr Louis Barouk. It is a versatile, stable technique, and restores foot biomechanics allowing good range of movement and low recurrence rates. Mr McKinley learnt this technique during the year he spent in Australia as a Foot and Ankle fellow and has been using it in his NHS practice almost exclusively since 2005.
If you are a smoker, you should try to stop as smoking increases the risk of wound complications after the operation. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation.
You will have some local anaesthetic injected into the foot or at the back of the knee at the time of the surgery and this will help to relieve some of the initial pain. Occasionally a nerve block may last 24 hours or even longer. You should start taking regular analgesia as soon as the local anaesthetic starts to wear off.
For the first seven to ten days it is important to take things as easy as possible, you should rest with your foot up as much as possible – this helps to reduce the swelling and therefore the risk of wound problems. Most patients require regular analgesia for the first couple of weeks.
The initial dressing is sterile and in most cases should be left untouched until wound check at around 10-14 days. However, if the dressing gets wet, if there is excessive leakage, if the pain gets worse or if the dressings start to smell you should arrange for a dressing change.
Possible Risks or Complications
As with any operation under general anaesthetic there is a very small risk of complications related to your heart or lungs. The anaesthetist will assess you before the operation
Wound healing problems are more common in the foot than in other parts of the body as a result of the blood supply. Generally any wound infection can be treated with simple antibiotics and dressings as long as the infection does not get into the deep tissues.
The bone is generally united by six weeks, although this can take longer, and in rare occasions this can result in loss of position or failure of the metalwork. Swelling can be prolonged. Generally the foot will fit into normal shoes by three months, but this can take much longer.
At the end of the surgical procedure the position of the toe should be greatly improved as planned, but in a small percentage of patients the toe can drift back to varying degrees.
Many patients describe nerve-type pain in the first few weeks which they describe as burning or small electric shocks. In about one in 1000 this may be permanent and a condition called ‘complex regional pain’ develops. This is very difficult to treat and may result in intractable pain.
However, it should be remembered that these complications are uncommon and most people are very satisfied with the surgical outcome. What’s more, most people are able to return to work at around six weeks and those in mainly sedentary jobs often return earlier. Generally, it takes at least up to three months to achieve full recovery and to get back to all pre-surgery activities.