Bunion Surgery the Minimally Invasive Way

We have them or we’ve seen them but often don’t know what they are or what they are made of.

A bunion (hallux valgus) is a very common foot/big toe deformity. It is often referred to as a bony bump on the joint at the base of the big toe. It forms when the pressure of your body weights falls unevenly on the tendons and joints of the feet. This makes the big toe joint unstable and causes the big toe to deviate inward and push against the second toe. This unnatural position eventually causes parts of the big toe joint to mould into a hard knob that sticks out. It can look alarming because the skin can sometimes turn red and look painful and sore.

In more severe cases, the lesser toes (second to fourth) may end up being deformed as well, leading to other deformities such as overriding or clawed toes. There are many causes for bunions, and the more established ones include genetic and biomechanical factors.

Bunions result in pain and deformity, and instability of gait. They may also lead to other further problems like pain in the mid/hind foot or ankle.

Ageing, an inherited structural or congenital deformity, stress or injury to the feet and medical conditions such as rheumatoid arthritis are all linked to bunions. For every male who suffers with a bunion, there are 4-5 women.

Opinion is divided on whether wearing tight, narrowcut shoes causes bunions or contributes to them developing.

When surgery is required

When the bunion causes pain or when the other toes start becoming affected/deformed, it is time for corrective surgery.

Traditional surgical correction for bunions used to involve open methods, with large and unsightly scars. These resulted in greater pain, higher risks of bleeding and infection, and of course, larger and unsightly scarring.

Minimally invasive surgery (MIS) or percutaneous correction of bunions or other deformities of the toes can be performed on patients with mild to moderate bunions. This approach results in less pain, has a lower risk of infection and bleeding, and a much more cosmetically acceptable wound/ scar. However, if the deformity is severe and there are other associated deformities, open surgery may be required.

MIS surgery for bunions is performed using specialised foot and ankle MIS instruments. The procedure takes about 30-45 minutes, and patients are able to fully bear weight or walk the next day with a special post-operative surgical shoe.

Stitches are removed 10-14 days after surgery, and the patient has to be monitored regularly post-surgery to allow proper management of the wounds and foot. This is to ensure that as ideal a position of the big toe as possible is achieved. As the procedure involves an osteotomy (cutting of bone), it takes about 6-8 weeks for complete union of the osteotomy. Patients will also be given the appropriate post-surgical medication, including antibiotics, anti inflammatory and analgesic medication. Post-surgical physiotherapy is also usually recommended.