Hallux Valgus (bunion): innovation in surgical techniques


This page is continually updated to include the latest case studies, and includes the answers to the most frequent questions and doubts -FAQs- about bunions

What is a bunion (Hallux Valgus)?

A bunion is a deformity of the first, or big toe of the foot caused by the head of the first metatarsal, the long bone which precedes the phalanges moving outwards. It appears as a bony protrusion, commonly called bunion, which is often only obvious in the advanced stages. The main symptom is the pain, which may lessen only to subsequently reappear.

Is it possible to prevent a bunion?

In order to prevent a bunion forming, care should be taken in the choice of shoes you wear and you should check your feet often. We recommend using comfortable, soft leather shoes, with a broad toe and with a heel no higher than 4 cm.

What causes bunions?

The main causes of a bunion can be divided into two types: congenital or acquired. Congenital causes when the bunion can be traced to the shape of the metatarsal head, to hereditary factors or connected to the anatomy of the foot. Instead, when external factors influence its appearance, then it is considered as acquired. Uncomfortable footwear with narrow sole and high heels is the principal causes of an acquired bunion.

What role do shoes have in the appearance of a bunion?

Wearing incorrect footwear causes the bunion to get worse. It is always best to avoid shoes with a narrow toe, because they cause excessive pressure on the toes, which moves both the first and fifth toes towards the centre, thus compressing the other toes. This compression increases even more when the shoes have a high heel, since the weight of the body automatically shifts forwards to the front of the foot. Very rigid shoes can hinder the natural flexion of the toes as you walk, thereby weakening your foot muscles and facilitating the appearance of deformities.

How is a bunion diagnosed?

A bunion is diagnosed via a bilateral X-Ray of the feet whilst standing. If the x-ray reveals a bowing of over 8-10o (which is considered physiological) then it can be considered as Hallux Valgus. The orthopaedic surgeon will evaluate the patient’s exact condition during the consultation and decide the necessary therapy.

Which test results should I bring to the initial consultation?

You should bring a bilateral X-Ray of the feet in a standing position to the initial consultation. The X-rays should be of both feet, even though the bunion is suspected in only one foot.

How can I resolve the problem of a bunion?

There are conservative treatments and/or surgery, which is more challenging.
When the bunion first appears, conservative, non-surgical precautions can be taken to slow the development of the condition. When the defect is slight, reddens occasionally and is only provoked by some types of footwear, you can choose suitable, broad, very soft shoes and also use bunion pads to separate the toes. A valid instrument, which serves to slow the deviation of the Hallux Valgus, is a corrective plantar, which can restore the correct orientation of the axis of the heel and contrast the insufficiency of the subtalar joint.

What are the techniques used to operate on a bunion?

There are approximately one hundred surgical techniques used to correct a bunion (Hallux Valgus). However, these techniques can be grouped into three main types:
TECHNIQUE 1: operations involving greater or lesser surgical foot wounds. The aim is to expose it, so all the necessary corrections on that particular section can be performed and then stabilised with metal fixtures.
TECHNIQUE 2: mini-invasive procedures are carried out using percutaneous techniques (small keyhole incisions). Once completed, metal fixative devices are used to stabilise the corrections.
TECHNIQUE 3: operations using mini-invasive, percutaneous techniques without the final use of metal fixative devices. Instead, bandaging resolves or reduces many of the problems faced by “open” surgery, as it reduces possible complications and simultaneously improves and shortens the post-surgery recovery process.

What is meant by the “PBS Procedure to treat Hallux Valgus”?

Over the years, the PBS team has refined a course of treatment for Hallux Valgus or bunion, which accompanies the patients from the initial consultation and guides them in the choice of the best solution (THERAPY or SURGERY) based on the condition and the physical and biological characteristics of each individual. The PBS approach to Hallux Valgus should not be identified exclusively with surgery. On the contrary, it stretches from before to after surgery in order to guide the patients towards full physical and biological recovery. See the page dedicated to the “PBS Procedure to treat Hallux Valgus

What problems will a non-treated bunion lead to?

A bunion is due to a deformation of the first, or big toe, which leads to a new position of the joint and which, in turn, makes the person walk incorrectly to try to avoid feeling pain. The risk is, therefore, to adopt incorrect postures, which lead to further problems in the spinal column.
In practical terms, the bony protrusion takes up space in footwear and requires the use of particularly comfortable shoes, which often have to be made to measure, so as to prevent the other toes from being squeezed and pushed one on top of the other.

What happens during surgery?

The steps in the operation carried out by the PBS team are: local anaesthesia of the foot, washing and disinfection, surgical correction, dressing and functional bandaging, placing the foot on the floor. For a description of the various steps of the operation, please see the page detailing PBS surgery to correct Hallux Valgus (bunion).

What should I bring when admitted to the clinic for the operation?

When you are admitted, you will need to bring your x-rays, any prescription drugs, your GP’s report on any current therapies and conditions, the referral for surgery, your health documents and identity document. For all pre-surgery information please consult the page “pre-surgery information”.

What happens after bunion surgery?

Once keyhole correction of the bunion has been completed, the foot can immediately be placed on the floor and you can start walking gradually. We recommend patients follow the specific instructions the doctors will give you at the end of the operation for the type of surgery they have carried out. Some general information can be found in the “post-surgery information” page.

Is the operation painful?

The operation is carried out under local anaesthesia, the effects of which usually last for some time, thus preventing pain. It is important to avoid ischemic bandaging during surgery, as any interruption of the blood flow will cause pain when the anaesthesia wears off and prevents accurate haemostasis.
Approximately 30% of our patients do require any painkillers. However, if you do feel pain caused by the operation, just take paracetamol or other similar analgesic.
The “post-surgery information” page contains further useful advice regarding pain.

Is the keyhole technique safe?

It is as safe as traditional techniques.

Is it better to operate on one foot at a time or both together?

Generally, we always advise operating on one foot at a time, starting with the most painful.

Is it better to have the operation at one time of the year rather than another?

Every time of year has certain advantages. The recovery of foot functions can be facilitated by walking. In winter, the cold helps to reduce the oedema and the convalescence period. We recommend choosing a time of year, which is quieter on a personal, family and work level, so as to be able to go through the rest period without worries.

What shoes will I be able to wear after the operation?

On leaving the operating theatre, a special orthopaedic shoe needs to be worn. Once the period of convalescence has come to an end, there are no limitations on the choice of shoes you can wear.

Will I need physiotherapy after surgery on my bunion?

You won’t need physiotherapy. We recommend you walk immediately after surgery, so your joints move normally.

How long do I need to wait after the operation before I can drive?

You can walk immediately after the operation with a post-surgical shoe specifically designed for this purpose. However, before driving, we recommend waiting until you can wear a comfortable shoe instead of the post-surgical shoe and even then, only if you feel you are ready and in good health.

Can the bunion reform after the operation?

The so-called recurrences were very frequent when plastic surgery using soft tissue was used to correct the Hallux Valgus. Today, the techniques currently in use are based on the geometric correction of the deformation and it is far less likely to reappear, although it is not impossible. It is fundamental the technique is carried out correctly by an expert to ensure a successful result.