Bunion Surgery (Scarf Osteotomy & Minimal Invasive Surgery)
Hallus Valgus SCARF
This operation is for painful or severely deformed bunions. It involves shaving the prominent bone and realigning the bones with an osteotomy (cut) of the metatarsal combined with a repair of the joint capsule and ligaments. This will produce a narrow foot and a straighter hallux (big toe). There may also be simultaneous surgery performed on the lesser toes, if indicated.
The capsule repair must be protected with the specialised dressing for 2 weeks and the osteotomy requires protection in the post operative shoe for 6 weeks
Elevation of the foot (above the pelvis) for the first 10 days is vitally important to prevent infection. Naturally, small periods of walking and standing are necessary.
This type of operation and the post operative shoe allow weight bearing (walking) immediately. Often this may be too uncomfortable for the first week. Crutches are usually necessary for the first for 4-6 weeks.
The surgery is routine, but the recovery is prolongued and swelling is the last feature to recover. Often shoeware will still be tight at the 6-week stage and it will be 3-4 months before walking is comfortable.
Hallux Valgus MICA
This operation is for painful bunions. It involves keyhole surgery to realign the bones (metatarsal and phalanx) combined with release of tight deforming ligaments and tendons. This will produce a narrow foot and a straighter hallux (big toe). There may also be simultaneous surgery performed on the lesser toes, if indicated.
The surgery is usually performed as a daycase under general anaesthesia. The operation is performed with a special burr through 4-5 small incisions.
The foot must be protected in a requires protection in the post operative shoe for 6 weeks.
Elevation of the foot above the pelvis (45 mins/hour) for the first 7 days is vitally important to prevent infection.
Naturally, small periods of walking and standing are necessary.
This type of operation and the post operative shoe allow weight bearing (walking) immediately. Often this may will be uncomfortable for the first week and crutches are usually necessary for the first for 2-4 weeks.
The surgery is routine, but the recovery is prolonged and swelling is the last feature to recover. Often shoeware will still be tight at the 6 week stage.
Driving is possible after 4 weeks, without the post-operative shoe. It will be 3-4 months before walking is comfortable and 5-6 months for running.
Risks of surgery
Stiffness & swelling
Initially the foot will be swollen and needs elevating. The swelling will disperse over the following weeks & months but will still be apparent at 6-9 months. The toe will be stiff but will normally regain its original movement.
There is always a risk of infection with surgery. You will be given 1 dose of intravenous antibiotics during surgery. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for 7 days. If there is an infection, it normally resolves with a course of oral antibiotics.
A nerve supplying the skin on the side of the toe is at risk of damage. Usually it is just bruised and will recover. If the damage is permanent, it will leave a small patch of numbness. This does not normally cause any disability.
Occasionally, the deformity of the toe is not wholly corrected. This is more common in severe cases. Rarely, this is problematic and requires further surgery.
Very rarely, the toe can be over-straightened so that it angles away from the foot (hallux varus). This is a rare complication and usually requires further surgery.
Recovery from surgery
For the first few days, the more time you can spend with your leg elevated, the better, but you will be free to go home as soon as you have recovered from the anaesthetic and feel comfortable.
- Discharge when safe and comfortable
- Mobilise fully weight bearing in post op shoe for 6 weeks
- Dressing to remain undisturbed for 2 weeks.
Activity and time off work
In general, up to 4 weeks off work is required for sedentary posts such as office work, 6 weeks for standing or walking posts, 8 weeks for manual / labour posts.
- 2 weeks for removal of sutures
- 6 weeks in Mr Rosenfeld's clinic - weight bearing X-ray
- 3 months for final review