Bunions - Hallux Valgus Treatment
How can bunions be treated?
Surgery should not be considered the only treatment. Although modern surgical techniques are generally very successful and the recovery period is not prolonged as it was in the past all surgery has inherent risks. For this reason we always advise a trial of sensible conservative (non-surgical) treatments in the first instance. The suitability of these for you is very much decided on a case by case basis and vary with the associated severity and cause of the bunion itself, any associated pathology such as Achilles contractures, medical problems and lifestyle choices.
The simplest measure that should be undertaken is to use shoes that are flat(ish), wide, soft and comfortable when you are likely to be on your feet for prolonged periods. The good news is that for many this is all that is required.
Those with flat feet or who over pronate the foot when walking often put more pressure over the bunion when walking. In this situation a simple in shoe orthotic or arch support can be very useful.
Those who are found to have a tight calf muscle or heel cord (Achilles tendon) frequently overload the forefoot when walking. Physiotherapy to stretch out the calf can then be very useful in getting rid of pain and returning function.
In addition to this a variety of pads, spacers, splints and modified or even bespoke surgical shoes exist. These are most suited to those who are less active and have multiple medical problems which can make surgery higher risk.
The purpose of surgery is to improve pain and function. This is achieved by correcting the deformity, narrowing the foot and improving the biomechanics (structure and function) of the foot. There are well over two hundred different types of surgery described to correct bunions. Mr. Al-Nammari has published on a new surgical technique to correct severe bunions and offers the full range of modern treatments. The best procedure for you depends on many factors and in particular the nature and severity of the deformity. Most procedures involve releasing the tissues that are too tight, reinforcing those tissues that have become too lax and creating surgical cuts thru the toe bones (osteotomy) enabling the bones to be shifted back to their original positions thereby correcting the deformity. The cut bones are held with metal implants- generally a type of low profile screw.
These operations are fairly small procedures and only take approximately 45 minutes to be performed. They can be undertaken as a day case under local anaesthetic block making the foot numb for six to twelve hours. You will be seen by an Anaesthetist and can be awake, sedated or have a general anaesthetic during surgery. It is possible to walk straight away after the operation with just a special shoe. There is no need for a cast or prolonged immobility with modern surgical techniques.
Mr. Al-Nammari undertakes the majority of his private operating at The Nuffield Hospital in Ipswich. Using the latest techniques in local anaesthetic blocks means that most people having surgery are comfortable enough to get home on the day of surgery should they so wish. For those who need to or just feel more comfortable spending the night in hospital after surgery this is of course possible. The choice of anaesthetic is based upon your own preferences and the opinion of the Consultant Anaesthetist who you will meet before any surgery. Many people prefer to be asleep during surgery and have the local anaesthetic block performed while asleep to control any post-operative pain.
When can i return to work after surgery?
This will depend on the type of work you do:
- Sedentary jobs: Return after 2 weeks, if able to maintain foot elevated at level of waist, otherwise 4 weeks off.
- Standing/walking jobs: Return after 6 weeks, but may be sooner depending on comfort and swelling.
- Manual/labouring jobs: 8+ weeks, but may be sooner depending on comfort and swelling.
When can i drive after surgery?
The DVLA state that it is the responsibility of the driver to ensure they are fit and able to stay in control of their vehicle. A good guide is if you can stamp down hard with the foot comfortably and are able to perform an emergency stop then you may be ready to drive. For left sided surgery in an automatic car i.e. no clutch is required, driving is probably safe at 2 weeks after surgery. For right sided surgery or a manual car, driving is probably safe at 6 weeks after surgery, once in a normal shoe. If you are unsure please ask Mr. Al-Nammari. It remains your responsibility to drive safely and you should check with your vehicle insurer to confirm you are covered.