Bunions have caused pain in feet since feet themselves existed! They are also known as hallux valgus or big toe pointing outwards. They affect women more than men and can present at any age group.
What are bunions?
They are the result of the big toe or great toe moving towards the outside of the foot or laterally. At the same time, the main long bone of the foot known as the first metatarsal moves inwards towards the inside of the foot. The end of this bone or head as it is scientifically known starts to put pressure on the skin from the inside and this in turn rubs on shoes from the outside. Overall the skin can become red and thickened and in response to the rubbing and unfortunately very painful.
What causes bunions?
This is an age old question and often footwear has been blamed – especially narrow or pointy shoes. It’s now well recognised that bunions are indeed passed down from generation to generation. Occasionally they skip a generation and very rarely a patient cannot point to a family member with bunions from memory. In the later stretchy tissue and biomechanics are to blame. Unfortunately we cannot do anything about what we inherit but we can seek advice on how to treat bunions.
How can you treat bunions?
With early or mild bunions some footwear modification can help. There is a limit to the width of shoes they we can buy and walk in comfortably though. No splinting and toe separators works to stop bunions. No medication can stop or prevent bunions. No insoles can generally help with bunions. The pain from a bunion is mainly from the bump and this must be addressed. Keyhole bunion surgery is often recommended for this.
What is the difference between keyhole bunion surgery and open bunion surgery?
Keyhole bunion surgery performed by an experienced fellowship trained orthopaedic surgeon allows for many and several key benefits over open surgery. The smaller scars in keyhole bunion surgery amount to under twenty percent of most open surgery scars. The bigger the scar the greater the risk of infection hence the risk is decreased in keyhole or minimally invasive bunion surgery utilising several small cuts instead.
Less soft tissue is disrupted in keyhole bunion surgery which contributes to it being less painful than open surgery. This in turn helps with early walking and stretching exercises specifically for the toe which allows for a more rapid recovery. Also as less soft tissue is disrupted there is less swelling compared with open surgery which again allows for a more rapid recovery and less pain associated with swelling.
What is keyhole bunion surgery?
This is also known as minimally invasive bunion surgery (MIS) or minimally invasive chevron Akin bunion surgery (MICA). It utilises several very small cuts to access the bone around the bunion and cut them (osteotomy) and shift them.
The cut bones are held with small specially crafted screws again passed through very small cuts. The bump of the bunion is much smaller after it is cut and shifted but is made smaller and less prominent still by shaving prominent bumps off using one of the very small or keyhole cuts. In open surgery the bone to be cut is accessed through a much larger cut which cuts through all layers of tissue around the bone all the way down to bone along the length of the cut.
As described this does indeed cause more pain a bigger and more expensive cut is used. This usually goes on the inside of the foot along the length of the great toe metatarsal and up half on the big toe itself. The open surgery scar is much bigger than the collection of small incisions used in keyhole bunion surgery
When is the right time to have bunion surgery?
The right time to see an orthopaedic foot and ankle surgeon is when the bunion causes pain. The bunion can get worse with time and cause more pain. If left it is more of a challenge to have a bunion operation on.
Can a bunion get worse?
Bunions can get worse as the pain of an early bunion is from rubbing on the skin as the toe moves out of place. If left the joint can wear can arthritis can affect the joint which causes more pain. As the big toe moves over the second and sometimes third toe can be affected with pain and deformity. In severe cases these toes can dislocate.
As the bunion gets worse less weight is put through it and more weight goes through the other long bones of the foot known as lesser metatarsals. This can result in transfer metatarsalgia which feels like walking on stones or pebbles. It can be treated by shortening these bones.
If caught early however most of these problems can be avoided.
What’s the recovery time with keyhole surgery?
After surgery, you will be advised to walk immediately afterwards with crutches for balance and support only. A special soft post operative bandage in a sterile setting in the operating theatre will be added and this should be kept on and removed by the Consultant at two weeks.
With open surgery often bandages and sometimes plaster of Paris and large waking boots are used for six to eight weeks.
With keyhole surgery, you will be back into a normal stretchy training shoe at the two week follow up for up to four weeks.
It is advised that comfortable elevation around light duties and activities in the first two weeks but encourage keeping active within sensible limits.
From two weeks, stretching exercises will be given to you and increased at four weeks. This promotes a nice supple joint and is part of the rapid recovery from keyhole bunion surgery (minimally invasive bunion surgery).
Who should do my bunion surgery?
I advise being seen by an orthopaedic surgeon who specialises in foot and ankle surgery alone. As an orthopaedic surgeon we are medically qualified and surgically trained and further qualified. Our training is completed with rigorous fellowship training. Minimally invasive surgery/keyhole bunion surgery should only be performed by fellowship trained orthopaedic surgeons with good fellowship exposure as advised by NICE.
About Kumar Kunasingam
Mr Kunasingam qualified in medicine from Guy’s and St Thomas’s medical school with degrees in medicine (MBBS) and intercalated in genetics and experimental pathology (BSc(Hons)). He taught anatomy at Guys after completing his house jobs and underwent specialist basic surgical training (BST) on rotation through Brighton and Haywards Heath attaining his further qualification in surgery from the Royal College of Surgeons England (MRCS).
He was selected for higher surgical training and rotation through London, Kent, Surrey and Sussex attaining his ultimate surgical qualification in trauma and orthopaedics and becoming a Fellow of the Royal College of Surgeons England (FRCS Tr&Orth).
He subsequently also qualified with a Dimploma in Orthopaedics from the University of Brighton and a Diploma in Sports and Exercise Medicine with the Royal College of Surgeons in Edinburgh. His fellowship training was in Sydney, Australia in all aspects of foot and ankle surgery with minimally invasive, sports surgery and major trauma with patients being flown back for repatriation to the major trauma centre at the Royal North Shore Hospital from all over the state of New South Wales, Australia.
Subsequently he also did a trauma fellowship at the major trauma centre at King’s College London before taking up a substantive post as a consultant in NHS and private practice.