Hallux Valgus Correction

Surgery involves correction of the bones to re-align the forefoot and improve biomechanics. This involves cutting and moving the bones (osteotomy) to remove the painful bump and straighten the toe.

The most common procedure utilised for bunion correction is an osteotomy of the phalanx and metatarsal bones. This is a stable operation that allows immediate weight bearing in a flat, stiff soled shoe. This is appropriate for those cases where translation is the primary problem, it is less effective at correcting a large rotation problem.

The operation is performed via an incision over the inside of the foot (medial incision), the tight soft tissues pulling the toe are released, the bones are cut with a saw, position of the bones improved and then they are fixed in place with headless screws that sit inside the bone. The soft tissues on the inside of the foot are tightened to assist in correction. X-ray guidance is used throughout the procedure to ensure alignment is excellent.

Figure 1: post-operative Xray showing correction obtained by an open bunion correction (Scarf-Akin)

Success rates: 90-93% of patients have a successful outcome with this procedure

Post-operative

  • Surgery is a day-stay or overnight.

  • A block of the foot is performed to help with post-operative pain.

  • 0-2 weeks: elevation at home to reduce swelling

  • 2-6 weeks: walking on the flat of the foot in a stiff soled shoe

  • 6-12 weeks: walking in a comfortable shoe, focusing on heel-toe walking

  • 12 weeks onwards: strengthening and return to full activity

Download post operative care guide

 

Risks of surgery

  • Swelling, stiffness

  • Infection

  • Wound healing problems or infection

  • Scar sensitivity

  • Recurrence of bunion (3-11% over long term follow up).

  • The recurrence is often not as bad as the original bunion, and may not require treatment

  • Ongoing pain

  • Secondary surgery such as removal of screws

[1] Kaufmann G, Hofmann M, Ulmer H, Putzer D, Hofer P, Dammerer D. Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study. J Orthop Surg Res. 2019 Dec;14(1):193.

[2] Clarke TAC, Platt SR. Treatment of hallux valgus by Scarf osteotomy – rates and reasons for recurrence and rates of avascular necrosis: A systematic review. Foot and Ankle Surgery. 2021 Aug;27(6):622–8.