Monday 16 September 2019

Dear Dr Nina: How successful is bunion surgery?

Bunions are not considered high-risk surgery
Bunions are not considered high-risk surgery

Nina Byrnes

Question: I am due to have bunion surgery in the New Year and have heard that it is not always successful. What are the risks and possible shortfalls?

Dr Nina replies: A bunion occurs when the base of the large toe moves away from the other joints of the foot at the same time the top of the large toe moves towards the other toes. This creates an angle at the base of the toe and this joint can become inflamed and tender. The skin on the outside can become thickened and red creating the classic angled red appearance that we all dread. Bunions can be painful and can also make it difficult to wear certain shoes. They are most common in women due to the shoes we wear but they can also occur in those with diabetes, or flat feet. They can run in families and 15pc are felt to be genetic.

Bunions are not dangerous but they may cause foot pain or be cosmetically unacceptable. Simple measures like applying ice, raising the foot and taking over the counter painkillers may help relieve pain. Wearing shoes that have a narrow toe or have a high heel will exacerbate the problem and should be avoided. See a chiropodist or physiotherapist who has an interest in foot pain. They may be able to prescribe orthotics, specially moulded insoles, which can be placed in shoes. These may relieve the pressure across the ball of your foot reducing pain. Losing weight if you are overweight will reduce the strain on your feet. If simple measures aren't working x-ray and /or scans may be organised. Referral to a specialist may be required and they can arrange injections into the area causing pain.

Bunions are amenable to surgical treatment though this is usually the last option. Bunion surgery should never be done purely for cosmetic reasons. It is considered where there is pain or where the big toe is turning and encroaching on smaller toes. This surgery requires a general anaesthetic so all the usual risks of this apply. For those who have no other medical issues general anaesthetic carries low risk. Those who have other health issues, particularly lung or heart problems, a general anaesthetic may be more risky. A pre-operative consultation with an anaesthetist may be suggested. All surgery carries the risk of post-operative pain, infections of the wound and chest complications.

In general, bunion surgery is not considered a high-risk surgery and most recover fully without any problems. You will be incapacitated for a number of weeks after as your foot needs to heal. A boot is usually worn for a while after the surgery. Possible complications specific to this surgery are nerve injury, pain, stiffness in the big toe joint, reoccurrence of the bunions and failure of the bone to heal fully.

Your orthopaedic surgeon is best equipped to advise you fully about the risks and benefits of surgery so don't be afraid to ask any questions before your operation day.

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