What is a Bunion?

The bunion (Hallux Valgus) deformity is probably the most common foot deformity.

The deformity leads to a prominent bunion joint and a big toe that shifts towards the second toe. This disrupts the mechanics of the foot and leads to abnormal weight-bearing function.

Pain is usually felt over the bunion and within the joint itself. Often the second toe becomes painful and deformed as a result of pressure from the big toe.

What Causes Bunions?

There are many causes of a bunion deformity.

In some people it is associated with a relatively flat mobile foot and in others it could be due to the shape of the foot or an imbalance in the local muscles. It is probably due to a combination of inherited abnormal foot mechanics and footwear.

Women suffer more often than men because of the style of shoes worn but not all bunions are because of narrow shoes.
Pain is caused because the prominent joint rubs on the shoe and also because the big toe is no longer straight.

When a bunion deformity occurs, the joint doesn’t take its share of weight and commonly (but not always) adjacent parts of the foot become painful.

What are the Treatment Options for my Bunion?

Non-Surgical Treatments

Non-surgical treatments (such as painkillers, bunion pads and suitable orthotics/footwear) can help ease the pain and discomfort caused by a bunion.

However, they can’t change the shape of your foot or prevent a bunion from getting worse over time, so surgery is usually recommended when the condition starts affecting your day to day activities.

Surgical Solutions

There are many different types of bunion operations but the operation of choice required for moderate bunion deformity is called a Scarf/Akin procedure.

This involves surgical correction to both the first metatarsal (the bone behind the big toe) and the big toe. The bones are realigned into a corrected position and held in place with screws and wires. This means that you should not need a plaster cast after surgery and there is usually no need for crutches.

What does Bunion Surgery Involve?

Bunion surgery is performed under local anaesthetic (this means you are awake but the foot will be numbed via a series of injections either around the ankle or an injection in the back of your knee, which most patients find comfortable).

Surgery then takes place to reduce the bunion deformity and realign the big toe.

The joint is accessed via a small incision along the side of the bunion joint and the operation involves cutting and realigning the big toe and metatarsal bone and fixing them with small screws or wires.

This gives a stable joint that generally heals quickly and puts the joint back into a corrected position to allow more normal function. The wound is then closed with non-dissolvable stitches and the foot is bandaged. In total the operation takes about 35-45 minutes and you’re able to go home the same day.

Are there risks or side-effects following foot surgery?

As with any medical procedure there are risks which Mr. Kannegieter will always thoroughly explain to you prior to your treatment, so you can be informed every step of the way.

The main risks following bunion surgery are:

• Pain
• Swelling
• Infection
• Deep vein thrombosis
• Chronic pain syndrome (CRPS)
• Numbness
• Joint stiffness
• Recurrence
• Failure to resolve all pain

What Happens After Surgery?

After the operation you will be taken back to the ward and given a drink and something to eat. You will be advised on pain relief and once ready you will be discharged from the day surgery unit with full information on recovering from your surgery.

You will be given a post-operative boot to wear and should not remove this until instructed. We advise you do not drive after foot surgery and you should be accompanied home by a responsible adult. We will be in touch to advise of your follow up appointment date, either on the day or by letter in the post.


Mr. Kannegieter has put together this useful PDF explaining what to expect from Scarf/Akin surgery for bunion surgery.

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