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Minimally invasive bunion surgery

For as long as there have been feet, there have been bunions. And, if you don’t have bunions yourself, chances are you know someone who has them. Medically referred to as hallux valgus, bunions appear as a bony lump on the outside of the big toe. They can present at any age and more commonly affect women.

What are bunions?

Bunions are the result of the big toe moving towards the outside of the foot while the metatarsal, (the main long bone) moves inwards. As the two bones work against each other they put pressure on the skin from inside the foot and a bunion forms where the two meet. Bunions can become painful and sore as the outer skin around them thickens and the lump rubs against footwear.

What causes bunions?

One of the largest myths surrounding bunions is that they are caused by wearing certain shoes – specifically high heeled or narrow, pointy shoes. The truth is that footwear is not the cause of bunions. It’s now well recognised that bunions are hereditary, passed down from generation to generation. Occasionally they can skip a generation, but if your parents or grandparents have suffered with bunions, it’s very likely that you’ll be genetically predisposed to experiencing them yourself.

Unfortunately we cannot do anything about genetic inheritance, but we can seek advice on how to treat bunions.

How can we treat bunions?

In the early stages a bunion may be completely pain free. If your shoes aren’t rubbing on the bunion you may not experience any redness, inflammation or thickening of the skin. With only mild bunion symptoms, some footwear modification can help. However, bunions put a limit on the width of shoes you can buy to walk in comfortably. Work boots, ski boots, narrow shoes and high heels will only exacerbate bunion symptoms.

Splints and toe separators don’t work to stop bunions. No medication can stop or prevent bunions and generally no insoles are able to help with bunions. The pain from a bunion is mainly from the lump rubbing against footwear and this must be addressed. The most effective way to treat this is with bunion surgery.

Bunions FAQs

Frequently Asked Questions

Consultant Orthopaedic Surgeon, foot and ankle Specialist and leader in the field of minimally invasive (keyhole) bunion surgery, Mr Kumar Kunasingam, answers all the frequently asked questions about bunions and minimally invasive bunion surgery.

The main difference between minimally invasive and open surgery is that minimally invasive surgery involves performing the procedure through several very small incisions, whilst open surgery generally uses one much larger incision.

Minimally invasive, or keyhole bunion surgery is performed by an experienced fellowship trained orthopaedic surgeon and has many key benefits over open surgery. The smaller incisions made through keyhole bunion surgery result in much smaller scars, amounting to under twenty percent of most open surgery scars. There is an obvious cosmetic benefit but also with a smaller scar there is a smaller risk of infection. The larger the scar the greater the risk of infection, so the risk is decreased in keyhole bunion surgery as it utilises several small cuts instead of one large one.

As less soft tissue is disrupted in keyhole bunion surgery you’ll find there is very little pain compared to open surgery, as the less disruption to the soft tissue also results in less swelling and pain associated to swelling. This in turn aids with rapid recovery as the patient is able to walk sooner after surgery and begin early stretching exercises specifically for the toe.

This is also known as minimally invasive bunion surgery (MIS) or minimally invasive chevron Akin bunion surgery (MICA).

The technique employs several very small incisions to access the bone around the bunion and reshape them (osteotomy) and straighten them. Once the bone is moved into its desired place it is held with specially crafted screws. The screws are accurately placed under the guidance of live X-rays during the surgery. The screws used have a special bevelled edge leading to less irritation under the skin.

The bump of the bunion is much smaller after it is cut and moved but is made even smaller by shaving prominent bumps off through the same incision used to reshape the bone. The surgery takes roughly 30 minutes to complete and is treated as a day-case procedure. This is quicker and less painful than open surgery and allows you to walk immediately after surgery. This minimally invasive approach often needs very little post-operative pain relief.

This is also known as minimally invasive bunion surgery (MIS) or minimally invasive chevron Akin bunion surgery (MICA).

The technique employs several very small incisions to access the bone around the bunion and reshape them (osteotomy) and straighten them. Once the bone is moved into its desired place it is held with specially crafted screws. The screws are accurately placed under the guidance of live X-rays during the surgery. The screws used have a special bevelled edge leading to less irritation under the skin.

The bump of the bunion is much smaller after it is cut and moved but is made even smaller by shaving prominent bumps off through the same incision used to reshape the bone. The surgery takes roughly 30 minutes to complete and is treated as a day-case procedure. This is quicker and less painful than open surgery and allows you to walk immediately after surgery. This minimally invasive approach often needs very little post-operative pain relief.

If left untreated bunions can get worse as the toe moves out of place. This can lead to joint wear and arthritis, causing even more pain. In more extreme cases, the big toe can move over the second or sometimes third toe, causing deformity and associated pain. In severe cases these toes can dislocate.

As the bunion gets worse and walking on the foot becomes more painful, weight bearing on the area can become difficult. As less weight is put through it and more weight goes through the other long bones of the foot, this can result in transfer metatarsalgia. Metatarsalgia feels like walking on stones or pebbles, but can be treated by shortening these bones.

If bunions are caught early however, most of these problems can be avoided.

Minimally invasive bunion surgery should be carried out by an orthopaedic surgeon who specialises in foot and ankle surgery alone. An orthopaedic surgeon is medically qualified, surgically trained and further qualified.

Minimally invasive bunion surgery should only be performed by fellowship trained orthopaedic surgeons with good fellowship exposure as advised by NICE.

At Schoen Clinic London we understand how important your time is, so we champion rapid recovery. Your surgeon will apply the soft post-operative bandage in the operating theatre and you will keep this on for the first two weeks of recovery. You’ll be able to walk immediately after surgery, only using crutches for balance or support if required.

With open surgery it’s not unusual to be in bandages, plaster of Paris or large waking boots for six to eight weeks.

With keyhole surgery you’ll be out of your post-operative bandage at your 2 week follow-up and back into a normal stretchy training shoe for up to four weeks.

For the first two weeks you’re encouraged to keep active within sensible limits and elevate and ice the foot to help minimise swelling. From 2 weeks you’ll be given stretching exercises which will gradually increase from 4 weeks. This gradual increase of strength and mobility exercise promotes good joint function and is part of the rapid recovery programme following minimally invasive (keyhole) bunion surgery.

Generally, the time taken for the bone to heal is around six weeks.

As a general outline of the cost of bunion surgery at Schoen Clinic London, a metatarsal osteotomy for a bunion (hallux valgus) daycase surgery is £4,760.

If you don’t have insurance or would like to self-fund your own treatment, we work with Chrysalis Finance to offer our patients convenient and easy ways to spread the cost with payment plans. No deposit required, up to 12 months interest-free, and you simply pay back the cost of your treatment with equal monthly payments over six to sixty months.

Patient story

A minimally invasive bunion surgery journey

Glynne had suffered with bunions all her life, she'd struggled with bunion pain and wasn't able to wear her favourite style shoes because her bunions would always rub or get in the way. Her bunions had severely limited what she was able to wear comfortably and she just wanted to be able to walk without bunion pain. After carrying out her own research to find the right surgeon for her, Glynne found that Mr Kumar Kunasingam had an excellent reputation for the minimally invasive (keyhole) procedure, and learnt that a friend of a friend had their bunion surgery done by Mr Kunasingam too. She decided to undergo the surgery and after her left foot was a success, she wanted to document the process on her right foot to help others who may be struggling with bunion pain.

Watch her full journey from beginning to end below. (Contains some mild scenes of a surgical nature.)

Before & After Minimally Invasive Bunion Surgery

See the success stories