Bunion Hallux Valgus (Bunion) continued...

Modern Surgery

Over the last decade foot & ankle surgery became more modern and reliable as increasingly these procedures are performed by surgeons that received subspecialty training. As a result, a more individualized surgical approach to the bunions has been developed, including the use of new techniques such as the ‘Scarf’ metatarsal osteotomy. These techniques provides a greater degree of correction in the more severe cases and, perhaps more importantly, a more stable internal fixation making immediate and full mobilisation without casts possible in most cases. Additional operations such as a lateral soft tissue release or a phalangeal osteotomy (Akin) are now often used to improve the correction depending on the individual features of the deformity. Procedures on the lesser toes, such as for a frequently associated 2nd hammertoe or a painfully subluxed MTP joint, can be safely carried out simultaneously and add to patient satisfaction. In the most severe cases proximal metatarsal procedures or, in an unstable plano-valgus foot, a tarso-metatarsal fusion may be indicated. Depending on the patient’s preference anaesthetic techniques vary from general anaesthesia to regional blocks that also allow excellent postoperative pain relief. Furthermore, many patients can be done as day-cases or as overnight stays and mobilise immediately and fully weight-bearing. A special hard-soled postoperative shoe is usually required for about 4-6 weeks. [more...]