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Clinical Director of the LFAC Mark Davies describes advances in bunion surgery and debunks the myths surrounding this very common problem.

MYTH! It is painful
In the past, bunion surgery has developed a reputation for being very painful. This is because older techniques have involved cutting the bone and not using any form of fixation, so that the bone ends are still mobile. Even plaster of Paris immobilisation, which mimics a fracture, can be associated with quite a lot of pain. It also means that the final position in which the bones heal is not controlled. With newer techniques pioneered by Louis Barouk in France the bones can be cut and then held in the correct position using screws without heads. This means that the metalwork is, to all intents and purposes, buried and therefore not palpable.

It also means that the bone fragments do not move relative to each other and therefore the pain associated with surgery is very much reduced. Using local anaesthetic techniques at the time of surgery, it is not uncommon to go through the whole process without experiencing significant pain at all.

MYTH! Surgery Does Not Work
All the techniques which in the past have been destructive rather than reconstructive are being replaced by procedures which maintain anatomy. If the precise bony anatomy of the foot can be restored, then not only is the bunion problem solved but there are no adverse effects from bone shortening or removal of joint. The Scarf osteotomy, for example, pioneered by Louis Barouk and Lowell-Scott Weil, allows the anatomy to be respected and therefore function to be restored. It is simply not true that bunion surgery does not work. Unfortunately, the older techniques are still widely used and therefore the myth persists.

MYTH! Physiotherapy Is Irrelevant
It is now clear that early mobilisation and specialist physiotherapy is a key in long term function after bunion surgery.
All bunion surgery is associated with a degree of stiffness of the big toe joints, and if left unattended, the stiffness can persist. With the modern fixation techniques, where the bone fixation is rigid, there is no downside to early mobilisation of the big toe joint. With early mobilisation, joint motion can be restored and stiffness avoided. In this, physiotherapy is a most important tool in the recovery of patients from bunion surgery. Physiotherapists are able to speed up the recovery process by instituting early mobilisation and also working on techniques to reduce swelling. There is no question that the patient who receives physiotherapy following bunion surgery is more likely to make a speedy recovery, and also achieve a better long-term result in terms of joint motion.