Bunion Correction
What is a Scarf osteotomy ?
This is an operation for painful or severely deformed bunions. It involves removing the prominent bump and realigning the metatarsal bone with an osteotomy (bone cut and screw fixation), combined with a repair of the joint capsule and ligaments. This will produce a narrower foot and a straighter Big toe. There may also be simultaneous surgery on the lesser toes, if indicated.
What happens after the operation ?
The capsule repair must be protected with the specialised dressing for 2 weeks and the osteotomy requires protection in the post-operative shoe for 6 weeks. The post-operative shoe allows for heel weightbearing (walking) immediately though this is often too uncomfortable for the first week. The foot must be elevated (above the level of the pelvis) for 90% of the time for the first 10 days. This helps to reduce swelling and the risk of infection, and helps wound healing. Naturally, short periods of walking/standing are allowed.
What are the risks of surgery?
Stiffness & swelling
Initially the foot will be very swollen and needs elevating. The swelling will disperse over weeks/months but may still be apparent at 6-9 months. Often shoes will remain tight for 8-12 weeks. The toe will be stiff but will usually regain its original movement.
Infection
There is always a risk of infection with surgery. You will be given 1 dose of intravenous antibiotics during surgery. The best way to reduce the chance of acquiring an infection is to keep the foot elevated for 10 days. If there is an infection it normally resolves with a course of oral antibiotics.
Nerve damage
A nerve supplying the side of the toe lies beneath the incision, and this is at risk of damage. Usually it is only bruised and will recover. If the damage is permanent, there will be a small patch of numbness. This does not normally cause any disability.
Undercorrection
Occasionally, the deformity of the toe is not fully corrected. This is more common in severe cases. This is rarely problematic and requiring further surgery.
Overcorrection
Very rarely the toe can be over-straightened so that it angles away from the foot (hallux varus). This usually requires further surgery.
Avascular Necrosis
This is where the blood supply to the bone is disrupted, leading to the bone tissue dying and collapsing, and the joint surfaces being damaged. This can lead to arthritis (pain and stiffness), which may require further surgery.
How long am i likely to be off work ?
4 weeks off work for sedentary jobs
6 weeks off work for standing/walking jobs
8 weeks off work for manual / labour jobs
A sick note is usually provided for the first 2 weeks; further notes can be obtained from your GP.
What are the usual follow up arrangements ?
2 weeks - Removal of sutures
6 weeks - Weight-bearing X-rays.
Article written by
Mr Henry Atkinson
Consultant Orthopaedic Surgeon
North London Sports Orthopaedics
Last updated 16/3/10
|
