Bunion Surgery
A Bunion (Hallux Valgus) is a foot deformity that results in prominence of the inner part of the big toe joint, in particular at the base of the joint where the big toe meets the first metatarsal bone.
The deformity progresses over time resulting in:
- Widening of the forefoot
- Increasing pain
- Stiffness
- Difficulty with wearing footwear comfortably
Our bunion specialist surgeon, Mr Kaser Nazir, specialises in the minimally invasive bunion operation. We will outline further details on the types of bunion surgery and what it involves, including postoperative recovery and typical pricing for bunion correction.
What is Bunion Surgery?
A bunion, or hallux valgus deformity, affects the big toe.
The aim of bunion surgery is to:
- Completely correct the underlying misalignment of the bones and ligaments causing the deformity.
- Appropriately realign the joint to ensure minimal risks of recurrence of the bunion
- Improve function.
- Relief from pain
- Cosmetically pleasing appearance
Our central London based bunion specialist, Mr Kaser Nazir, primarily assists with:
- Minimally invasive bunion correction, also known as “keyhole bunion surgery”
- Scarf and akin osteotomy
- Lapidus procedure for more severe bunions
Bunions: Diagnosis, Cause and Treatment
Bunions often develop over a long period. They are progressive, meaning that without intervention a Bunion will get worse over time. A Bunion will typically first appear as a mild bump below the big toe that protrudes out from the foot. As it develops the bony bump may become more severe, causing irritation in footwear, redness and inflammation. As the joint deviates further, the big toe may start to underride or overlap the adjacent toes, causing further issues and painful symptoms.
Know more about Bunions: Diagnosis, Cause and Treatment
A bunion or hallux valgus deformity is more common in women than men and is often a hereditary issue. Bunions can also be caused by narrow fitting footwear or high heels, where the toes can be pushed together and put pressure on the big toe.
It is worth visiting a podiatrist or a foot surgeon specialising in bunion surgery when you see a bunion starting to develop, they can assist with advice and conservative treatment including:
- Custom orthotics
- Toe splints
- Advice on appropriate footwear
Whilst splints and orthotics can slow down progression of the bunion, the deformity can not be corrected without surgery. If you find that your bunion symptoms are deteriorating or become pain and you can’t wear the shoes you would like to then it is time to arrange an appointment with a bunion specialist.
On arranging a consultation with Mr Kaser Nazir to discuss bunion surgery, we will also schedule an X-ray appointment.
Bunion Symptoms:
Clinically signs of a bunion include:
- Swelling, redness or pain around the big toe joint
- A bump at the side of the base of your big toe
- Pain under the ball of the big toe or often the second toe due to the bunion pushing it over
- Widening forefoot
- Difficulty wearing closed shoes comfortably
X-ray examination of the bunion may confirm:
- Bone displacement
- Joint swelling
- Bone overgrowth
- Big toe joint arthritis
- An increases angle of the hallux valgus (big toe)
- An increased angle between the first and second metatarsal, thus a wide foot
- Flat foot associated with bunion
- Quality of bone and osteoporosis
Bunion surgery has come a long way from the old traditional bunionectomy. The recovery following a minimally invasive bunion surgery is much quicker and will not require a cast.
Though there are many types of bunion surgery, Mr Kaser Nazir typically suggests either:
- Minimally invasive bunion correction or keyhole bunion surgery for most bunions with good quality bone and minimal or no arthritis evident on X-rays.
- Scarf and akin osteotomy for mild to moderate bunions, very slim bones or with osteopenia.
- Lapidus procedure for severe bunions deformities with arthritis of the midfoot or severe hypermobility (least common).
- Big toe joint fusion for those with arthritis and bunion deformity of the big toe (rare).
Mr Kaser Nazir also specialises in arthritic bunion issues. Visit our big toe arthritis page for further information.
Types of Bunion Surgery
Minimally Invasive Bunion Surgery
Minimally Invasive Bunion Surgery, also known as Keyhole Bunion Surgery, uses specialised burrs that are used to cut and reset the metatarsal and proximal phalanx bone into a corrected alignment alongside specially designed screws through very small incisions.
Mr Nazir typically uses the PECA bunion correction system. The procedure is carried out with the aid of an X-ray machine and specialised instrument to accurately calibrate the required bunion correction. This allows the bunion surgeon to make three – four 2mm incisions and minimises the damage to the soft tissue.
Advantages of the minimally invasive bunion surgery include:
- Less downtime
- Less swelling
- Minimal postoperative pain
- Less chance of joint stiffness due to reduced trauma
Why is a screw fixation still required for the minimally invasive bunion correction?
Research shows that without a fixation keeping the joint in place once the bones have been realigned increases the risk of complication such as delayed or non-union of bones and recurrence of the deformity. Using the PECA correction system with screws significantly reduces the chance of the bunion recurring and predictable recovery, including immediate weightbearing with minimal pain and swelling.
Steps of the minimally invasive bunion surgery
Step 1: A small 2mm incision is made on the inner side of the foot allowing the first metatarsal to be cut using a cutting burr known as a Shannon.
Step 2: The head of the first metatarsal is repositioned, to minimise the bony prominence. The Pecaplasty jig device is used to secure the corrected bones temporarily and checked on X-rays.
Step 3: Two screws are used to fix both sections of the metatarsal in its new position.
Step 4: A wedge is sometimes removed from the first proximal phalanx to reposition the big toe into a straighter natural alignment if required. This is also fixed in place with a screw.
Step 5: The protruding bone is cut away and flattened to a natural outer arc.
Recovery following the minimally invasive bunion surgery
Scarf and Akin Osteotomy
- Restores foot mechanics
- Allows for correction of small and moderate deformities
- Low recurrence rate
The procedure is carried out using titanium screw fixations that hold the big toe in the corrected position whilst the foot heals. It has a good long-term evidence base with predictable and repeatable excellent outcomes.
Steps of the scarf and akin osteotomy
Step 1: An approximately 8cm incision is made on the inner side of the bunion joint. The soft tissues are released to expose the bunion joint.
Step 2: The Bunion prominence is shaved using a bone saw.
Step 3: Metatarsal bone is cut and joint is realigned, then screwed in place using 2 titanium screws.
Step 4: A small wedge is removed from the phalanx to straighten the end of the toe (Akin Osteotomy)
Step 5: The phalanx is fixed together with a further titanium screw where the wedge has been removed, promoting a correct alignment of the toe
Recovery following the scarf and akin osteotomy
The Lapidus Procedure for Bunion Surgery
The Lapidus procedure is carried out to correct more severe bunions or for patients who have a bunion and suffer from hypermobility. Patients who are hypermobile have an increased chance of recurrence following other bunion techniques.
Steps of the Lapidus procedure
Step 1: An incision is made at the side of the foot measuring 13-15cm.
Step 2: The soft tissues around the bunion and midfoot joint are released to expose both the big toe bunion joint and the midfoot joint.
Step 3: The bony growth of the inner bunion is removed using a bone saw.
Step 4 The joint near the instep (tarsometatarsal joint) is removed, realigned and fused with a fixation which includes screws and a plate.
Recovery following the Lapidus procedure
Bunion Surgery Costs
Mr Kaser Nazir is covered by all major insurance companies. If you plan on using medical insurance please contact your provider and request authorisation for a consultation and X-ray. Following your appointment, our team will provide you with details on how to authorise the surgery.
If you are privately funding your appointments and procedure, the cost of bunion surgery will depend on which type of bunion surgery is recommended. This will vary depending on the severity of your bunion. Below is a guide to the bunion pricing:
Consultation with Mr Kaser Nazir: £200
Preoperative X-ray per foot: £100
Bunion correction for one foot under sedation:
Minimally invasive bunion correction: From £6,053
Scarf and akin osteotomy: From £4,634
Lapidus procedure: £8,016
Postoperative X-ray per foot: £100
Please note that the above fees are approximate, fees may change depending on Mr Kaser Nazir’s recommendations.
The Lapidus procedure will require additional postoperative fees including cast changes and an aircast boot.
Find out further pricing information through our quote generator
Contact our team on 02078208007 or email admin@londonfootandanklesurgery.co.uk if you have any questions regarding pricing.
Bunion Surgery: Frequently Asked Question
Keyhole bunion surgery, or minimally invasive bunion surgery, is a modern technique to surgically correct a bunion. The procedure is carried out with the aid of a live X-ray machine to cut and reset the bone malalignment using 3-4 small 1 to 3mm incisions to guide the specialised surgical instruments and fix the bones in the corrected position using specialised screws designed for bunion correction.
As there is minimal scar tissue, the area heals much quicker than more traditional bunion correction. Mr Kaser Nazir has seen excellent results with his patients who have reduced pain and quicker recovery.
Mr Kaser Nazir is the leading bunion surgeon based at 17 Harley Street in central London. He specialises in the minimally invasive/ keyhole bunion correction and is internationally recognised for performing this operation.
Discomfort from a mild bunion can be helped with a toe splint, custom orthotics or wider footwear. Some mild bunions can also require surgical intervention if they are painful.
There are a few procedures that may be suggested, such as the scarf and akin osteotomy or lapidus procedure for more severe bunions. Mr Kaser Nazir, however, can carry out the minimally invasive/ keyhole bunion procedure that provides an excellent cosmetically pleasing result, with reduced pain and recovery.
Early signs of a bunion may include:
- Swelling, redness or soreness around the big toe joint
- Limited movement of the big toe
- A bump on the outside of the base of your big toe
- Stiffness in the big toe joint
- Pain under ball of second toe due to overloading