Suzy is a Consultant Podiatric Surgeon working for the NHS in Central London and in private practice at Premier Podiatry Ltd. She specialises in foot surgery, paediatric and adult foot problems, sports injuries and complex biomechanical analysis of pelvic and lower limb pathology.
Gait analysis is integral to her work and she is experienced with in-shoe pressure and 3D technologies.
Suzy was part of The Podiatric Sports Medicine Team at the 2012 London Olympic Games and is a visiting lecturer at The University of East London and the University of Brighton.
For National Bunion Day, Suzy agreed to answer some of the most frequently asked questions about bunion surgery.
Can you have corrective surgery for bunions successfully more than once? My original operation was in 1980 but they returned about 10 years ago.
Yes, you can have a repeat operation to successfully correct a bunion that has recurred following previous surgery. Although it is disappointing when surgery fails, this can happen for a variety of reasons. The surgeon may not have been a foot specialist, the wrong procedure may have been chosen, the patient may not have followed the post-operative instructions, adversely affecting the outcome of surgery by not resting, injuring the foot or not doing the exercises. In some cases there is no obvious reason for recurrence of the bunion and you may just have been unlucky!
Revision surgery is never as straightforward as the primary operation so you should discuss the pros and cons with your surgeon carefully in order to make an informed decision. Repeat surgery may require more complex realignment of the bones in more than one direction, necessitate a bone graft to lengthen a bone that has shortened or involve fusing the big toe joint because it is damaged and stiff. There may be a period of immobility post-operatively. Every revision case is unique but there is no reason why a good outcome canʼt be achieved with appropriate planning and the right advice from your specialist.
I’ve heard about minimally invasive bunion surgery that can be done whilst awake, and under which you can walk soon after surgery. What are your thoughts on that type of surgery – is it successful even for severe bunions? Is it possible to avoid surgery for severe bunions, or does delaying only make things worst? Do you recommend surgery on both feet at the same time?
Minimally Invasive Surgery (MIS) is becoming increasingly popular with patients, it is offered more frequent in private practice. Special training is required. Operations are performed through a smaller skin incision and visualisation is aided by the use of intra-operative X-rays. Patients are attracted to this type of surgery by the promise of smaller, more cosmetic scars and a quicker return to work and activities. What we must not forget is that skin and bone healing times remain the same regardless of the size of the incision made. Procedures are technically more challenging due to a lack of visibility. There are also limitations in the amount of correction achievable and the ability to stabilise the bone fragments adequately with screws or wires whilst they heal. Post-operative complication rates appear to be slightly higher with MIS. There remains much debate as to whether there is a place for MIS bunion surgery, so Iʼm afraid the jury is still out!
Bunion surgery can be performed while the patient is awake and this is common practice in the field of Podiatric Surgery. Anaesthetic is injected behind your knee or around your ankle to selectively numb the foot only (local anaesthetic). Patients do not have to watch the operation and you can listen to music or chat to a member of staff during the procedure which generally lasts a maximum of an hour.
Surgery performed in this manner enables you to leave hospital more quickly by helping to avoid the unwanted side effects of general anaesthesia. However, if your preference is to have a general anaesthetic and go to sleep for your surgery, this is also an option.
Modern screws and plates now enable immediate or early weight-bearing with crutches in a post-operative shoe or boot following bunion correction. This helps reduce the risk of a blood clot (thrombosis), maintain muscle strength and joint mobility and helps facilitate an earlier return to footwear, work and sporting activities.
We know that bunions increase in size overtime, but symptoms do not always deteriorate proportionally. As a bunion gets larger, the protective surface (cartilage) within the big toe joint often degenerates and the joint becomes stiffer and more painful. Normal bunion corrections are not as successful when joint damage is present. Surgical options become more limited and procedures such as joint fusion are often more appropriate. So, if your bunion is symptomatic it is better to get specialist advice regarding treatment options sooner rather than later.
Unless bunions are small, I tend to avoid operating on both feet at the same time. However, many people opt to have both bunions corrected at the same time privately due to cost and concerns regarding recovery time. When surgery is performed on both feet, crutches are required for an extended period, activities are more limited and there is an increased risk of falling or sustaining a fracture. Generally I advise a period of 6 months between feet to allow full recovery and to assess the outcome from the first operation.
I have had a bunion on one foot but after three operations I am still in pain. I have a bunion on my other foot and question whether I should have that one done as I am in pain with it. Or should I leave well alone?
It is difficult to comment on individual cases without knowing all the facts, but undergoing 3 operations on one foot to correct a bunion is unusual. I do not know if you sustained a post-operative complication, whether these operations were performed by the same surgeon in relatively quick succession or over a number of years by different surgeons. As mentioned before, revision surgery is never straight-forward and post-operative complications can affect the eventual outcome of surgery. There is no reason why you should require more than one operation to correct your other bunion. If you are fit and healthy, the correct procedure is chosen, you follow the surgeon’s advice, have family support/help and give yourself enough time to recover fully, a good outcome should be achievable. Seeking a second opinion from another foot and ankle surgeon is always an option.