Left untreated, foot conditions can cause significant pain, discomfort and limit mobility. Our practitioners are able to manage your foot and leg complaints with expertise. We are your trusted Podiatrist in Canberra. For further information or to make an appointment with one of our podiatrists, just call our clinic today.

What are bunions?

Bunions, otherwise known as hallux abducto-valgus, are a common bony deformity of the foot where the big toe deviates towards the lesser toes. It is often associated with a bump on the inside of the foot as part of the big toe joint. There are varying degrees of deformity with bunions, ranging from mild to severe. In severe cases, over load to the forefoot can lead to subluxation (dislocation) of the 2nd metatarsophalangeal joint and an associated lifting of the 2nd toe. This can cause a problem with fitting footwear comfortably, as the 2nd toe rubs on the shoes, which can develop into corns or other pressure lesions. Bunions are a progressive disorder; they tend to get worse with time. Generally, a leaning of the big toe towards the 2nd is the first sign noticed. Gradually this deviation becomes greater, the foot wider, and the smaller toes become progressively deformed. Over time finding comfortable shoes becomes more difficult and the big toe joint may persistently ache.

What causes bunions?

Bunions are contributed to by many factors, some of which we have control over and others which are largely genetic. The shape of our joints, the level of mobility of the foot joints, the way our feet move and the mechanics of our feet and legs are all contributing factors. There is some research to suggest that poorly fitted footwear and specifically footwear that is too narrow in the toe box can exacerbate the progression of bunions. It is not actually the bunion itself that is genetic or inherited, but rather the predisposing foot mechanics that tend to be familial.

What common symptoms associated with bunions?

Symptoms of bunions include pain or soreness, inflammation, redness at the joint, a burning sensation and possible numbness. Symptoms are often exacerbated by wearing unsuitable footwear, and so footwear alteration or recommendation often forms the basis for conservative management of bunions.

How are bunions diagnosed?

Diagnosis of bunions is largely made by clinical observation and often an x-ray or other imaging is unnecessary unless you are considering surgical intervention. When surgery is being considered, your foot and ankle surgeon will use x-rays to visualise the bones and possibly grade the deformity.

How are bunions treated?

Before considering bunion surgery in Canberra, pain from bunions may be improved with conservative therapies which your podiatrist can discuss with you.
Therapies they may consider with you include:

• Footwear modification
• Biomechanical assessment
• Gait retraining or exercise programs
• Offloading padding
• Custom prescription orthoses
• Mobilisation techniques
• Medications for inflammation
• Ice therapy
• Therapeutic injections

Quite often biomechanical assessment and treatment (looking at and altering the way the foot interacts with the ground and your body) and footwear advice with or without custom prescription orthoses can help to reduce the pain associated with bunions. These work to reduce stress through the tissues in the big toe joint by changing the way the foot manages force when it is in contact with the ground. Footwear changes or custom prescription orthoses are aiming to deflect the force away from the injured tissue, giving it a chance to heal and decreasing the likelihood of further tissue injury.

When should surgery be considered?

In severe cases or cases that do not respond adequately to conservative therapies and where pain persists and interferes with daily living, surgical intervention may be the best option. In which case, a podiatric surgeon comes highly recommended. Podiatric surgeons are podiatrists who have undergone rigorous post graduate training including a registrar process and are a fellow of the Australasian College of Podiatric Surgeons. This training and experience qualifies podiatric surgeons to perform foot and ankle surgery, including bunion surgery.

There are a few approaches to bunion surgery and your surgeon will complete a thorough examination and take a thorough medical and surgical history from you during your initial consultation with them. This will enable them to determine the best option for you, your bunion and your medical situation. Usually the surgery is a day procedure, and recovery varies depending on your situation and the procedure type.

So if you think you have a bunion that is bothering you with rubbing or aching when you wear shoes, or aching and pain in the joint and surrounding tissue, book an appointment at ACT Podiatry to have your footwear and feet assessed. We will be able to give you good advice about footwear and custom prescription foot orthoses, or refer you to our podiatric surgeon, Dr Clayton Clews, if a surgical assessment is appropriate.

What can I do to prepare for foot surgery?

Your surgeon will discuss with you what you need to do to prepare for surgery. Generally, foot and ankle surgery can be undertaken under day-case conditions, so you’ll need to organize someone to pick to you up from hospital and be available to care for you for at least 48 hours after the surgery day. You should not drink or eat anything after mid-night, the day prior to surgery. You’ll also have to organize time off work, usually ranging from 2-4 weeks (sometimes 6 weeks). The exact time frame can be discussed with your surgeon.

What kind of procedure am I likely to have?

The type of procedure that is suitable for you is generally determined by your presenting complaint, your medical history/general health, the biomechanics of your foot and the quality of your joints and bones. The podiatric foot and ankle surgeon will ask you a lot of questions about your medical history (including previous surgery), current medications and allergies. The procedure selection is based on a clinical assessment (or what you presenting complaint is, including an assessment of your joints and soft tissues) and what is shown on medical imaging, usually, plain film radiographs.

Recovery time, non-weight bearing, being off work, when can I drive?

Recovery time can vary between procedures and your individual recovery time may change due to your health and age. Older people (70’s and above) generally having a slower cell regeneration rate, including bone healing and can expect a longer healing time. For example, most bunion corrections, other than big toe joint fusions, require the use of a stiff-soled protective post-operative walking shoe, for about 4-weeks. Fusions will require at least a further 2-weeks of use in such a shoe. A mid-foot procedure used to correct bunions usually requires more time than this. It is important you keep your post-operative dressings (applied at the time of surgery) dry and clean during this time. Your dressings will often hold a lot of Betadine antiseptic solution, which sometimes can be confused for post-operative bleeding. If your dressings have a brown colour to them, this is Betadine, if a dark red colour, this is blood and may require an earlier dressing change. Your surgeon will generally wish to consult with you again from 7-10 days post- surgery. At this time your wounds will be inspected, your feet cleansed and your sutures removed. A further dressing will then be reapplied, offering you, ongoing protection and comfort. Advice is likely to be provided in regards to management of pain (which is expected to be low) and swelling (which is expected to be low). It is likely you can return to driving following your first consultation (and possibly earlier for younger patients). It is important your post-operative shoe does not interfere with your ability to drive correctly.
Again, you will likely need 2-4 weeks off work, possibly longer if you have an active job, such as in the building trade. Our practice will be able to provide you with a medical certificate if this is required from your employer.

Do I need a referral?

You do not require a referral from any practitioner, including GP to consult with a podiatric surgeon. However, we commonly receive referrals from a number of different practitioners (GP’s, other podiatrists, physiotherapists etc) for patients who have not responded to non-surgical types of treatment.

When will I fit into normal shoes?

Post-operative oedema (swelling) starts immediately following surgery and usually hits a peak between 4-8 weeks. However, oedema can continue for up to 12-18 months following surgery, depending on the predisposition of the patient. Initially, your post-operative shoe will accommodate your oedema, but after usually 8 weeks you can start commence wearing regular capacious shoes (such as walker or runners). As your oedema improves you can commence wearing a greater range of shoes, including court shoe designs. The first normal shoe you can wear might be a size or two bigger than what you were using pre-operatively. Removing the innersole from such a shoe can help with a better fit. Because the surgery has been undertaken to address bunions, your foot will end up narrower around at the forefoot and you will ultimately be able to wear narrower fitting shoes than what you could prior to surgery.

How long do I spend in hospital?

Most elective foot and ankle surgery can be undertaken under day case conditions. That is once your surgery is completed, you will be able to go home. However, you must be taken home by another person. You cannot drive home or even take a taxi home by yourself. There are some special circumstances where an overnight stay may be appropriate, but this is uncommon.

What do I need to do at home after surgery?

At the end of the surgery, while you are still under general anaesthesia, the surgeon and their assistants will apply a dressing that aims to support, brace and lightly compress your foot. This dressing is large and can stay on for weeks at a time. The wounds have been closed with sutures, and so heal by primary intention. This usually results in very little bleeding from the wound sites. Again, the surgeon will have used a lot of Betadine solution as a component of the dressings applied to your foot/feet to dress your wounds. This can temporarily stain your skin a brown or orange colour. You will be mainly required to keep your dressings dry and clean and should elevate your feet as much as possible, when not standing and walking. An ice pack placed at the front aspect of the ankle can assist with the early stages of swelling and somewhat with pain. During the first 7-10 day your standing and walking should be restricted to getting around the house and to light activities. It is important to take your post-operative medications as prescribed. The use of anti-inflammatories is very important during the first 3-5 days after surgery. Other medications will often include an anti-biotic, anti-thrombotic (blood thinner) and additional pain medication such as paracetamol and Endone (used sparingly for break through pain). Break through pain occurs when your level of pain is greater than expected and requires a stronger medicine to bring it down. Most people experience a pain level of between 1-3 immediately following surgery. Levels greater than this require a phone call to your surgeon to discuss measures to improve this.

Can I have surgery performed on both feet at once?

Yes you can, if your surgeon assesses that your situation and health is suitable. Bilateral foot surgery is very common in modern day practice.

How pain can I expect following my surgery?

Every effort during and before your surgery is made to limit factors that contribute to the pain experience around surgery. The anaesthetist and your surgeon work together to use a variety of medications before, during, and after your surgery to limit side effects and maximize a good outcome. Your surgeon will apply a dressing that incorporates compression, to limit swelling, which is a big factor in post-operative pain. Your anaesthetist and surgeon will prescribe you post-operative medications and advise you how to use these appropriately to manage your expected pain. It is important you follow these instructions carefully. A multi-modal approach has proven to be more effective than the use of a single strong drug like Endone (oxycodone), so don’t underestimate the importance of medications such as paracetamol and ibuprofen. Their role in the management of swelling and pain is crucial to a pleasant post-operative experience. Rest and a good amount of sleep are also important. Excessive amounts of standing and walking can increase pain in the early stages of healing.

Will my surgery be performed under a local or general anaesthetic?

Most bunion surgeries are undertaken with the combined use of local and general anesthesia. Your surgeon will work closely with an anesthetist and a team of nurses, to provide you with the best of care. Intra-operative and post-operative management is discussed between the anaesthetist and the surgeon, to ensure your experience is as comfortable as possible, both during and in the days after surgery.