Introduction
This leaflet is for anyone being listed for a Scarf and Akin Osteotomy surgery at Gateshead Health NHS Foundation Trust.
What is this operation for?
This surgery is to correct a Bunion which may be advised if your symptoms are significant, non-surgical measures have been exhausted and do not relieve the discomfort of the bunion.
What is a bunion?
A bunion is a lump at the base of the big toe, caused by outward drifting and angulation of the big toe. The Latin name is hallux valgus. This lump is made up of bone and soft tissue. Sometimes it is painful in itself, but more commonly it causes symptoms by pressure when you wear shoes or, on occasions, by crowding or crossing the smaller (lesser) toes. It can cause a secondary deformity in the second toe when it becomes so crowded that it becomes ‘clawed,’ and crosses over the big toe.
What are the non-surgical treatments?
Early and mild bunions may respond to:
- Suitable footwear (flat, wide fitting supportive shoes and avoid pointed or high heel shoes).
- Bunion splints, padding, toe spacers or insoles and orthotics.
- Modify or pace activities that worsen your symptoms.
- Use pain relief, such as paracetamol or ibuprofen, to help relieve the pain and swelling of your bunion.
What indicates surgical treatment?
More severe bunions can only be corrected by surgery. Surgery should only be undertaken if the symptoms are significant and appropriate non-operative management has been considered.
The main reason for surgery is to relieve symptoms and not for cosmetic reasons.
The surgery aims to straighten the big toe and reduce the bump of the deformity.
What does the procedure involve?
A ‘Scarf osteotomy’ is an operation when a bony cut (osteotomy) is made in the bone in the foot (the metatarsal bone) and realigns its position. Small screws are used to hold the position while the bone heals together again. The bony bump is usually trimmed at the same time.
Akin osteotomy’ is performed at the same time which also involves a bony cut (osteotomy) in the big toe and realigns its position. A staple or wire is also used to hold the position.
How long will I be in hospital?
The operation is usually carried out as a day case if you are medically fit and feel comfortable after the procedure. This means that you will usually be in hospital a day.
Before you are admitted to hospital
Before you are admitted to hospital, you may need to have a pre-operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. The pre-operative assessment nurses will help you with any worries or concerns that you have and will give you advice on any preparation needed for your surgery.
Before the date of your admission please read, very carefully, the instructions given to you. If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose a risk and we may have to cancel your surgery. You should bath or shower before coming to hospital.
On admission a member of the nursing staff will welcome you. The nurses will look after you and answer any questions you may have. You will be asked to change into a theatre gown.
The surgeon and anaesthetist will visit you and answer any questions that you have. You will be asked to sign a consent form. A nurse will go with you to the anaesthetic room and stay with you until you are asleep.
A cuff will be put on your arm, some leads placed on your chest, and a clip attached to your finger. This will allow the anaesthetist to check your heart rate, blood pressure and oxygen levels during the operation. A needle may be put into the back of your hand to give you the drugs to send you to sleep.
What happens after the operation?
A nurse will check your blood pressure, pulse and the area where the operation has been done. You will normally be able to have a drink shortly after the procedure and eat as soon as you feel hungry.
You can usually get out of bed an hour or so after you wake up and you should wait for the nurses to help you as you may feel a little dizzy at first. It is likely to be a bit painful where the operation has been carried out, but if you move carefully, the pain is usually limited. The nurses will monitor your pain and give you painkillers, if necessary. It is quite normal for a small amount of blood to soak through the dressing and this can easily be changed. Sometimes the staff will need to press gently on the dressing for a while to prevent this happening again.
Recovery after surgery
Your foot is protected in a special post-operative shoe to protect the surgical area. This is normally for 6 weeks and you are able to walk as normal wearing this as comfort allows.
You will have discomfort and swelling; therefore you should manage this with pain relief and elevate your leg to reduce swelling.
After 6 weeks you will be seen by the consultant’s team and you will be advised if you can remove the post-operative shoe and start to walk in normal footwear.
What complications can occur?
All surgeries have potential complications. Some pain and stiffness around the joint are common after surgery, but complications are rare. Whilst this section is not intended to scare you as a patient, it provides information to help you make an informed decision in the consent process.
Complications can include:
- Accidental damage to the joint
- Damage to the structures inside or near to the joint such blood vessels or nerves
- Infection
- Bleeding into the joint
- Blood clots
- Unexpected reaction to anaesthetic
- Loss of feeling in the skin around the joint
- Failure to improve symptoms.
- Under or over correction
- Recurrence of deformity (especially with hypermobility)
- Non-union / mal-union or delayed union.
- Chronic regional pain syndrome.
- Further surgery
- Risk to limb including amputation
Walking
Unless you have any restrictions you must try to walk normally as soon as you can in the post-operative shoe. You may need to use a stick or crutches for a few days to help you walk without a limp. Please remember to return the walking aids when you no longer need them.
Swelling
Swelling and inflammation is a normal part of the healing process. Dependant on your surgery this can last up to a few months.
Following your discharge from hospital; you need to apply the ice pack three to four times daily for 15-20 minutes. You will be able to reduce the frequency after this time but will find that you will benefit from ice therapy for up to three months to help manage the swelling.
Elevating your leg on a stool or on the bed will also help manage the swelling.
Physiotherapy
Physiotherapy is not normally required following this procedure. An appointment will be arranged if necessary or the appropriate contact details will be provided for your local physiotherapy team if you have any problems.
Work
You should return when you feel able to cope with the physical demands of your job. You can discuss this with your GP or Consultant if you are not sure.
Driving
You won’t be able to drive for the first 6 weeks whilst you are wearing a post-operative shoe to protect the surgical area. Once you have been seen in consultant’s clinic usually after 6 weeks, they will advise if you can start walking without the postoperative shoe.
Then you can then drive when you feel safe to do an emergency stop and safely control the car. You must tell your insurance company that you have had surgery. If in doubt, contact your consultant or GP.
