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jackie@foot-surgery.co.uk

Our Centre in London - Harley Street Foot and Ankle Centre

The Bunion Surgery Centre London is part of the Harley Street Foot and Ankle Centre based at 9 Harley St, in the famous West End of London. This specialist foot surgery clinic has hallux valgus (or bunion) surgery at the centre of its range of surgical expertise. In the past bunion procedures have had a poor reputation regarding success rates, difficult recovery and post-operative pain. With advances in safe and accurate bunion corrective techniques, our patients' recoveries are faster than ever, with fewer complications and a strong medical-evidence base to support the bunion treatments we provide.

After having performed over 6000 bunion procedures we will ensure that you will be walking one week after your procedure. Many of our patients return to work in as little as 2-weeks after their bunion procedure, without compromise to your outcome. This centre provides corrections for mild, moderate and severe bunion deformities, often with associated deformities such as hammertoes. We also provide multi-procedure interventions and will happily perform corrections to both bunions on both feet in one sitting. Our new hospital has state-of-the-art equipment and uses the best techniques in anaesthetics for your pain-relief post-operatively. This includes the “gold standard” technique of ultrasound-guided local anaesthetic nerve blocks so that you will not be in any pain when you wake up from your bunion procedure.

Our outpatient centre at number 9 Harley St offers a full range of diagnostic tests and investigations – on-site – including x-rays, MRI scans, CT and ultrasound scans with our expert team of radiographers and radiology doctors.

Why have corrective bunion surgery?

Bunion deformities are usually an inherited trait, are always progressive, and are unfortunately irreversible by conservative (non-surgical) treatments. They can lead to deformity of the whole forefoot, causing further pain, deformity and shoe-fitting problems. Treatment is now safer, very effective and carries few complications.

Has your operation gone wrong?

Our main Consultant has 20-years' experience in performing bunion corrections. He also has a wealth of experience in revising failed bunion operations. Many patients may believe that nothing more can be done if a bunion operation has failed or the deformity has returned. This is not the case and patients can still have a good result even after previous failed operations. If we can't help you, we will refund your consultation costs.

20-years experience in performing bunion corrections

Our aims at the Harley Street Foot and Ankle Centre

Research shows that if we can eradicate the bunion deformity (thus narrowing the forefoot), remove any pain and give you a greater range of footwear options, then you will be a happy bunny; so that is our aim for you.

Considering having your corrective procedure in London? Talk to us today.

Our patients travel from all around the world for their treatment; including Canada and the USA, Japan, Australia, Saudi Arabia, Sweden, France, Holland, Spain, Malta, India, Switzerland, Egypt, Kuwait, Dubai and Africa. We will help you with your travel plans and accommodation, although our hospital offers boutique-style luxury accommodation and great food. The BMI Weymouth Hospital is fully covered for all the Health Care Insurance providers. We will ensure that your experience is as relaxed and comfortable as possible. We have a highly experienced team who are always on hand to help, advise and ensure your visits to us are stress-free.

Hallux Valgus Procedures in more detail:

Hallux Valgus Procedure

There are no conservative or non-surgical treatments that can reverse your bunion or hallux valgus deformity, but some may give temporary relief.  Many studies have found that over 90 percent of patients who undergo treatment are satisfied with the results.

Recent publicity claiming “lunchtime” procedures and “minimal” invasive procedures are often inadequate and lack a solid medical evidence base. They are only really effective on very small or mild deformities, but these "quick fixes" can sometimes do more harm than good. Also be wary of unrealistic claims that the operation can give you a "perfect" foot. At the very least you will have some scarring although it will be on the side of the foot and will fade over time.

Types of Hallux Valgus Corrective Procedures:

surgery in action

Foot surgeons may use different surgical procedures to treat bunions. The technical aim in most procedures is to anatomically realign the big-toe joint into a more normal position.

These procedures include:

 

 

Exostectomy/bumpectomy (simple removal of bony lumps & bumps around the big toe joint)

Exostectomy/bumpectomy

Sometimes called a Silver’s procedure, which is the simple removal of the bunion bump on the toe joint. Nowadays, this is rarely used on its own unless the hallux valgus angle is within normal limits or there are medical reasons where a more complex procedure should not be contemplated. In more elderly patient where it is just the bump rubbing in shoes, this can be considered due to a quick healing time. In younger patients the procedure may greatly increase the deformity over time and a realignment “osteotomy” should be considered.

removal of a painful bunion bump from the top of the big toe joint
Osteotomy (procedure to cut and re-set the bones around the big toe joint to re-align the deformity).

OsteotomyOsteotomy: The bones on each side of the big toe joint are cut and slid into the new realigned position and the bones are fixed with screws, pins or small plate. The diagram above illustrates the “scarf” procedure, which is our most used realignment procedure. It has a high success rate and a low complication rate. The scar is hidden on the side of the foot for better cosmesis. We can give you scar-care advice following your corrective bunion procedure.
Before and after a scarf osteotomy procedure

 

Before and after photo following scarf osteotomy procedure

 

Correction of a moderate bunion deformity

 

Scarf osteotomy

 

Modified Lapidus bunion procedure (reduction of larger hallux valgus deformity by surgical fusion of a small joint at the base of the 1st metatarsal)

This is for more severe or unstable bunion deformities. By unstable we mean hypermobility or joint laxity existing at the base of the 1st metatarsal which could increase the chance of the deformity coming back. If there is wear and tear arthritis we also perform this type of procedure. This involves fixing the unstable joint at the base of the 1st metatarsal with a titanium plate and screws, which allows the abnormal metatarsal position to be reduced to normal. The procedure takes a little longer than the scarf osteotomy, but you will still be able to walk in a protective boot one week after the operation, just keep on the heel and use crutches for the first week.

Before and after a modified Lapidus procedure for severe bunion

 

To show a modified Lapidus procedure for correction of severe & unstable Hallux Valgus

 

To show realignment of the big toe joint.

 Arthrodesis (salvage for failed hallux valgus procedure - fusion of the big toe joint)


ArthrodesisThis is not a primary bunion procedure and is usually reserved for patients with severe wear and tear (osteo) arthritis in the big toe joint. It can also be used for cases where a previous bunion operation has failed or where the joint has developed permanent pain and stiffness after the procedure. For this procedure, the damaged joint surfaces are removed and plate and screw fixation hold the surfaces together until it heals.

arthrodesis

Your Initial Consultation at The Harley Street Foot & Ankle Centre:

If you are interested in exploring a bunion corrective procedure, your GP can refer you to our clinic for an evaluation.

  • At the consultation we will take a medical history, in which your Consultant gathers information about your general health and asks you about the nature of your presenting problems. He also will ask you about other medical conditions that could affect your surgical outcome. For example, diabetes and rheumatoid arthritis can increase the risk of infection and interfere with proper healing. Circulatory problems can increase postoperative pain and impede healing as well.
  • A physical examination to assess the extent of the misalignment and soft tissue damage and to check for the presence of other foot conditions or deformities, such as hammertoes, neuromas and corns.
  • X-rays to determine the extent of damage and deformity in your toe joint.

Your specialist will review your overall evaluation and tailor the treatment plan to suit your needs and give you the best result. Non-surgical options such as switching to different shoes and or joint injections for inflammation can also be discussed.
This image shows a normal big toe joint on the left x-ray and a hallux valgus/bunion deformity on the right.Our information sheets contain lots of pictures and information to explain the aftercare requirements and any potential risks and complications of bunion operations. You are advised to read this thoroughly and contact us if you have any questions, before the procedure date.

Realistic Expectations about your Corrective Procedure:

An important factor in deciding whether to have hallux valgus corrections is understanding what the procedure can and cannot do. We will aim to realign the big toe joint deformity to straighten the big toe. In most cases this gives good relief of the bunion pain. Some patients have continued stiffness and pain, especially if there is wear and tear arthritis in the joint that was present before the bunion operation. Any patient may require physiotherapy, joint injections and joint mobilization under anaesthetic if the joint doesn’t settle. In most cases you can drive after four weeks and with a sedentary job, return to work after two-weeks.

Footwear Advice:

Footwear advice

Most of our patients will wear a special walker boots for around 4-weeks after surgery to allow full weight bearing after the first week of rest. The next stage after the walker boot, is to wear a trainer, Ugg type boot or other roomy footwear to accommodate the swollen joint. Swelling is completely normal after surgery and usually takes 3-6 months to resolve. Most patients with a good result will be able to wear a greater range of footwear after the operation, and we have no objections to our patients wearing fashionable heels after 10-weeks from the bunion surgery. Of course it may take longer to achieve this and some patients may still never be able to wear the full range of shoes that they would wish to wear. It is also possible with wearing persistent pointed shoes that your bunion may return!!

Revision of Failed Hallux Valgus Corrections:

Even with the best surgery there is a recurrence rate of 10% over a ten-year period after these procedures. We specialise in revision of failed or recurrent bunion surgery if the original procedure is unsuccessful.

Preparing for Your Bunion Surgery Procedure:

Preparing for your procedure

If you decide to have bunion surgery, you may be asked to have a complete physical with your family GP before surgery to assess your health. Before surgery, please tell us of any medications you are taking, or any allergies. We can advise on which medications you should and should not stop taking before the operation.

Tests, including blood samples, a cardiogram, a chest X-ray, a urine sample, and special foot X-rays/MRI scans or ultrasound scans, may be ordered by your specialist to help him plan your procedure.

Your Bunion Surgery

Anaesthetics

Anaesthetics

A lot of bunion surgery can be done as an outpatient procedure (day-case) with recovery at home. Some patients may even choose to have this under a local anaesthetic (awake surgery). Some patient may prefer sedation or a full general anaesthetic and we are happy to provide all of the above methods in our practice to suit your needs. We understand that some patients have fears of being asleep during the bunion surgery and some patients have fears of being awake! Even if you choose sedation or a general anaesthetic (GA) we give all of our patients a local anaesthetic block. We use ultrasound-guidance for these blocks, which is safer and more effective and is considered the gold standard for local anaesthetic blocks.

For further information from an anaesthetic doctor please visit www.anaesthesia.limited

If you are self-funding and are happy to have the procedure under a local anaesthetic and have a carer to give home support, it will be more cost-effective than having surgery under a general anaesthetic. This is because surgery under a general anaesthetic is undertaken at the BMI Weymouth Hospital, off Harley Street, Central London; whereas day-case surgery under local anaesthetic is undertaken at the Chingford Foot and Ankle Centre, in North London.

Staying Overnight

We can only provide this at the BMI Weymouth Hospital. Most patients will have this as a day-case procedure even under sedation or a GA, but we recommend an overnight stay if you are having bunions corrected on both feet at once.

After admission, you will meet the anaesthetist who will evaluate your anaesthetic needs. He or she will stay with you throughout the procedure to administer your anaesthesia, and to make sure you are comfortable.

A bunion surgery procedure normally takes about 30-40 minutes per foot. Afterwards, you will be moved to the recovery room. You will be ready to go home in the afternoon (for day-case bunion surgery) or midday the next day if you are staying overnight

It is important that you have a carer (friend, partner or family member) to escort you home and public transport should be avoided if possible. Use of car or taxi is recommended.

Possible Complications

If complications occur, they are treatable but may affect the extent of your full recovery. Your specialist will explain various options in treating these complications if they occur.

Your Recovery at Home after your Procedure:

Your recovery

For the first week after surgery you will be required to only bear weight on your heel and use the crutches provided. Rest and elevation of the leg is the key to reducing post-operative complications, including abnormal swelling and wound-healing complications such as infections. You should take the prescribed pain-killers and use ice as directed. You should not disturb the dressing without advice first and you must keep it dry. You can obtain a waterproof dressing cover which allows you to fully submerge your foot in water, from the following link: http:/www.limboproducts.co.uk/shop/configurator

After the first week, we will check the wound in our outpatient centre at number 9, Harley St, and put a much lighter dressing on the foot. You will also have x-rays after the first week to check inside the foot. Your special boot will have been delivered to go straight into and commence full-weight bearing. We will normally see you for 2-3 more follow ups after this to make sure you are healing properly.

Exercises to Strengthen Your Foot Following Bunion Surgery

Please download the following PDF file for this advice.

Advice Regarding Sports:

Barring any healing complications, we recommend swimming after 4-weeks. After 6-weeks you can use the cross-trainer, rowing machine or cycle. After 10 weeks you can commence gentle jogging and build up to running thereafter. You will still have some residual swelling which may persist for 3- 6 months. We are happy to see you at any stage if you have any concerns.

Avoiding Problems After Your Bunion Procedure:

Though uncommon, complications can occur following bunion surgery. Contact your specialist for advice if:

  • Your dressing comes off or gets wet
  • Your dressing becomes soaked with blood or drainage
  • You develop side effects from postoperative medications

Also, call your specialist immediately if you notice any of the following warning signs of infection:

    • Fever
    • Chills
    • Persistent warmth or redness around the dressing
    • Increased or persistent pain
    • Significant swelling in the calf above the treated foot

Jason Hargrave Podiatric Surgeon

Your Podiatric Consultant has had extensive specialist training in the diagnosis, nonsurgical and surgical treatment of the foot and ankle, including bones, joints, ligaments, tendons, muscles, and nerves. He has 30-years experience in treating the foot and 23 years experience in operating on the foot and correcting bunions, having performed over 15,000 foot operations.

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Call us: +44 (0)207 870 1076  Email us: jackie@foot-surgery.co.uk