Bunion Surgery at Premier Foot & Ankle Centre, London
"At Premier Foot & Ankle Centre we have perfected the ideal Bunion operation allowing quick recovery and excellent cosmetic result with well managed post-operative discomfort."
The Scarf Procedure
What is it?
Scarf osteotomy is an operation to correct a moderate to severe bunion (hallux valgus) deformity.
Why would it be done?
Surgery for a bunion may be advised if simple measures, such as well-fitting shoes and padding do not relieve the discomfort of the bunion. It is only suitable once your individual needs are discussed with the consultant and your deformity thorougly assessed. A scarf osteotomy is suitable for moderate to severe deformities; for milder deformities another operation, such as a Chevron, are better.
Are there any alternative treatments?
The best way to treat a bunion is to wear shoes that have enough room for you feet. Sometimes simple padding helps to relieve pressure. If this doesn’t work, the only treatment that is likely to help with the discomfort or pain of the bunion is an operation. You might see adverts for splints, insole or other treatments in magazines or the internet. As far as anyone knows, these don’t work.
What does it involve?
A cut is made over the bunion. The big toe joint is opened and the bony lump is removed. The knuckle bone (first metatarsal) is cut through, re-positioned and fixed with two small screws. The soft tissues of the big toe joint are tightened on the inside to correct the deformity and the wounds stitched up, usually with stitches that dissolve inside your skin. Dressings and bandages are applied.
Can it be done as a day case operation?
If you are medically fit, have someone who can collect you and look after you after the operation, and you are comfortable afterwards, the operation can be done on a day case basis.
However, if you have other medical problems such as diabetes, you may have to be admitted the day before for tests and stay overnight after surgery. If you cannot be collected and looked after you must stay overnight to avoid complications.
Modern Local anaesthetic techniques can help with post-operative pain management and therefore allow you to go home on the sameday.
Will I have to go to sleep (general anaesthetic)?
The operation can be done under general anaesthetic (asleep). Alternatively, an injection in the back, leg or around the ankle can be done to make the foot numb while the patient remains awake. Your anaesthetist will advise you about the best choice of anaesthetic for you.
In addition, local anaesthetic may be injected into your leg or foot while you are asleep to reduce the pain after the operation even if you go to sleep for the surgery. You will also be given pain-killing tablets as required.
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What will it be like after the operation…
Pain?
We will usually give you an injection of local anaesthetic in the foot to reduce pain after the operation. We will also give you pain-killers to take. As soon as you start feeling pain, take a tablet - don’t wait for the pain to get bad. Most people need to take pain killers for at least 3 days after surgery - it varies from person to person.
Will I have a plaster?
You don't usually need a plaster after a scarf osteotomy. Usually we will put dressings and a bandage on your foot and you can walk on it in a protective sandal with a stiff sole. However, if your bone is particularly soft or the soft tissue repair of the joint needs extra protection, a plaster shoe will be put on which you would usually wear for four weeks. A few of our patients choose to wear a plaster even if they don't strictly need one, as they feel more secure.
Will I have stitches?
Normally, we stitch up the cut in your foot with a thread that is buried under your skin and comes out at each end of the wound. It dissolves inside your foot, so it doesn’t need to be taken out. Occasionally we use ordinary stitches that need taking out about 10-14 days after the operation
Will I need crutches?
Most people can walk without crutches after having an operation on one foot. If you have an operation on both feet, it’s usually easier to walk with elbow crutches. We will offer these and show you how to use them.
Will I come back to clinic?
Before you leave hospital we will arrange an appointment in the nurse dressing clinic 5-7 days after the operation. The dressings will be taken off and new, lighter dressings put on. We’ll check you can get about and your pain is controlled.
The second appointment is 10-14 days after the operation. We’ll check your wound again. We’ll usually take an Xray of your foot, and show you how to exercise your toe, look after your wound, and show you how to splint your toe to stop it bending back against the smaller toes.
The third appointment is 2 months after the operation. We’ll check how you are recovering and that you know how to look after your foot. We’ll get another Xray (standing up this time).
If all is well you won’t need any more appointments, but you can contact us if you have any problems.
How soon can I....
Walk on the foot?
Normally you can walk on the foot immediately after surgery, using a stiff sandal that we will provide for you. If you have a plaster, you will be able to walk on the foot once the plaster has dried (48 hours).
Go back to work?
This depends on what you do and how you get to work. If you have a sitting-down job that you could do with your foot in bandages or plaster, and you can get to work, you could probably go back to work a few days after surgery. On the other hand, if you have a heavy manual job you may be off for up to 6 weeks. If you need to drive to work, this will affect when you can go back. Your surgeon will advise you about going back to work.
Drive?
Once your toe has healed, about 6 weeks after surgery, you may be able to start driving again. You must be comfortable and not too stiff before trying to drive. Start by sitting in the car and trying the pedals then drive round the block. Drive short distances before long ones. Remember, if you cannot safely make an emergency stop your insurance will not cover you in the event of an accident. Ask your surgeon when it is safe for you to drive again.
Play sport?
As you get over the operation, you can start gently exercising your foot and walking further each day. When you are comfortable doing this you can start gentle running and stretching. Contact, twisting and impact sports can follow as comfort dictates. Everyone is different in how quickly they can take up exercise again: be guided by your own body's reactions and the advice of your surgeon.
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