Back on her feet: 71-year-old Theo Spring
THE PATIENT
Over the past ten years, the big toe on my left foot has been gradually turning inwards and a lump has been growing on the side of the joint. I knew it was a bunion because some of my friends suffered with them.
At first it didn’t hurt so I didn’t worry about it, but recently it became red, sore and was often painful when I walked. I also found I could no longer stretch and separate my big toe from the one next to it as it was too stiff to move.
I’ve never been into pointy shoes or high heels, so I knew my footwear wasn’t to blame, but even so I started buying shoes that were softer and provided a bit more room. Sadly this didn’t help.
I volunteer at a hospice shop and when I’d had a busy day on my feet, the bunion would really ache and I couldn’t wait to take my shoes off afterwards. Walking for long periods or gardening also became more difficult.
So in April this year, I finally accepted it wasn’t going to get better on its own and I went to see my GP. By now, the top layer of skin had rubbed off and it was red raw.
My GP said I probably needed surgery. I was wary as my friends had found the operation painful and said that recovery was slow, but the doctor mentioned a new technique that’s less invasive.
Apparently an orthopaedic surgeon had visited the clinic a few days earlier to give a talk about the new procedure and it sounded much simpler, so I used my private health insurance to see him a week later.
The surgeon X-rayed my foot and showed me how far my big toe was leaning over and the bunion looked huge. He explained surgery would cut off the bunion and straighten my big toe with screws. But rather than needing a large incision, he could now do it through five tiny cuts. It meant I could go home on the same day as the operation.
Foot fall: More than 15 million Britons suffer with bunions, a bony bump near the big toe
I underwent the half-hour procedure in May at the BMI Shirley Oaks Hospital in Croydon under general anaesthetic. I woke up with a large bandage around my foot but I wasn’t in pain. I went home later that day and was given a special shoe with a thick sole to wear when walking. I was back to driving within a week.
The bandages were removed two weeks later and I could start wearing soft trainers in a larger size, which wouldn’t rub against my foot as it was healing. I wore a light splint on my toe for four weeks — mainly for comfort — and was examined again after six weeks. All was well, so my surgeon discharged me.
Now my foot is back to normal and the scars are barely noticeable, even in sandals. I can wear any shoes I want and I’m as active as I ever was with my grandchildren and when I’m gardening.
THE SURGEON
Kumar Kunasingam is a consultant orthopaedic surgeon at Croydon University Hospital and BMI Shirley Oaks Hospital.
Recent figures show around a quarter of all adults have bunions, and by the time we reach 65, this figure rises to more than a third.
In many cases we don’t know the exact cause, but studies suggest it is inherited. Although footwear doesn’t cause bunions, shoes rubbing on them can make them worse and more painful.
Bunions form when the bone or tissue at the joint at the bottom of the big toe moves out of place.
The big toe is made up of two bones: the lower one is attached to the foot where it joins the metatarsal bone. This joint has a capsule made of a thick, soft tissue around it, but over time, the bones and capsule become worn and they stretch, making the joint less stable.
At the same time, the stronger tendons that help the toe move start to pull it out of line and, as a result, the big toe bends inwards and a painful lump forms on the joint.
Cause: Bunions form when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out
It is painful because a fine nerve around that area of the foot becomes squashed by the misaligned bone.
Slowly, people start to walk differently and the big toe puts pressure on the smaller toes, causing deformities in the other toe joints, too, such as the condition hammertoes, where they start to curl underneath the foot.
The only cure for bunions is surgery. Traditionally this has been done using open surgery. We make a 10cm to 15cm incision in the skin and cut through until we reach the bunion — then we shave it off using a saw. We take a wedge out of the bone, straighten the toe and hold it in place with large screws.
The operation is successful but because of the large incisions in the skin, tissue and bone, it takes a while to heal. Patients get a lot of swelling and stiffness which can be very painful.
Often, patients can’t walk for days as putting weight on the foot causes too much pain. They must also wear a bulky bandage, cast or boot for six weeks while it recovers.
The bandage stops the tissue stretching around the toe before it has healed. If it gives way too early, the bunion could recur.
At the beginning of this year, I started performing a new, less invasive operation for bunions, which means patients can start walking a few hours after surgery rather than days later. It’s a technique that has been refined in the past few years as better equipment has become available.
As with traditional surgery, it’s done under general anaesthetic and takes 30 minutes. The biggest difference is that we now have much smaller tools which allow us to work through tiny incisions.
First, I make five 3mm incisions. I go through one of these to cut off the bunion with a tool called a burr, which is only 2mm wide and makes lots of tiny cuts in the bunion so there is less damage to the surrounding tissue. That means less swelling overall and a quicker recovery.
The screws we use in this new operation are also different: they have a bevelled edge that sits flush on the bone without leaving any bumps that could otherwise rub on footwear and cause longer-lasting pain — this can sometimes be a problem with traditional surgery.
These newly developed titanium screws from Germany were approved for use in the UK only at the start of 2017. They are very robust and fit into smaller cuts than the screws we used before.
Because I haven’t made any large incisions, I don’t need stitches. I use Steristrips on each of the incisions and then bandage the foot. Patients can walk and go home the same day.
When I examine the foot after two weeks, I give the patient some simple stretching exercises to help recovery.
The patient is mobile quicker than with open surgery because there’s no painful wound to heal. This leads to reduced stiffness and swelling.
I’ve carried out about 50 of these operations both privately and on the NHS since January. There are about 25 other surgeons in the UK doing it, too.
It’s a game-changer because it takes away the bunion pain using small incisions, the patient gets back to their normal life much more quickly and there are no obvious scars.
This surgery costs £4,100 privately and about £3,500 to the NHS