A bunion is a bony lump that forms on the side of your foot, at the base of the big toe. If a bunion becomes worse over time it can cause further problems, such as arthritis in the joint of the big toe.

The cause of a bunion is unknown. Possible reasons for bunions on your feet include:

• A joint deformity such as your big toe joint bending outwards (hallux valgus)
• A genetic tendency
• Osteoarthritis or rheumatoid arthritis
• Previous foot injuries
• Wearing badly fitting shoes

Not all people get bunion foot pain; the most obvious symptom of a bunion is an angular, bony bump on the side of the foot. This might be covered with sore skin.

Other symptoms may include:

• Your big toenail pointing inwards towards other toes
• The foot becoming wider so shoes may not fit
• Pain on walking, standing, running or squatting
• Unusual tenderness at the base of the big toe and in the ball of the foot, caused by swelling and inflammation around the joint
• Hard, callused, red skin where your toes overlap

Your GP should be able to diagnose bunions on your feet based on the pain you’re experiencing and the shape of your toe.

They can refer you for further tests at Benenden Hospital, such as x-rays, to determine the severity of your condition. Blood tests may also be recommended to investigate whether arthritis could be causing your pain.

If painkillers, bunion pads or orthotic aids (such as wearing insoles) are unsuccessful at managing the symptoms of bunions, then osteotomy surgery will usually be recommended. The type of surgery you undergo will be discussed with your Consultant beforehand. It’ll depend on the exact condition you have, its severity, the shape of your foot and whether you have any wear and tear (osteoarthritis) in the joint.

Surgery is a successful treatment for around 90% of people, helping to relieve bunion foot pain and improving the straightness of the big toe.

A scarf osteotomy (sometimes performed with an Akin osteotomy) is surgery for bunion removal or the correction of a deformity at the base of the big toe, and the realignment of the toe itself.

During the procedure parts of bone are removed and the bones of the foot and toe are realigned correctly. Any bunions, or bumps on the joint, will be removed at the same time. The procedure will help correct the deformity, alleviate the pain associated with the condition and reduce the pressure caused by the big toe jamming against the other toes.

Chevron osteotomy

This is the most common bunion removal surgery and is ideal for less severe bunions. The end of the long bone leading to the big toe (metatarsal) is cut and rotated to straighten the big toe. Your surgeon may also make soft tissue adjustments around the joint.

Scarf and Akin osteotomies

In a scarf osteotomy, the bone is cut and re-joined to improve the alignment of the toe, alleviate the pain associated with the condition and reduce the pressure caused by the big toe jamming against the other toes.

The operation is carried out through one cut on the foot, to the side of the big toe. A tendon is adjusted to bring the toe into the correct position before the bone is cut and realigned. The bone is then fixed with screws and the joint is repaired to keep the toe straight.

In some severe cases, an additional procedure called an Akin osteotomy may be needed to achieve good correction and alignment.

The osteotomy may be carried out under a general anaesthetic (so you’ll be asleep) or a local anaesthetic (so you’ll stay awake but won’t feel anything). The operation usually takes around an hour and you’ll usually be able to go home on the same day.

Immediately after surgery we’ll help you manage any pain or discomfort with painkillers. We’ll discuss your aftercare and arrange any follow-up appointments with you before you leave hospital.

In the next few days you’ll be able to walk with the aid of crutches but you’ll need plenty of rest with your foot raised. You will be given a special shoe to make sure you don’t put too much weight on the wrong part of your foot.

After three to four weeks you may be able to return to work and resume normal day to day activities. After eight to twelve weeks your foot should start to feel normal again and it may be possible to return to sport. After six months there should only be slight swelling (if any) and you should be feeling the full benefits of surgery.