Mark Blackney discusses the treatment of a common foot problem – Bunions
Bunion Treatment: Scarf / Akin Osteotomy
Bunions are a common deformity in our community. They occur due to a muscle imbalance that is either inherited or caused by inappropriate footwear. Bunions worsen as we get older and can eventually cause pain and deformity. The bunion may damage other parts of your feet as well. Pain is felt because of their size and abnormal mechanics. The time to have treatment is when they cause significant pain or you have difficulty in finding comfortable footwear. Occasionally bunions are treated when they are not painful in themselves but are placing the rest of the foot at risk of major problems.
At Park Clinic Orthopaedics we use a treatment known as the Scarf/Akin Osteotomy. This is one of the most advanced treatments available. This practice was one of the first in the country to use this treatment which in our opinion has revolutionised the management of this problem. We have used this treatment exclusively for the last 5 years and now have performed around 900 procedures.
If you know someone that has had bunion surgery but not at this practice they may not have had the same treatment as we are recommending. This treatment is only available at a small number of centres. Please understand that many operations for bunions have been tried over the years with varying levels of success.
Most have failed due to high recurrence rates, excessive joint stiffness or by transferring problems to other parts of the foot. The reason why we use the Scarf/Akin Osteotomy is it solves many of these problems.
The procedure has been popularised by Mr. Louis Barouk, a French foot specialist and this procedure is the most common bunion operation performed in that country. The keys to its success are that it is restores foot mechanics, allows excellent joint motion and has very low recurrence rates.
The Scarf / Akin Osteotomy Procedure
The procedure has five components performed through two incisions. Initially, one of the tight ligaments on the opposite side of the bunion is released. Then the bunion is shaved. Following this the metatarsal bone is cut and adjusted to narrow the foot and realign the joint. This is called a Scarf Osteotomy and a small screw is placed in the bone at this time to provide solid fixation. After this a fine wedge of bone is removed from the phalanx bone to straighten the toe. This is the Akin Osteotomy and a small staple is used to hold the bone in place. Finally the joint capsule is tightened where it had been stretched by the bunion and the skin is closed. The metalwork does not need to be removed.
Immediate weight bearing is possible and plaster is not required. Once the bandages are removed in 14 days and the wound healed you are free to move about as you wish. As with all foot surgery, swelling occurs and this is the main limitation to activity and footwear in the early phases. Swelling increases over a 6 week period and then reduces over a further 6 weeks. As such your final result begins 3 months after surgery. As the mechanics in your foot have been substantially changed, your body will go on making subtle adjustments over a 12 month period.
Perhaps just as significant as the procedure advancements is the improvements we have made in post operative pain relief. Foot surgery without appropriate pain relief is extremely uncomfortable. This practice was the first in Victoria to extensively use a sciatic nerve block for foot surgery. While the operation is performed under general anaesthetic a small injection is directed behind the knee toward the sciatic nerve. This puts the foot to sleep for around 12-18 hours meaning that you wake up from surgery without pain and generally don’t get much pain at all when the block wears off. This has made a large difference in the overall surgical experience reducing anxiety and improving recovery.
Unilateral Bunion Surgery
Hospital Stay - 1 night
Rest & Elevation - 7 days
Suture Removal - 2 weeks
Crutches required - 7 days
Time off work
Seated - 2-3 weeks
Standing - 4-5 weeks
Bilateral Bunion Surgery
Hospital Stay - 2-3 night
Rest & Elevation - 10 days
Suture Removal- 2 weeks
Crutches required - 7 days
Time off work
Seated - 3-4 weeks
Standing - 6-7 weeks
Foot swelling 12 weeks
Hospital 3-4 weeks
Wide 4-8 weeks
Normal 8-12 weeks
New > 12 weeks
Good - 3 months
Better - 6 months
Best - 12 months
These timeframes should be used as a guide only and may vary for individual patients based on the nature or extent of the actual surgery performed and individual circumstances. Please contact Mr Mark Blackney’s rooms on (03) 9417 0762 or Mr Terence Chin’s rooms on (03) 9928 6450 if you require further information.