Bunion Surgery - The Scarf Osteotomy

Bunion surgery

Scarf osteotomy
This is an operation for painful or severely deformed bunions. It involves removing the prominent bump and realigning the metatarsal bone with an osteotomy (bone cut and screw fixation), combined with a repair of the joint capsule and ligaments.  This will produce a narrower foot and a straighter Big toe.  There may also be simultaneous surgery on the lesser toes, if indicated.
The capsule repair must be protected with the specialised dressing for 2 weeks and the osteotomy requires protection in the post-operative shoe for 6 weeks. The post-operative shoe allows for heel weightbearing (walking) immediately though this is often too uncomfortable for the first week. The foot must be elevated (above the level of the pelvis) for 90% of the time for the first 10 days. This helps to reduce swelling and the risk of infection, and helps wound healing.  Naturally, short periods of walking/standing are allowed.

The surgery is routine, though the recovery is prolonged.

Risks of surgery

Stiffness & swelling
Initially the foot will be very swollen and needs elevating. The swelling will disperse over weeks/months but may still be apparent at 6-9 months.  Often shoes will remain tight for 8-12 weeks. The toe will be stiff but will usually regain its original movement.

There is always a risk of infection with surgery. You will be given 1 dose of intravenous antibiotics during surgery. The best way to reduce the chance of acquiring an infection is to keep the foot elevated for 10 days. If there is an infection it normally resolves with a course of oral antibiotics.

Nerve damage
A nerve supplying the side of the toe lies beneath the incision, and this is at risk of damage.  Usually it is only bruised and will recover.  If the damage is permanent, there will be a small patch of numbness.  This does not normally cause any disability.

Occasionally, the deformity of the toe is not fully corrected. This is more common in severe cases.  This is rarely problematic and requiring further surgery.

Very rarely the toe can be over-straightened so that it angles away from the foot (hallux varus). This usually requires further surgery.

Avascular Necrosis
This is where the blood supply to the bone is disrupted, leading to the bone tissue dying and collapsing, and the joint surfaces being damaged. This can lead to arthritis (pain and stiffness), which may require further surgery.

Sick leave            
4 weeks off work for sedentary jobs
6 weeks off work for standing/walking jobs
8 weeks off work for manual / labour jobs
We will provide a sick note for the first 2 weeks; further notes can be obtained from the GP.

Post operative instructions for the ward
Elevate the leg
Check X-ray prior to discharge
Mobilise fully HEEL weight-bearing in post op shoe for 6 weeks
Dressings to remain undisturbed for 2 weeks.    

Follow up
2 weeks - Removal of sutures Mr Henry Atkinsons Foot clinic
6 weeks - Weight-bearing AP and Lateral X-rays - Mr Henry Atkinsons Foot clinic

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