Bunion surgery in Barcelona

What is a tailor's bunion and how does it differ from an ordinary bunion?

A tailor's bunion (bunionette) is a bump on the fifth metatarsal bone, at the base of the little toe, and it is less common than an ordinary bunion, with similar symptoms and causes.⁴ It is usually due to an inherited defect in the structure of the foot, and sometimes it is actually a bony spur on the side of the head of the fifth metatarsal.⁴

Its symptoms are redness, swelling and pain, which narrow shoes make worse.⁴ It is easily diagnosed because the bump is visible, and the specialist may request X-rays.⁴

According to Foot Health Facts (the American society of foot and ankle surgeons), treatment starts without surgery: wide-last shoes, pads, anti-inflammatories, ice, corticosteroid injections or orthotic devices. Surgery is considered if the pain continues despite these measures.⁴ The cited sources do not detail the risks of these options for a tailor's bunion, nor do they compare custom-made orthotic devices with off-the-shelf ones, so there is no evidence here in favour of any paid option.

What options are there without surgery and what drawbacks do they have?

A podiatrist or the doctor may advise insoles (orthoses), toe spacers and toe splints to reduce pain.² The CGCOP informed consent for hallux valgus surgery states that painkillers and anti-inflammatories, suitable footwear, offloading insoles and silicone sleeves may improve the discomfort but not correct the deformity.³ The cited sources do not detail the adverse effects of painkillers for a bunion nor compare custom-made insoles with off-the-shelf ones.

What is the operation like and what does the evidence say?

The most common surgery is osteotomy: the bunion is cut or scraped away, the bone of the toe is straightened and fixed with screws or staples that are often left in permanently. The NHS says it is usually done under general anaesthetic, sometimes under local, and that most people go home the same day.² The CGCOP consent says it usually requires local or locoregional anaesthesia, so the sources do not agree: ask which anaesthesia is planned in your case.³

The evidence is limited. In the Cochrane review (25 studies, 1597 adults), a trial of 140 participants found that surgery may reduce pain by a clinically important amount at 12 months compared with no treatment (21 versus 39 points out of 100), with a slight increase in function and no difference in quality of life, all with low certainty.¹ The effect of surgery on reoperation and adverse events is uncertain, there are no trials against sham surgery and most of the trials had a risk of bias.¹ Complex osteotomies probably make little or no difference to pain compared with simple ones and may increase reoperation.¹

How long does recovery from bunion surgery take?

Recovery takes months. The NHS says to rest with the feet raised for at least 2 weeks, avoid driving for 6 to 8 weeks, be off work for 2 to 12 weeks and avoid sport for 3 to 6 months.²

• Rest with the feet raised: at least 2 weeks.²
• Driving: not before 6 to 8 weeks.²
• Work: 2 to 12 weeks off.²
• Sport: not before 3 to 6 months.²

The cited sources do not say how many follow-up appointments are needed after the operation.

What are the risks of bunion surgery and can bunions come back?

Bunion surgery has risks, and bunions sometimes come back.² The CGCOP informed consent for hallux valgus surgery describes pain for weeks or months and shortening of the toe with temporary inability to move it as certain consequences.³ As risks it lists:³

• Injury to vessels, nerves or tendons.³
• Thrombosis with swelling of the leg and, rarely, pulmonary embolism.³
• Wound infection.³
• Infrequently, recurrence of the deformity, skin necrosis (death of an area of skin), a painful scar and breakage or rejection of the screw or the pin.³

After the operation, the toes may be weaker or stiff, not perfectly straight, or may still hurt.² Among the options without surgery, footwear, pads, insoles and silicone sleeves relieve the discomfort but do not correct the deformity.³

When should you see a podiatrist or a doctor about a bunion?

The NHS advises seeing someone in these cases:²

1. The pain has not improved after a few weeks of home care.²
2. The bunion stops you doing your normal activities.²
3. The bunion is getting worse.²
4. You have diabetes and bunions.²

If you have already had surgery, the CGCOP consent lists thrombosis with swelling of the leg, pulmonary embolism (rare) and wound infection as risks of the operation.³ The cited sources do not detail the warning signs after surgery, so if you notice swelling of the leg or problems with the wound, contact whoever operated on you.

This list is a guide and does not replace assessment by a health professional.