Patient information. Bunion Hallux Valgus Trauma and Orthopaedic Directorate PIF 694 V3

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1 Patient information Bunion Hallux Valgus Trauma and Orthopaedic Directorate PIF 694 V3

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3 Your Consultant / Doctor has advised you to have bunion surgery. There are various procedures used, and your doctor will discuss with you, which is the most suitable for you. What is a Hallux Valgus (Bunion)? The big toe of your foot is called the Hallux. If your big toe starts to deviate (turn) inward in the direction of your little toe (valgus), the condition is called Hallux Valgus. As your big toe moves over, a bump starts to develop on the inside of your big toe over the metatarsal bone. This bone prominence (bump) is called a bunion. Bunions may be hereditary but can also be caused or aggravated by footwear. The condition is more common in women than in men. Once a bunion appears, the deformity of Hallux Valgus worsens slowly over time. Bunion Surgery is often carried out as day case surgery although you may be in hospital for longer depending on your recovery and your general condition. What are the benefits of having bunion surgery? The aim of bunion surgery is to ease your pain and discomfort, which can be quite severe and disruptive to your everyday life. Your surgery should allow you to wear your footwear more comfortably, although you should continue to wear roomy and sensible shoes. What are the risks of having Bunion (Hallux Valgus) surgery? There is a risk that your bunion can recur after surgery.

4 Providing they wear suitable footwear, most people enjoy success, but there is always the risk that it may not be as successful as you wished for. All surgical procedures carry risks of wound infection and delayed wound healing. Damage to the small nerves of toes can also happen. In addition the bone may fail to heal or heal incorrectly, which may leave you with numbness or a painful scar. If you are a smoker and are about to undergo bunion surgery, you are strongly advised to stop smoking for at least one week before your surgery and three weeks after your surgery. By doing this you are lessening the risk of developing a clot and you will find the healing process similar to that of a non-smoker. Are there any alternative treatments available? If you decide not to have surgery you will be given advice about suitable accommodative footwear, which should help you to feel more comfortable and may delay further progression of your bunion. If appropriate, you may also be supplied with a night splint, which can also help to delay further progression of your bunion. What will happen if I don t have any treatment? If you decide not to have any treatment your symptoms will continue and progress What sort of anaesthetic will be given to me? You will be given either a general anaesthetic or a local anaesthetic with sedation. A general anaesthetic is drug-induced unconsciousness: an anaesthetist, who is a doctor with specialist training, always provides it.

5 Unfortunately, general anaesthetic can cause side effects and complications. Side effects are common, but are usually shortlived: they include nausea, confusion and pain. Complications are very rare, but can cause lasting injury: they include awareness, paralysis and death. A local anaesthetic involves an injection that will numb the area being operated on. You stay conscious but free from pain. If having a local anaesthetic you may also be given some sedation to help you relax more. The risks of anaesthetic and surgery are lower for those who are undergoing minor surgery, and who are young, fit, active and well. For more information, please ask for a copy of the leaflet You and Your Anaesthetic (PIF 344). You will be given an opportunity to discuss anaesthetic options and risks with your anaesthetist before your surgery. If you are worried about any of these risks, please speak to your Consultant or a member of their team before you are due to have this treatment. Getting ready for your operation You will usually be seen in the pre-operative clinic before you are admitted to hospital. Here you will have blood tests and sometimes a heart trace and a chest x-ray, if appropriate. You will be assessed to see if you are fit for the anaesthetic. The staff will ask routine questions about your health, the medicine you take at the moment and any allergies you may have. You will be given instructions on eating and drinking.

6 You will be asked to sign a consent form to say that you understand the procedure, and what the operation involves. You will be able to discuss the operation with a doctor. The day of your operation You will come into hospital either the day before or the day of your operation. Please make sure you contact the ward before you leave home to check bed availability. Please bring any medication you are taking into hospital. Please leave cash and valuables at home. If you need to bring any valuables into hospital, a nurse can lock them away at your request. The Trust does not accept responsibility for any items not handed in for safekeeping. You will be asked to remove jewellery - plain bands can be worn but they will be taped. Please leave body piercings at home. False nails and nail polish will also need to be removed. If you are on regular medication, you will be told to take this if necessary. You will be asked to take a shower and put on a gown and disposable underwear. A bracelet with your personal details will be attached to your wrist. You may be prescribed some medication to take before your operation by the anaesthetist. A member of the nursing staff will give this to you. A nurse and porters will take you to the operating theatre. Your dentures, glasses or hearing aid can stay with you on your journey to the operating theatre. When you arrive in the waiting area, a theatre nurse will check your details with you. You will then be asked to put on a disposable hat. The ward nurse will then leave you and you will be taken to the anaesthetic room.

7 What should I expect after my operation? After your operation you will be kept in the theatre recovery room before being transferred back to your ward. A nurse will check your pulse, blood pressure, and breathing rate regularly. It is important that if you feel any pain you must tell the nursing staff, who can give you painkillers to help. The nursing staff will also advise you when you can start taking sips of water. Anaesthetics can make some people sick. If you feel sick we advise you not to drink until this feeling has passed. The nursing staff may offer you an injection to help this sick feeling go away. The first time you get out of bed, please make sure you ask a nurse for assistance / supervision. This is in case you feel dizzy or unsteady. It is also important that you don t put your operated foot to the floor until the physiotherapist has assessed you using crutches and provided you with a stiff-soled sandal, which you will have to wear every time you get up to walk. Going Home You may be discharged on the day of your operation. If so and you have had a general anaesthetic and/or sedation, you must have a friend or relative to take you home and have a responsible adult to stay with you for 24 hours. However, in most cases you need to stay in hospital overnight to allow you to be assessed by the physiotherapist who will teach you how to walk safely, with the aid of crutches, wearing your stiff-soled sandal. You must wear this sandal every time you either stand or walk. This is usually for six weeks or until the specialist advises.

8 For next 24 hours you must not Travel alone Drive a car or ride a bicycle or climb ladders (Your specialist will inform you when you are able to resume these activities, usually around 8 weeks after surgery) Operate machinery (including domestic appliances such as a kettle) Make important decisions, sign any business or legal documents Drink alcohol Return to work within 12 hours of treatment. Your general health and any medicines you are taking may increase the time you need off work. You should Take it easy for the rest of the day, avoid strenuous activity Take your medications as usual Let someone else care for anyone you usually look after, such as children or elderly or sick relatives. Your foot will be bandaged following your bunion surgery. A physiotherapist will assess and advise you of the safest way to use your crutches, especially if you have stairs to manage at home. You will be fitted with a stiff-soled sandal, and will be advised to put your weight through your heel / hind foot so you will not disturb your operation site. You must wear this shoe every time you get up to walk. You will be given an outpatient follow-up appointment for two weeks following your surgery, when you will have your wound checked and any sutures (stitches) will be removed. A physiotherapist will assist and advise you on exercising your ankle and keeping your joints moving.

9 Discharge Information Pain relief & medication When you return to the ward from theatre recovery you will have a numb foot. During your surgery you will have been given numbing injections of local anaesthetic into the nerves which supply the foot so that your post-operative pain is not overwhelming. This numbness will eventually wear off usually after quite some hours and you will need to let the nursing staff know as soon as you feel a tingling sensation so that you can be given painkillers before your feeling fully returns. In about 1 in 20 patients this numbing injection isn t effective and you may require appropriate painkillers much sooner, as prescribed. The nursing staff will advise you about painkillers before you leave the hospital. Please tell the nurses what painkilling tablets you have at home. Your wound It is important to keep your bandages undisturbed and dry to prevent infection and problems with wound healing. Keep your leg raised so that your heel level is above your hip level to prevent excessive swelling and pain. If following discharge you find your foot is more swollen, smelling or oozing, please contact your family doctor (G.P.) immediately and contact the foot and ankle specialist nurse so that an urgent review appointment can be arranged

10 Getting back to normal Between four to six weeks following your surgery you should feel that your life is getting back to normal again, although you will have to continue using your crutches and stiff-soled sandal, as previously instructed. Returning to work You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your hospital doctor to cover the expected time off you will need. Your Consultant will inform you how long you are likely to need off work and this will also depend on your occupation. Further Appointments You will be seen in outpatient clinic at about two weeks and six weeks after your surgery.

11 Further Information If you have any queries or concerns following your discharge, please contact the ward or the specialist nurse below. Waiting list office Tel: Chris Atkinson Specialist Nurse for foot and ankle surgery Tel: and ask for bleep 4634 Or Ankle and Foot Secretaries Jenny Williams Tel: Lisa Rent: Tel: NHS Direct Tel: Authors: Jacqui Dolan and Chris Atkinson Review date: March 2012

12 All Trust approved information is available on request in alternative formats, including other languages, easy read, large print, audio, Braille, moon and electronically.