What will the surgery involve?
i. Anaesthetic - usually a general anaesthetic, you will have a chance to discuss this with the anaesthetist before the operation. You will also have local anaesthetic placed around your ankle, which should reduce the amount of pain you experience.
ii. Scars - two scars:
one on top of the foot
one on the inside of the foot extending down to the big toe
iii. The surgery - The bone at the base of the big toe is cut, straightened and secured with two screws (Scarf osteotomy) and the tendons controlling the alignment of the big toe are rebalanced (distal soft tissue release). One of the bones in the big toe itself usually needs to be realigned, this correction is secured with a staple (Akin osteotomy)
iv. Stitches - Dissolving sutures will usually be used to close the skin.
v. Dressings - Special dressings will be placed on the foot that should be left in place until the post operative review in the clinic.
You will have a ’post operative shoe’ rather than a plaster. This should be kept on for 4 weeks unless instructed otherwise
What happens after the surgery?
i. Going home - This will either be the same day or the following morning depending on the time of surgery and home situation.
ii. Pain relief - The local anaesthetic placed around the ankle at the time of surgery, this will wear off several hours after surgery. It is important to take the pain relieving tablets regularly before the local anaesthetic wears off. You can gradually reduce the frequency with which you take these after twenty four hours.
iii. Walking - You will be able to walk on your heel after surgery. It is important to keep your foot elevated as much as possible, preferably above the level of your heart, for the first two weeks after surgery.
The post operative shoe can be removed at 4-6 weeks after surgery as comfort allows. It might take some time for you to regain full confidence in your walking, you might notice some mild discomfort, but should not experience pain.
iv. Shoes - You will be able to wear normal shoes when the post operative shoe is removed about 4- 6 weeks after surgery.
You may not be able to fit into your usual shoes at this stage as the foot may be swollen, this can last up to 3 months (after the surgery).
You should avoid pointed shoes as these will increase the chance of recurrence (the big toe drifting back across).
v. Driving - You will not be able to drive until you can walk confidently after removing your post-operative shoe, this is usually six weeks after surgery.
If however you the surgery is on your left foot and you have an automatic car you may be able to drive after your two week review, but you should check with your insurance company first.
vi. Follow up - You will be reviewed in the outpatient clinic at:
2 weeks after surgery for wound review and application of a dressing to hold the great toe in the correct position.
6 weeks when an X Ray will be obtained, if this is satisfactory you will be able to start walking in a normal shoe.
3 - 4 months after surgery, further follow up will then depend on your progress.
vii. Work - Returning to work will depend on your job:
Sedentary - 2 weeks
Mobile - 6 weeks
Manual labour - 8-10 weeks
What are the risks of the operation?
There are a small number of risks of surgery including infection, nerve damage, blood clots, ongoing pain and the need for further surgery (please see General Risks of Foot and Ankle Surgery for further information)