T

he Hallux valgus (bunion) is the most common foot deformity. A bunion is a bony protrusion on the side of the big toe and is a common source of pain and difficulty when wearing shoes (see Figs. 2 and 7). Bunions are commonly associated with deformities of other toes, such as hammer toes and claw toes. The main underlying problem is the protrusion of the “knuckle bone” of the foot, (the metatarsal bone).

These foot deformities can also cause painful corns under the balls of the feet, or along the sides of the feet at the bunions, and occasionally on the fifth toe (also known as a bunionette deformity). Another common association is that of flat feet, and tight calf muscles.

Many people live with these problems by wearing broader extra-width shoes or open sandals but more severe and problematic conditions often need surgery. Unfortunately, foot surgery has traditionally been associated with long downtime needed to recuperate afterward, which has deterred many patients. Fortunately, new techniques and concepts in surgical management have shortened downtime by as much as half.

Traditional techniques include Distal Osteotomies (e.g. Mitchell or Chevron Osteotomies) for milder bunions. An osteotomy is a cut made in a bone to correct a deformity. This is a relatively simple procedure. However, it cannot correct more severe deformities. Recuperation from an osteotomy takes about six to eight weeks. (Figs. 1 and 2).

More severe deformities require Proximal Metatarsal Osteotomies or fusions (Lapidus procedure) and take a longer time to heal — around three to four months. Usually, a cast also has to be worn on the foot for about six weeks followed by a period using a walking boot.

The Scarf Osteotomy is a hybrid procedure that includes the best of both worlds. It is able to correct extremely severe deformities and yet has the shortest downtime of all: four weeks to regain full weight-bearing walking. This is even quicker than a Mitchell Osteotomy, which typically takes about six to eight weeks for full recovery. The term “scarf” comes from carpentry and the nature of the scarf cut is that it is more stable, allowing for quicker recovery and weight bearing.

With the aid of a special walking shoe, the patient is able to walk immediately with a minimal amount of pain soon after surgery. By about four weeks, most patients are walking reasonably well. If the patient is into sports, they should be able to resume sporting activities within around three months.

Dr Yung is a consultant Orthopedic Surgeon at the Mount Elizabeth Medical Center, Singapore. He has a special interest in the field of Foot and Ankle Surgery, as well as Shoulder Surgery.