Bunions

By Simon Moyes

There are a number of deformities of the big toe which are often incorrectly bundled together as a "bunion". A true bunion is a condition called hallux valgus which is when the great toe deviates away from its normal axis normally pushing up against the adjacent second toe. This produces the painful and often rather red prominence on the inside of the great toe. Osteo-arthritis of the great toe is sometimes confused with bunions and this too can produce painful lumps over the top of the great toe with stiffness.

True bunions are caused by a combination of familiar or predisposition to the condition and use of tight compressing inappropriate footwear. The pain from bunions tends to be worst when walking in enclosed shoes, often with little bunion pain in sandals or going bare foot.

Treatment options for bunions range from non operative to operative. Non operative options obviously using wider shoes, softer shoes, sandals and sometimes little spacers between the toes. Most patients are able to tolerate these treatments for a little while but the majority of patients normally wish eventually to undergo surgery.

The decision to have surgery is based on a combination of the amount of pain, level of deformity/angulation of the great toe and also rate of progression of that deformity. The surgery is straight forward and commonly performed and involves a combination of removing the bony and soft tissue prominence on the inside of the great toe, this is combined with a z-shaped cut through the bone immediately behind the great toe together with a soft tissue correction to completely realign the great toe, returning its architecture to normal.

The surgery takes approximately half an hour per foot, and can be done under other general or local/regional anaesthesia. Post operatively patients are in compressive dressings no longer requiring plaster casts and are requested to normally rest and elevate their feet at home for forty-eight hours. For the first fourteen days after surgery the compressive dressings remain on, after which patients come up to clinic, dressings are removed, and sutures are removed and patients can switch over to loose comfortable footwear such as trainers or
sandals, normally being able to get back into more normal footwear after approximately six weeks. The incisions used to carry out the surgery are very cosmetically friendly ones on the inside of the great toe, normally just over 4 cm in length.

The reason that bunions are so common and they often become such an issue after the long winter is as already mentioned one of the causative factors is tight footwear and obviously during the winter period, ones feet have often been compressed into inappropriate footwear for some months, obviously aggravating a pre-existing condition.

 

About the author:

Simon Moyes was inspired to train as an arthroscopic (key-hole) surgeon by his early boss David Dandy who was one of the first surgeons to use arthroscopy in 1983. Since then, Simon has become one of the UK’s leading practitioners in this field, performing countless operations in the specialist areas of the shoulder, knee, foot and in particular ankle. Research interests currently include development of minimally invasive and arthroscopic techniques for the knee, shoulder, foot and ankle. Simon is also an accomplished writer in the field of sports injuries and joint ailments, having written articles for a variety of publications including Vogue, GQ, GP Magazine and broadcasting on radio stations like LBC and Radio 4.

Simon’s medical career started when he qualified from The Middlesex Hospital in 1982. His first house job was with the Queen's Orthopaedic Surgeon, Sir Rodney Sweetnam, at his teaching hospital. Following this he went on to Cambridge to do a Trauma rotation for a year before returning to London to study for his primary FRCS, the first part of the Fellowship of The Royal College of Surgeons.

After achieving this he commenced in 1985 a surgical SHO rotation based at St Bartholomew's Hospital whereby he rotated through The National Hospital for Nervous Diseases, Queen Square, amongst other central London hospitals. He then spent one year at Cheltenham General Hospital gaining considerable operative experience in general vascular and neurological surgery, also passing his General Surgical Fellowship, the "FRCS" at the same time.

Mr Simon Moyes then returned to London to commence his specific orthopaedic surgical training at The Westminster Hospital as an Orthopaedic Surgical Registrar. He spent two years on this programme before obtaining a Senior Registrar's rotation out of The Royal National Orthopaedic Hospital. This he commenced in 1989. He also won a research fellowship that allowed him to take six months out of his training programme at The Royal National Orthopaedic Hospital to work at the Clinical Research Centre in Northwick Park Hospital. Whilst the Senior Registrar at The Royal National Orthopaedic Hospital he was able to rotate through other centres of excellence, including Great Ormond Street Hospital and University College Hospital.

Mr Moyes was one of the first Senior Registrars in the country to sit the New Specialist exit exam for orthopaedic surgeons, the intercollegiate FRCS Orth, which he sat and passed in 1991. He then continued on his rotation and became a lecturer in Orthopaedics at The Royal National Orthopaedic Hospital in 1992, this being a twelve month post. Also during this time he had organised visiting fellowships in the Royal North Shore Hospital in Sydney and the Southern California Orthopaedic Institute in Los Angeles.

Simon Moyes took up a post of Consultant Orthopaedic Surgeon at UCL Hospitals in London in 1994 with a special interest in arthroscopic surgery in sports medicine. He went into full time private practice in 1997 and continues this.

Mr Moyes consults out of The Wellington Hospital in St John's Wood, The City of London Medical Centre in the City and also 30 Devonshire Street in the West End. He does seven private clinics a week and two full operating lists per week. Simon Moyes performs around 600 arthroscopic operations a year.