SCARF OSTEOTOMY
PLEASE KEEP YOUR FOOT ELEVATED ABOVE YOUR HEART AS MUCH AS POSSIBLE FOR THE FIRST FEW WEEKS AFTER YOUR SURGERY
Cheilectomy of the Big Toe
Scarf osteotomy is an operation to correct a moderate to severe bunion (hallux valgus) deformity.
Why have it done?
Surgery for a bunion may be advised if simple measures, such as well-fitting shoes, simple painkillers and padding do not relieve the discomfort of the bunion. It is only appropriate if you are willing to be realistic about shoe wear after surgery, and understand and accept the potential problems of the procedure. A scarf osteotomy is appropriate for moderate to severe deformities; for mild deformities lesser operations are better.
What does it involve?
Two incisions are made; these are between the big and second toes and also over the bunion. The bony lump is removed and the knuckle bone (first metatarsal) is cut through, re-positioned and fixed with two small screws. The soft tissues of the big toe joint are tightened to correct the deformity and the wounds stitched up, usually with stitches that dissolve inside your skin.
How long will I be in hospital?
You will be required to stay in hospital for 1-2 nights.
Bunion surgery can be painful for 36-48 hours. The most common reason for having to stay overnight after bunion surgery is for pain control. The post operative pain is limited by a local anaesthetic block of the toe (applied during surgery).
General / Local anaesthetic?
You will usually have a general anaesthetic. In addition to this, a local anaesthetic may be injected into your leg/foot while you are asleep to reduce the pain after the operation even if you go to sleep for the surgery. You will also be given pain-killing injections and tablets as required.
Will I have a plaster on afterwards?
Very rarely. An x-ray will be taken after the operation.
A dressing and a bandage will be placed on your foot and you will be fitted with a protective wedge shoe with a stiff sole. You will be allowed to fully weight bear through your foot and you will need to wear the wedge shoe for the first six weeks after surgery.
Two weeks after surgery
You will need to be seen again by Mr Williams in his clinic. Your wound will be checked and you will be given a Velcro splint to wear all of the time for a further 2 weeks. You will also still be required to wear the wedge shoe for a further 4 weeks. Frequent elevation of your foot is vital until this stage. Physiotherapy is arranged and is to start at 4 weeks after surgery.
Six weeks after surgery
You are now allowed to commence weaning out of the wedge shoes. Some patients find this difficult due to the amount of swelling in the foot. It is advisable to try wearing an open shoe initially, and as your swelling reduces, you can try a trainer or supportive shoe. Most patients have progressed out of the wedge shoes by 6 weeks after surgery.
Why do I need to attend physiotherapy?
It is important that you regain as much function as possible from your foot after toe surgery. As the joint will be stiff and swollen in the early stages post operatively, it will limit how well you are able to walk.
Physiotherapy will include mobilising your toe joint and foot to help you regain normal movement. You will be given exercises to do at home until you are moving properly and your foot is comfortable. Your physiotherapist will advise you when to return to normal activities.
Physiotherapy will maximise the effect of your operation. If the joint was left to heal on its own, it may remain stiff and affect your walking. This can lead to further ankle, knee and back problems.
On average, 8-10 sessions of physiotherapy are required post operatively.
Orthotics
Mr Williams may recommend that you have a pair of orthotics made to help maintain a healthy foot position in your shoes and to maximise the benefit of your surgery. Orthotics are custom made insoles made by a qualified Podiatrist. This is however, unusual.
Returning to work
This depends on what you do and how you get to work. If you have a sedentary job that allowed you to work with your foot in bandages, you can return to work a week after surgery.
If you have a heavy manual job or are on your feet all day e.g. a nursing/teaching, you may be off for up to 3 months. If you need to drive to work, this will affect when you can go back. Mr Williams will advise you about going back to work.
Driving
Once your bandages have been removed, you may be able to start driving again. You must be comfortable and not too stiff before trying to drive. Start by sitting in the car and trying the pedals then drive round the block. Drive short distances before long ones. Remember, if you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. Ask Mr Williams or your physiotherapist when it is safe for you to drive again.
Playing sport
You will be guided by both Mr Williams and your physiotherapist regarding how and when to return to sport. Each individual varies with how quickly they can take up exercise again. Be guided by your own body’s reactions and the advice that you have been given.
Most people can get back to most of their previous activities within 6 months of bunion surgery.
What can go wrong?
Research shows that 85% of people who have bunion corrections are satisfied with the results. However, a number of problems can arise.
The big toe is occasionally stiffer than before. For most people this does not matter, but for athletes or dancers it is very important.
In some people the big toe slowly tilts back toward the original position, but this is usually cosmetic only.
Elevation of the foot is vital within the first 2 weeks after surgery, as your foot will tend to swell up quite a lot otherwise.
Swelling is part of your body’s natural response to any injury and surgery is no exception. In addition, as your foot is at the bottom of your body, fluid tends to collect in its tissues and cause swelling. People vary in how quickly this swelling disappears after an operation and 6 months is not all that unusual. Provided you are not having undue pain or inflammation there is probably nothing to worry about and you can afford to give it time.
If you develop a fever associated with an increase in pain and a discharge from the wound please call Mr Williams’ secretary. If you have any questions please call Mr Williams’ secretary.
Thank you.
