A bunion is a bony bump that forms at the base of the big toe. It occurs when the big toe joint becomes misaligned and starts to protrude outward. Bunions can cause discomfort, pain and difficulty in wearing certain types of shoes. If conservative measures fail to alleviate the symptoms, a surgical procedure called the Scarf Akin procedure may be recommended.
The Scarf Akin procedure is a surgical technique used to correct bunions and realign the bones in the foot. It involves two main components: the Scarf osteotomy and the Akin osteotomy.
This part of the procedure involves making a precise V-shaped cut in the bone of the first metatarsal (the long bone behind the big toe). We then carefully realign the bone to narrow the foot and remove the bunion bump. It is then secured with screws or other fixation devices. This technique helps correct the angulation of the metatarsal bone and improves the alignment of the big toe.
The Akin osteotomy is performed on the first phalanx bone (the bone of the big toe). A small cut is made in the bone, and a wedge of bone is removed to correct any deviation of the toe. The bone is then stabilized using a staple or a screw.
The Scarf Akin procedure is performed under general anaesthesia and takes around one hour. It is done as a day case procedure, which means you can go home on the same day.
The Scarf Akin procedure is recommended for patients with moderate to severe bunions who have not found relief from non-surgical treatments such as changes in footwear and/or insoles. The procedure aims to alleviate pain, improve the alignment of the foot, and restore normal function.
After the procedure, you will spend a short time on the ward whilst you recover.
After a few hours you will be safe to return home. This is usually after you have had something to drink and eat and have managed to pass urine. This surgery is routinely done as a day case operation.
You will likely have no feeling in the foot for around 12 hours due to the anaesthetic injections that were done to keep you comfortable. Occasionally this numbness can last longer and this is very normal.
You will receive some painkillers to take for the first week or so. Take these regularly for the first 5 days or so. When the foot feels more comfortable you can reduce them and only take them as and when you need.
You will have a bandage around the foot that comes up above the ankle. This should be kept dry and left in place until you return to your follow up appointment with the nurses after around 2 weeks. If the bandage gets wet / soiled or comes very loose please contact the ward for advice. Please keep the wound dry for the first 3 weeks.
Please elevate the foot above the level of your hip and on a pillow at night for the as much time as you can during the first 2 weeks. This will help reduce the swelling and pain and improve the healing of the wound.
You will be given a post operative shoe to wear. This should be worn at all times when walking and standing. It does not need to be worn at night or when you are sat resting and elevating. The shoe has a heel platform to protect the surgery by making you walk on the heel of the foot. The shoe must be worn for the first 6 weeks after the surgery.
You will receive an appointment to attend the nurse-led treatment room clinic at around 10-14 days after your procedure. This is to take the bandages off and remove and/or trim the stitches. You will then be given a smaller dressing only. Keep the wound covered and dry for another few days to ensure it is fully healed. After this the foot can be allowed to get wet and the dressing can be changed once the foot is completely dry.
A further appointment will be made after around 6 weeks from your surgery, where some x-rays will be taken and you will be allowed to mobilise out of the post-operative shoe and in comfortable broad fitting footwear, such as trainers.
You will be required to fast for a specific period before your hospital admission time. This information will be given to you before the day of your procedure. Fasting times are usually 6 hours for food and 2 hours for clear liquids such as water. Please adhere to these instructions to ensure your surgery is carried out as planned and as safely as possible.
Arrange for some transport both to and from the hospital, as you will not be able to drive yourself home after the surgery.
Once you are admitted to the ward, we will discuss the surgery again and go over any questions you may have. You will be asked to sign a consent for procedure form to document this discussion. An arrow will be drawn on the foot to mark the site of surgery.
The surgery is usually performed under a general anaesthetic with the addition of some local anaesthetic injections around the foot and ankle to make sure you are comfortable when you wake up. Our Anaesthetist who is a specialist in this procedure will see you before your operation to discuss this all with you.
The procedure takes around 1 hour to complete. Afterwards you will be taken to the recovery area where you will wake up. You will have a bandage around the foot that goes above the ankle. After a short period of observation, you will be taken back to the ward.
In total, it will take around 6-9 months to fully recover from the surgery. This is the time it will take you to return to most, or all of your normal activities including sports, without the foot causing some degree of aching or swelling. The foot will remain slightly swollen during this time, usually getting a little worse towards the end of the day and if you walk more on it. This is perfectly normal. The majority of your recovery however will happen during the first 3-4 months. You can usually drive once you are fully walking comfortably, which is often at around 10-12 weeks after surgery on the right foot and 8-10 weeks for the left (unless you drive and automatic). Remember it is up to you to determine if you are safe to drive, including being able to do an emergency stop.