Making decisions based on facts: Bunion surgery – when is the best age?

 

 

I am always dubious about making fast decisions when treating the big toe for bunions (Hallux valgus). For that matter, I prefer my patients to observe caution, so all the facts are laid out and understood. Ponder two cases: one patient – C in her sixties and F in her twenties.

C had was recovering from her second operation on her opposite big toe. Like before she developed problems but was not dissuaded from proceeding. Slow healing, a small wound infection, swelling all took time to heal. I was pleased when we finally reached a point when all was mended at 10 weeks. All the rules were followed, but that was just the way it was. Most patients do well, and certainly sixty plus is not a problem for age, as long as medical health is straight forward, and C’s was.

F was a delightfully independent young woman. She wanted both feet managed for a modest deformity but wanted to travel long haul to Australia 8 weeks after surgery. This raised the risk of blood clot. We can minimise this risk by limiting alcohol on the flight, a 75mg aspirin and flight socks, but not Aussie sun on wound. First you must realise, IF 2 feet are operated on together you are DISABLED! This could go on for 2-6 weeks, depending on how well you do. Reoccurrence? Yes, under 30 is riskier but not unrealistic. You can be operated on at any age but 35-45 is still my best age with least risks and optimism.

 

Look out for more information on bunions during 2018

Bunion surgery the best age?

Bunion surgery the best age?

‘Bunion surgery the best age?’ is asked more times than one might imagine. I add up my surgeries on the bunion I reckon over the years to have operated on over 3000 feet and I am by no means an overactive foot surgeon in that respect. The bunion, also know medically as hallux valgus, is the most common referral to podiatric surgeons, the group of podiatrists who specialise in elective surgery. As you navigate my website you will find there is quite a bit of information about this common condition. We might be obsessed with not having feet like grandmother or mother but there is a right time and a wrong time. After the age of 30-35 the deformity reoccurs slightly less than in earlier years. We reckon on a risk of 7-15% depending upon the source you read. In this brief article or if you like ‘post’ I consider two of my patients from 2016. I am always dubious about making fast decisions when treating the big toe for bunions (Hallux valgus) although sometimes it is inevitable. However, I prefer my patients to observe caution, so all the facts are laid out and understood. Ponder two cases: one patient – C in her sixties and F in her twenties.

C had was recovering from her second operation on her opposite big toe. Like before she developed problems but was not dissuaded from proceeding. Slow healing, a small wound infection, swelling all took time to heal. I was pleased when we finally reached a point when all was mended at 10 weeks. All the rules were followed, but that was just the way it was. Most patients do well, and certainly sixty plus is not a problem for age, as long as medical health is straight forward, and C’s was.

F was a delightfully independent young woman. She wanted both feet managed for a modest deformity but wanted to travel long haul to Australia 8 weeks after surgery. This raised the risk of blood clot. We can minimise this risk by limiting alcohol on the flight, a 75mg aspirin and flight socks, but not Aussie sun on wound. First you must realise, IF 2 feet are operated on together you are DISABLED! This could go on for 2-6 weeks, depending on how well you do. Reoccurrence? Yes, under 30 is riskier but not unrealistic. You can be operated on at any age but 35-45 is still my best age with least risks and optimism.

So when is it the right age?

Under the age of skeletal maturity, around 15-17 girls and 16-19 boys, any bunion surgery can recur. In fact it is possible to have surgery and have to repeat it not once but twice in some less common situations. I have operated on a 14 year old as my youngest and seen a severe bunion in a 9 year old.

Leaving the decision for surgery later is better, provided that the skin is not damaged, that the joint retains some reasonable function and lastly that you as a patient can find a conservative approach to keep you comfortable. This does mean watching out for correctly fitting shoes which to females can be disappointing. Thirty-five to seventy-five works well but patients with good overall mobility do better. Over this age the decisions can be prejudiced by medical problems but do not preclude surgery although the complexity will depend on bone quality factors. My oldest bunion patient was 94 years so I am not keen on being ageist when I make decisions but healing quality diminishes with age as a general observation. 

Check out my these articles by clicking over the subject matter

Factsheet on bunions 
Jo’s Bunion Journey

 

Thanks for reading ‘Bunion surgery the best age?’.

David is a retired podiatric surgeon turned author, public speaker and educationalist and has been in practice for 40 years.