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?

 

Is there a best age for bunion surgery?

What is the best age for surgery for bunions? This is asked more times than one might imagine. If I add up my surgeries on the bunion  over the years I reckon 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 heaps 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 to have surgery.


Age thirty upwards

After the age of 30-35 the deformity reoccurs slightly less than in earlier years. We reckon that there is a risk of 7-15% reoccurence depending upon the source you read. In this brief article 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.

-20’s-

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 the Aussie sun on a 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.

-60’s-

C 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.


The Go to Book you can trust

my journey books

If you want more details about the after effects of surgery on your bunion read these true life journey stories as well as the risks in a behind the scenes publication. Read the website article (click here)

e-book and paperback from Amazon (click)


So when is it the right age?

Any bunion surgery can recur. The age of bone growth maturity is around 15-17 (girls) and 16-19 (boys).  
In fact it is possible to have surgery and require a repeat not just once but twice in some less common situations.
My youngest patientI I have operated on was 14 year old, but the most severe bunion was in a 9 year old! 
Children scar more than adults and this can add to concerns

Leaving the decision for surgery later is better
Some of the criteria include:

ensuring  that the skin is not damaged,
that the joint retains some reasonable function
and that you  can find a conservative approach to keep you comfortable.

 Watching out for correctly fitting shoes can be disappointing to some people.
Thirty-five to seventy-five years of age still 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.
Healing quality diminishes with age as a general observation. 


Check out my other articles on bunions

Jo’s Bunion Journey (click)
Patient feedback on bunions with surgery bias
The Bunion hallux valgus deformity Number One
When is surgery indicated for the bunion?


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. Updated and re-published 18th December 2020