Bunion Surgery (Scarf Osteotomy)

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Expert Patient Guide  ·  Foot & Ankle Surgeon  ·  London & North London

Bunion Surgery (Scarf Osteotomy) in London

A patient information guide by Mr Matthew Welck — Consultant Orthopaedic Foot & Ankle Surgeon, RNOH Stanmore & North London

At a Glance: Bunion Surgery

ProcedureAn operation to straighten the big toe (hallux valgus correction). The bone behind the big toe is cut carefully (scarf osteotomy) and moved into a straighter position. Often a small cut is also made in the big toe itself (Akin osteotomy).
Who is it for?A painful bunion that makes walking, wearing shoes, work or sport difficult, even after trying wider shoes, padding and insoles.
AnaestheticYou can be asleep (general anaesthetic) or awake with your foot numbed (ankle block). Numbing medicine is also used to ease pain afterwards.
Hospital stayMost people go home the same day; a few stay one night.
RecoveryYou can walk the same day in a flat surgical shoe. Keep your foot raised for 2 weeks. Wear the surgical shoe for 6 weeks, then wide trainers from about 6–8 weeks. Swelling goes down over 6–12 months.
ResultsIn a large UK study, about 97 in 100 patients said their foot was better or much better after this operation.
SurgeonMr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL. Private clinics in London, North London and Hertfordshire.

Mr Matthew Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at University College London (UCL). His NHS and private practice covers North London, Central London, Hertfordshire and the wider Greater London area. He has published more than 50 research papers, including award-winning research on bunions using weight-bearing CT scans (3D scans taken while standing). He specialises in bunion and forefoot surgery, total ankle replacement, complex reconstruction and sports injuries of the foot and ankle. This guide explains what happens during bunion surgery, what to expect as you recover, and the possible risks.

01

Why Have Bunion Surgery?

A bunion (hallux valgus) is not just an extra lump of bone. The long bone behind the big toe (the first metatarsal) moves inwards, and the big toe leans outwards towards the second toe. This makes the joint stick out. This is why just shaving off the bump rarely works — the bones need to be moved back into line. Surgery may be an option when the bunion is painful and simpler treatments, such as wider shoes, padding and insoles, are no longer enough.

Bunion surgery can give you:

  • Less pain over the bump and the big toe joint
  • A straighter big toe and a narrower front of the foot, so shoes fit more comfortably
  • Less pressure on the smaller toes and the ball of the foot, which can ease or prevent problems such as hammer toes and pain under the second toe
  • Easier walking and standing, and a return to exercise and sport
  • A long-lasting result for most patients

What the research shows: In a UK study of almost 1,200 patients who had this operation, about 97 in 100 said their original foot problem was better or much better, and more than 9 in 10 said the operation met their expectations.

Important: bunion surgery is not a cosmetic operation. It is done to ease pain and help your foot work better, not just to improve how it looks — a painless bunion is usually best left alone.

02

Preparing for Surgery

Preparing well helps your recovery go more smoothly and lowers the risk of problems. Before your operation you will:

  • Have a health check before surgery (pre-operative assessment) to make sure you are well enough for the anaesthetic
  • Have X-rays taken while standing (and sometimes a 3D CT scan while standing) so your operation can be planned carefully
  • Be asked to stop smoking — smoking increases the risk of the bone not healing and other serious problems by up to five times
  • Go through your medicines with the team, as some (such as blood thinners, HRT or the combined contraceptive pill) may need to be changed
  • Arrange time off work, a lift home and help around the house for the first two weeks

It helps to buy a few things before surgery:

  • A foam leg elevator (a wedge-shaped cushion to rest your leg on) — keeping your foot raised above groin level for the first two weeks greatly reduces swelling, throbbing and wound problems
  • A waterproof cast and dressing protector, such as LimbO — so you can shower while keeping your dressings completely dry
  • Loose trousers or shorts that fit over a bulky bandage, and a flat, supportive shoe for your other foot
  • Ready meals and a clear, clutter-free route between your bed, bathroom and kitchen

For more detailed advice, please read our patient leaflets: Preparing for Foot Surgery (PDF) and Recommended Products Guide (PDF).

03

What Does the Surgery Involve?

Bunion surgery is done either while you are asleep (general anaesthetic) or while you are awake with your foot numbed (ankle block). Either way, numbing medicine (local anaesthetic) is injected around the foot, so it stays numb for several hours afterwards. The operation usually takes 45–90 minutes.

During the operation, the surgeon:

  • Makes a cut along the inner side of the big toe joint
  • Shaves away the bony bump
  • Loosens the tight tissues on the outer side of the big toe joint so the toe can straighten — sometimes through a second small cut on the top of the foot
  • Performs a scarf osteotomy — a Z-shaped cut along the long bone behind the big toe (the metatarsal). The bone is then moved (and, if needed, turned) into a straighter position
  • Holds the bone in place with two small screws. These sit inside the bone and normally stay in for life
  • Often adds an Akin osteotomy — removing a small wedge of bone from the base of the big toe to straighten it further. This is held with a small staple or screw
  • Closes the skin with stitches and puts on a padded bandage

If the smaller toes are also bent (for example, hammer toes), these can often be fixed during the same operation.

Why the open scarf osteotomy? Mr Welck mainly uses the open scarf osteotomy because, in his experience, it gives consistently accurate and reliable results. The surgeon can see the bone clearly, correct its position accurately and hold it firmly with screws — so you can walk the same day in a surgical shoe, without a plaster cast. Keyhole (minimally invasive) bunion surgery may suit some patients, and you can talk about this at your consultation.

04

How Long Will You Be in Hospital?

Most patients go home on the day of surgery. Some people need to stay one night. This depends on your general health and how quickly you recover from the anaesthetic. You will be ready to go home once you:

  • Have your pain under control with tablets
  • Can walk safely in your surgical shoe, with crutches if needed
  • Have been seen by the physiotherapist and shown how to use stairs safely

You will need someone to drive you home. Everyone is checked for their risk of blood clots, and some people are given blood-thinning medication to take at home.

05

What Does Recovery Look Like?

Early Phase (0–2 weeks)

  • From the day of surgery, walk on your heel in a flat, stiff-soled surgical shoe. Use crutches for balance at first
  • Keep your foot raised above groin level as much as possible — only walk short distances around the house
  • Take regular painkillers and keep the dressings clean and dry
  • At your clinic appointment after 2 weeks, we check the wound and remove the stitches. Once the wound has healed, you can shower normally

Mid-term Phase (2–12 weeks)

  • Keep wearing the surgical shoe until 6 weeks. At this point an X-ray checks that the bone is healing
  • Switch to wide, soft trainers from around 6–8 weeks
  • Do regular big toe exercises — moving the toe gently up and down — to prevent stiffness. Physiotherapy will help you get back to normal walking and build strength
  • Work: you can usually return to a desk job from around 2–4 weeks if you can keep your foot raised. Jobs where you stand or do physical work may need up to 3 months off
  • Driving: if your left foot was operated on and you drive an automatic, usually from around 3 weeks. Otherwise, usually after 6–8 weeks, once you can do an emergency stop safely. Tell your insurance company
  • Flying: avoid flying for around a month after surgery to reduce the risk of blood clots

Long-term Phase (3–12 months)

  • Swelling goes down slowly — some swelling at the end of the day is normal for 6–12 months
  • You can usually return to running and most sports between 3 and 6 months, and to swimming and cycling earlier
  • Narrower and fashion shoes usually become comfortable from around 4–6 months
  • Most patients see their final result about 12 months after surgery
06

What Are the Risks?

Modern bunion surgery works well for more than 90 in 100 patients, but as with any operation there are risks. The figures below come from a large review of more than 1,500 of these operations. The main risks of this operation are:

  • The bunion gradually coming back (recurrence) — in about 5 in 100 patients. This is more likely with very severe bunions
  • Over-correction (hallux varus) — the big toe moving too far inwards, in about 3 in 100
  • A stiff big toe joint — doing your exercises helps reduce this risk
  • Bone healing problems — the bone not joining (around 2 in 100) or healing in not quite the right position. Smoking greatly increases this risk
  • Nerve irritation — numbness or tingling on the inner side of the big toe, which usually gets better with time
  • Transfer pain — new pain or hard skin under the ball of the foot
  • Screws that stick out or rub — occasionally these need to be taken out later
  • Infection — around 2 in 100, usually minor and treated with antibiotics
  • Loss of blood supply to the end of the metatarsal bone (near the big toe joint) — rare (around 1 in 100)

General risks of any foot surgery — including blood clots in the leg or lungs (DVT/PE), complex regional pain syndrome (a rare, long-lasting pain condition), scar sensitivity and anaesthetic risks — are explained in our patient leaflet: Forefoot Surgery Risks (PDF).

Contact the team urgently if you develop severe pain, a lot of swelling, increasing numbness or pins and needles, calf pain, or shortness of breath.

07

Why Choose Mr Welck?

Mr Welck completed two international fellowships (advanced specialist training), including at the Foot and Ankle Institute in Baltimore, USA. If you have bunion surgery with Mr Welck, you can expect:

  • A surgeon who focuses entirely on the foot and ankle
  • Care from a surgeon active in research — including internationally recognised work on how bunions twist (rotation) and on standing CT scans
  • Careful planning before surgery, with a standing CT scan if needed
  • Experienced physiotherapy and nursing support throughout recovery
  • Private clinics at HCA The Princess Grace Hospital (Central London), Spire Bushey (North London), HCA The Wellington Hospital Elstree (North London) and the RNOH Private Patients Unit (Stanmore, North London), alongside his NHS practice at RNOH Stanmore
08

Frequently Asked Questions

Is bunion surgery very painful?

Your foot is numbed during the operation and usually stays numb for 12–24 hours afterwards. The first one to two weeks are the most uncomfortable, and this can be managed with regular painkillers and keeping the foot raised. Because the bone is held in place with screws, most patients do not need a plaster cast.

When can I wear normal shoes again?

Most patients move from the surgical shoe into wide, soft trainers at around 6–8 weeks. Narrower or fashion shoes are usually comfortable from around 4–6 months, once the swelling has settled.

Can both feet be operated on at the same time?

It is possible, but most patients have one foot done at a time because walking and elevating are much easier with one good foot. Mr Welck will discuss the best option for you.

Will my bunion come back?

It is uncommon for a bunion to come back — this happens in about 5 in 100 patients in large studies — and is more likely with very severe bunions. Careful correction during surgery and following your recovery plan both help reduce this risk.

Do the screws need to be removed?

Usually not. The screws are buried inside the bone and stay in for life. Occasionally a screw starts to stick out or rub and is removed later in a small operation, going home the same day.

When can I get back to running and sport?

Swimming and cycling are usually possible from around 8–12 weeks, and running and most sports between 3 and 6 months. As a foot and ankle surgeon with a specialist interest in sports injuries, Mr Welck will plan a return-to-sport programme with you and your physiotherapist.

Why choose Mr Matthew Welck as your foot and ankle surgeon in London?

Mr Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the RNOH Stanmore and Honorary Associate Clinical Professor at UCL. His research on bunions and weight-bearing CT has received international awards, and his practice covers bunion and forefoot surgery, sports injuries, total ankle replacement and complex reconstruction, with clinics across London, North London and Hertfordshire.

09

Book a Consultation

If you are looking for a foot and ankle surgeon in London or North London for bunion surgery, Mr Welck offers a thorough assessment and a clear, personalised treatment plan.

This guide is for general information and does not replace advice about your own situation. Please discuss your specific case with Mr Welck or another qualified Consultant Foot & Ankle Surgeon.

Written and medically reviewed by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon. Last reviewed: September 2026.

Key Evidence

  1. Clee S, Flanagan G, Pavier J, Reilly I. Correction of hallux abducto valgus by scarf osteotomy: a ten-year retrospective multicentre review of patient reported outcomes. J Foot Ankle Res. 2022. doi:10.1186/s13047-022-00546-3
  2. The incidence of complications following scarf osteotomy for the treatment of hallux valgus: a systematic review with meta-analysis. J Foot Ankle Surg. 2022 (online). 25 studies, 1,583 procedures.

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 28 September 2026

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