Bunions (Hallux Valgus)

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EXPERT PATIENT GUIDE · LONDON

Bunions — Hallux Valgus

A comprehensive patient guide to bunion surgery in London by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL, serving patients across London, North London and Hertfordshire. Mr Welck is a highly experienced, fellowship-trained foot and ankle surgeon whose NHS and private practice covers bunions and bunion surgery, ankle replacement, sports injuries of the foot and ankle, and the full range of forefoot and hindfoot conditions.

What Is a Bunion (Hallux Valgus)?

A bunion — known medically as hallux valgus — is a progressive deformity of the joint at the base of the big toe (the first metatarsophalangeal, or 1st MTP, joint). The big toe gradually drifts towards the lesser toes while the first metatarsal bone deviates the opposite way. The result is the familiar bony prominence on the inner side of the forefoot.

It is not, as is sometimes assumed, simply a lump of extra bone or “growth”. The bump is the head of the first metatarsal becoming exposed as the underlying alignment changes. Over time, the soft tissues around the joint stretch on one side and tighten on the other, the cartilage can wear unevenly, and the deformity tends to progress.

A specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — gives you an accurate picture of the deformity, the right imaging, and the widest range of treatment options, from footwear and orthotic advice to modern minimally invasive bunion surgery.

At a Glance: Hallux valgus — progressive deformity of the big toe joint (1st MTP). Affects roughly 23% of adults aged 18–65 and over a third of those aged 65+; far more common in women. Patient satisfaction 85–90% in specialist hands.

How Common Is It in the UK?

Hallux valgus is one of the most common forefoot conditions seen in UK foot and ankle clinics. Large pooled studies estimate it affects around 23% of adults aged 18–65 and more than a third of adults over 65, with a strong female predominance (approximately 9:1 in surgical series).

That makes bunions considerably more common than is often appreciated, and they are increasingly seen in active adults, runners and dancers as well as older patients.

As a London-based foot and ankle surgeon with a tertiary referral practice at the RNOH Stanmore, Mr Welck regularly treats patients across North London, Central London and the wider South East — from those with mild, footwear-related symptoms to severe deformities requiring complex reconstruction.

What Causes Bunions?

Bunions are multifactorial. There is rarely one single cause; instead, several factors typically combine:

Genetics and family history — the strongest risk factor. Between 60% and 90% of patients undergoing bunion surgery report a first-degree relative with the same deformity. The shape of the first metatarsal, the orientation of its joint surfaces, and ligament laxity are all heritable.
Pes planus (flatfoot) and over-pronation — increase load on the inner forefoot.
Generalised joint hypermobility — allows the first ray to drift more easily.
Tight calf muscles — transfer pressure to the forefoot during gait.
Footwear — does not on its own cause bunions, but narrow, pointed or high-heeled shoes can accelerate progression and worsen symptoms in someone already predisposed.
Inflammatory arthritis (e.g. rheumatoid arthritis) — can drive aggressive deformity.
Previous foot trauma or surgery, or neuromuscular conditions affecting foot posture.

Mr Welck has conducted widespread research on the role of first metatarsal rotation in bunion formation, which is increasingly recognised as a key factor in deformity and recurrence.

What Are the Symptoms?

Many patients tolerate a bunion for years before seeking help. Typical features include:

Pain over the bump — particularly in enclosed shoes, often with redness and a thickened bursa overlying the joint.
Pain inside the joint itself — a deeper ache suggesting cartilage wear (hallux rigidus may co-exist).
Transfer metatarsalgia — pain under the lesser metatarsal heads as load is shifted away from the big toe.
Lesser toe deformities — hammertoe or claw toe of the second toe, sometimes with crossover. These tend to happen later and are difficult to live with.
Difficulty with footwear — work shoes, sports shoes and dress shoes all become harder to wear.
Numbness or tingling — from irritation of the medial dorsal cutaneous nerve over the bump.
Sports impact — runners, footballers, dancers and racquet-sport players often notice push-off pain and altered foot mechanics, which is why sports injury and bunion assessment frequently overlap in clinic.

Symptoms do not always correlate with deformity: some patients with very prominent bunions are pain-free, while others with mild radiographic changes are very symptomatic.

Investigations

Accurate imaging is essential before any decision about surgery.

Weight-bearing X-rays — standing AP, lateral and sesamoid (axial) views are the cornerstone of bunion assessment.

Weight-bearing CT (WBCT) — where available, WBCT gives a true three-dimensional picture of the deformity, including rotation of the first metatarsal — a factor increasingly recognised as important and often missed on plain X-rays. Mr Welck uses WBCT routinely in complex, recurrent or severe cases and has done widespread research on the role of metatarsal rotation in bunions.

Other investigations:

MRI — if cartilage wear, soft-tissue or nerve pathology is suspected.
Blood tests and rheumatology referral — if inflammatory arthritis is suspected.
Gait analysis and pedobarography — in selected cases, particularly in athletes.

Non-Surgical Treatment

Non-operative care does not correct the bony deformity, but it can ease symptoms and is the right starting point for many patients. Mr Welck always discusses non-surgical options first. It is important to note that these treat symptoms but do not reverse the deformity.

Footwear modification — shoes with a wide, deep toe box, low heel and soft uppers often dramatically reduce pain. Bespoke or stretched footwear can be helpful for established deformities.

Bunion pads and silicone shields to offload the bump.
Toe spacers between the first and second toes.
Custom orthotics for associated flatfoot or transfer metatarsalgia.

Physiotherapy — calf stretching, intrinsic foot strengthening and gait retraining can help, particularly in patients with hypermobility or sports-related symptoms. Mr Welck works closely with experienced foot and ankle physiotherapists across London.

Simple analgesics and short courses of NSAIDs can manage flares.
Image-guided steroid injection has a limited role in true hallux valgus but can be useful when there is significant joint inflammation or co-existing 1st MTP arthritis.

No splint, exercise or device has been shown in high-quality studies to reverse an established bunion.

Surgical Options

Surgery is considered when symptoms persist despite sensible non-operative care and significantly affect quality of life, work or sport. There is no single “best” bunion operation — the right procedure depends on the size of the deformity, the rotation of the first metatarsal, joint condition, bone quality and the patient’s lifestyle.

Shaft Osteotomy (Scarf)

A long Z-shaped cut along the metatarsal shaft, fixed with two screws. Allows correction of moderate to severe deformities, including some rotation. A workhorse procedure with excellent long-term published outcomes. It has a small scar and allows accurate correction of the deformity.

Lapidus Procedure

Fusion of the first tarsometatarsal joint, often with a plate. Particularly useful where there is hypermobility of the first ray, severe deformity, or recurrent bunion after previous surgery.

Minimally Invasive Bunion Surgery (MIS / PECA / MICA)

Modern third-generation MIS uses small (3–5 mm) incisions, specialised burrs and percutaneous screws to correct the deformity with less soft-tissue disruption. In appropriately selected patients, MIS offers comparable correction to open surgery with less swelling and a more cosmetic scar. Mr Welck performs MIS bunion surgery for selected patients and discusses honestly when an open technique is more appropriate. The complication and recurrence rate has come down significantly in recent years as the technique has developed.

1st MTP Fusion (Arthrodesis)

Reserved for severe deformity with significant arthritis, inflammatory arthritis, or recurrent bunion. The joint is permanently fused in a corrected position. Patients usually retain a normal walking gait and can return to most activities, although deep squatting and very high-heeled shoes are limited.

Recovery

Day 0–2: surgery as a day case or one-night stay; foot elevated. Weeks 0–6: walking in a stiff post-operative shoe; regular elevation; dressings and stitches reviewed. Weeks 6–12: gradual return to normal trainers, driving and low-impact exercise once X-rays confirm bone healing. 3–6 months: return to running, racquet sports and most footwear; swelling continues to settle for up to 12 months.

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — the UK’s largest dedicated orthopaedic hospital — and Honorary Associate Clinical Professor at UCL. He runs a tertiary referral foot and ankle practice covering London, North London, Hertfordshire and the wider South East.

Sub-specialist training — double fellowship-trained in foot and ankle surgery, including a fellowship in Baltimore, USA.
Tertiary referral practice — regularly manages complex, severe and recurrent bunion deformities referred from across the UK.
Modern techniques — offers the full spectrum of bunion surgery, from traditional open osteotomies to modern minimally invasive (MIS) bunion correction, selected on an individual basis rather than “one size fits all”.
Sports foot and ankle care — extensive experience treating runners, footballers, dancers and recreational athletes with sports injuries of the foot and ankle, including bunions affecting performance.
Ankle surgery and ankle replacement — full scope of ankle care including total ankle replacement, ankle arthroscopy, ligament reconstruction and management of ankle arthritis, alongside forefoot and hindfoot reconstruction.
Research-active — over 50 peer-reviewed publications and active involvement in teaching as co-organiser of the long-running Stanmore Foot & Ankle Course.
Patient-centred — clear explanations, evidence-based recommendations, and an honest discussion of when surgery is — and is not — the right answer.

Mr Welck consults at the RNOH Stanmore and at leading private hospitals in Central and North London. To learn more about his practice, see matthewwelck.com.

Frequently Asked Questions

Do I need surgery for my bunion?

Not necessarily. If footwear modification, orthoses and physiotherapy control your symptoms, surgery is rarely needed. Surgery is offered when pain, deformity progression or functional limitation outweigh the inconvenience and recovery of an operation. Mr Welck will give you an honest opinion at consultation.

What other foot and ankle conditions does Mr Welck treat?

Alongside bunions, Mr Welck treats the full spectrum of foot and ankle conditions, including ankle arthritis and total ankle replacement, sports injuries of the foot and ankle, Achilles tendon problems, ankle ligament injuries and instability, hallux rigidus, Morton’s neuroma, flatfoot reconstruction, and revision foot and ankle surgery. He sees both NHS patients at the RNOH Stanmore and private patients across London, North London and Hertfordshire.

Will my bunion get worse if I leave it?

Bunions tend to progress slowly over years, but the rate is highly variable. Some remain stable for decades; others worsen quickly, particularly during pregnancy or after weight gain. Operating earlier does not always mean a better result — what matters is choosing the right time and the right procedure.

Is minimally invasive (MIS) bunion surgery better than traditional surgery?

Modern third-generation MIS techniques can achieve correction comparable to open surgery in carefully selected patients, with smaller scars and often less soft-tissue swelling. However, MIS is not appropriate for every deformity — particularly severe, rotational or arthritic bunions. Mr Welck offers both open and MIS techniques and will recommend the option best suited to your foot.

How long will I be off work after bunion surgery?

This depends on your job. Desk-based workers often return at 2–3 weeks, with the foot elevated as much as possible. Jobs involving prolonged standing or manual labour usually require 6–10 weeks. Driving typically resumes at 6–8 weeks once you can perform an emergency stop comfortably.

When can I return to running and sport?

Most patients return to walking and gentle gym-based exercise by 6–8 weeks. Running, racquet sports and football are usually possible from 3–4 months, with full performance typically by 6 months. For competitive athletes, this is planned around the season.

Can bunions come back after surgery?

Recurrence is possible, with reported rates of around 4–15% depending on the original deformity, technique chosen and underlying biomechanics. Choosing the right procedure for the right foot — and addressing rotation and hypermobility where present — significantly reduces this risk.

Will I be able to wear normal shoes again?

The vast majority of patients return to normal trainers and work shoes after recovery, and most can wear smarter footwear comfortably. Very high heels and very narrow shoes may still be uncomfortable — surgery aims to relieve pain and correct deformity, not to enable extreme footwear.

Is bunion surgery painful?

Modern bunion surgery is typically performed under general or regional anaesthetic, often combined with a long-acting ankle block that controls pain for the first 12–24 hours. Most patients describe the post-operative discomfort as moderate, well-controlled with simple analgesics, and significantly less than they expected.

Which areas of London and the UK do you cover?

Mr Welck consults at the RNOH Stanmore (NHS) and at private hospitals across North London, Central London and Hertfordshire. Patients regularly travel from across the South East and from further afield in the UK, particularly for complex, revision or rotational bunion deformities and for ankle replacement.

Do you see private and NHS patients in London?

Yes. Mr Welck has an NHS practice at the RNOH Stanmore and a private practice across leading hospitals in North and Central London. Self-pay and all major private medical insurers are accepted. Visit matthewwelck.com for clinic locations and contact details.

Book a Consultation

If you would like an expert opinion on a bunion, ankle problem, sports injury or any other foot and ankle condition, you can request an appointment with Mr Welck at his clinics in London, North London and Hertfordshire.

Via matthewwelck.com/appointments
By telephone on 07547 395 270
Referrals are welcome from GPs, physiotherapists, podiatrists and other specialists.

Important note: This guide is for general information only and does not replace individual medical advice. Outcomes vary between patients and depend on the severity of deformity, general health, and many other factors. Please discuss your specific circumstances with a qualified foot and ankle surgeon before making treatment decisions.

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