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This is a summary of the NEW Devon and South Devon and Torbay CCG commissioning policy for surgery for hallux valgus (bunion).
Hallux valgus, often referred to as a bunion, is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. Not all bunions are symptomatic and surgery for cosmetic reasons is considered a low clinical priority. Overall satisfaction rates following surgery are good but studies are small and follow up short.
Evidence of effectiveness of conservative treatment, surgical treatment, or the potential benefit of one over the other is limited. A randomised controlled trial reported short-term favourable outcomes for orthoses in patients with mild to moderate hallux valgus deformity. The same trial found that waiting for one year, with or without orthoses, did not jeopardize the outcome of surgery.
Patients should be aware of the potential complications associated with surgery which include pain, stiffness, infection, swelling, delay or failure of bone to heal and deep vein thrombosis.
Surgery for hallux valgus (bunion) for cosmetic purposes will not be routinely commissioned. Surgery for symptomatic hallux valgus (bunion) will only be commissioned in the following circumstances:
Failure of conservative methods of management after three months.
Conservative management techniques include:
the patient suffers from either:
Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.
Publication date: 9 February 2015