Bunion Surgery

Our specialist Perth podiatric surgeons Dr Andrew Knox & Dr Burke Hugo offer both traditional and minimally-invasive keyhole bunion surgery approaches. Dr Andrew Knox is the premiere provider of keyhole bunion surgery in Western Australia which offers a significantly reduced recovery time over most traditional surgical approaches still used today. For further information on keyhole bunion surgery in Perth, please refer to our website dedicated to this unique approach: www.1300keyhole.com/bunion


There are 5 types of bunion surgery procedures which are offered at our practice by Dr Andrew Knox and Dr Burke Hugo that are described below. Our clinicians pride themselves on providing an individually-tailored strategy to select the most appropriate bunion surgery procedure for you based on your individual foot-type and degree of deformity. During assessment with one of our specialist podiatric surgeons, we can provide patients with an in-depth discussion of the procedure options, post-operative protocols, costs, and risks specific to the procedure.


  1. Ostectomy (Bony Shave)

The ostectomy procedure, also known as ‘simple bunionectomy’ is usually performed for patients with an isolated bony bump who do not have any significant angulation of their big toe. It can be performed through either a limited-open approach, or minimally invasive keyhole procedure and is relatively straightforward. It is also a good option for elderly patients who experience pain or rubbing in their shoes from the bony bunion bump but may not otherwise be fussed about the alignment of their big toe. This procedure is usually performed on a day surgery basis within hospital under an intravenous sedation or general anaesthetic and immediate weightbearing is permitted.


  1. Traditional Austin/Akin Bunionectomy

The traditional open Austin/Akin bunionectomy is a reasonably versatile procedure which can be performed for patients with moderate bunion deformity associated with valgus angulation of their big toe joint. Although we do not often perform this as a primary bunion surgery procedure, we prefer to use it mainly for patients that have mild arthritis associated with their bunion and also for patients with underlying metatarsus adductus. The procedure involves performing an osteotomy (surgical cut) of the metatarsal bone +/- proximal phalanx bone in order to re-align the joint and straighten the toe. It is usually a permanent procedure. A type of titanium compression screw and surgical staple are used to hold the bones in their corrected position which takes time to re-set. Weightbearing is permitted post-operatively in a rigid sandal and patients who undertake this procedure generally recover well on the whole, taking between 2-3 months for full recovery. This procedure is usually performed within hospital under an IV sedation or general anaesthesia on a day surgery or inpatient basis.


  1. Keyhole bunion surgery (Minimally Invasive Chevron/Akin Procedure)

Keyhole bunion surgery, also known as ‘minimally-invasive bunion surgery’ has become an increasingly popular method of bunion correction throughout the world due to its reduced downtime compared with traditional ‘open’ surgery approaches. Dr Andrew Knox was the first podiatric surgeon to introduce this technique to Western Australia in January 2018 and this has since become one of our practice’s core service offerings, with over 350 procedures performed to date. The technique we perform is often referred to as the MICA procedure and involves performing an osteotomy (realignment) of the metatarsal +/- proximal phalanx bones percutaneously, under fluoroscopic (live x-ray) guidance. The procedure is performed through two tiny incisions made through the skin, and causes minimal disruption to the soft-tissues around the joint. This is the primary difference between keyhole bunion surgery, and traditional open methods which involve quite extensive soft-tissue dissection and repair to perform the same bony work. The procedure works well for mild to moderate bunion deformities, and allows for immediate weightbearing post-operatively with transition to a supportive sneaker usually ok at 2 weeks. The recovery process is approximately 50% faster than traditional surgery which means less down-time and faster return to normal activities including exercise. This procedure is usually performed within hospital under an IV sedation or general anaesthesia on a day surgery basis. For further information on keyhole bunion surgery in Perth, please refer to our website dedicated to this unique approach: www.1300keyhole.com/bunion


  1. Lapidus Arthrodesis (1st Metatarso-Cuneiform Joint Fusion)

The Lapidus Arthrodesis is not widely performed in Western Australia, however it is one of the most popular bunion surgery in the US, often referred to as the ‘Lapiplasty’. Studies have shown that the Lapidus arthrodesis can produce tri-planar correction, meaning that the deformity is addressed in all three planes of movement and the stability and longevity of the procedure is very predictable. At Perth Podiatric Surgery, we prefer to reserve this procedure for patients who have a bunion deformity associated with instability of the first ray, flat feet, or a hypermobile medial arch because it can be used to rectify this problem concurrently. Patients who otherwise have significant medial arch collapse or flat feet may be at increased risk of bunion recurrence over time from the other common surgical procedures which are routinely performed. The procedure involves realigning the big toe joint by fusing the 1st metatarso-cuneiform joint which lies in the inside arch area. In most cases, a low-profile titanium plate and compression screws are used to achieve rigid compression across the surgery site. The post-operative recovery from this procedure is more involved initially for patients, as restricted weightbearing in a moon boot must be performed for at least 4 weeks, after which time transition to a rigid sandal is usually permitted. This is because the bone healing process is more extensive than the other procedures described here, and fusion of the joint generally takes 8-12 weeks for most patients. Once the site is healed, patients generally undertake rehabilitation exercises and on the whole obtain excellent clinical and functional outcomes. Patients are still able to bend their big toe freely after surgery, and generally do not have to wear orthotics or other arch supports long-term to maintain their correction, because the medial arch has now been stabilised.


  1. 1st Metatarsophalangeal Joint Fusion

First metatarsophalangeal joint fusion is generally reserved for patients with a severe bunion associated with osteoarthritis, however it is also performed routinely as a revisional procedure in patients who have had a failed bunion surgery. This procedure is permanent, and involves realignment of the big toe bone and removal of the 1st metatarsophalangeal joint in order to arrest movement permanently. The procedure may sound drastic compared with the other approaches described here, but it offers a definitive solution and can give patients back a straight, painless toe which can enable them to wear normal footwear and function again. In most cases, a low-profile titanium plate and screws are used during the procedure to hold the bones in position whilst they heal and these do not generally have to be removed. The aftercare for the procedure requires immobilisation in a rigid post-operative sandal for between 4-6 weeks, followed by transition into a supportive sneaker and rehabilitative exercises. Once the surgery site has healed, the joint at the base of the toe remains rigid and cannot be bent, however the joint at the tip of the toe can still freely be moved. This allows patients to still walk normally and push through their big toe. It does not usually leave patients with a limp or significant gait problems. On average it takes between 2-3 months for most patients to properly get-over this procedure, and there is a high degree of patient satisfaction associated with the long-term outcome from surgery.


Please note:

This website is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. For more information, follow the link to make an appointment to see our specialist podiatric surgeons Dr. Andrew Knox & Dr Burke Hugo.