Hallux valgus (bunion)

This is a summary of the NEW Devon CCG commissioning policy for surgery for hallux valgus (bunion).

Supporting referral guidelines

Assessment

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.

Referral

Referral Criteria

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:

  • Avoiding high heel shoes and wearing wide fitting leather shoes which stretch
  • Exercises specifically designed to alleviate the effects of a bunion and keep it flexible
  • Applying ice and elevating painful and swollen bunions
  • Non-surgical treatments such as bunion pads or orthoses.
  • Appropriate analgesia

AND

the patient suffers from either:

  • Severe deformity (overriding toes) that causes significant functional impairment

OR

  • Severe deformity that prevents patients from finding comfortable footwear

OR

  • Severe pain that causes significant functional impairment
    • Significant functional impairment is defined as:
      • Symptoms that prevent the patient properly fulfilling their required work or educational responsibilities
      • Symptoms that prevent the patient properly carrying out their required domestic or carer activities
      • Symptoms that prevent the patient carrying out recreational physical activities

Complete NEW Devon CCG hallux valgus (bunion) commissioning policy

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.

Individual funding requests

Referral Instructions

Applications for consideration for funding approval should be sent to:

Email: d-ccg.ifr-newsdt@nhs.net

Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH

Supporting Information

Patient Information

Individual Funding Request (IFR) Patient information leaflet

Publication date: 9 February 2015

 

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