Please click here to view the full Bunion Surgery Commissioning Statement.

Please click here to access the referral form. 

NHS Scarborough & Ryedale and Vale of York CCGs do not routinely commission surgery for asymptomatic hallux valgus (bunion), regardless of cosmetic appearance. Concerns about cosmetic appearance should not be referred to secondary care. These procedures will not be funded.

All patients should be referred to local podiatry services prior to referral to secondary care. (This does not affect the existing diabetic foot pathway). URGENT referral to Podiatry required if patient has a skin ulcer not healing.

Requests for the removal of symptomatic bunions will ONLY be considered where:

• Appropriate conservative measures have been trialled for 3 months and have failed⁽²⁾ (these include trying accommodative footwear, considering orthoses as advised by podiatry and using appropriate analgesia). OR
• In the view of the podiatrist, three months of conservative treatment is futile

AND the patient suffers from either

• Pain on walking (not relieved by appropriate analgesia) that causes significant functional impairment OR
• Deformity (with or without lesser toe deformity) that causes significant functional impairment or prevents them from finding adequate footwear OR
• Recurrent or chronic ulceration or infection

The clinician needs to ensure that the patient fulfills all the criteria before they are referred to secondary care. 

Before referral patients must be informed that

• They will be unable to drive for 6-8 weeks
• It will take at least a further 2 months to regain full function
• They will be out of sedentary work for up to 6 weeks and out of physical work for up to 3 months
• The prognosis for treated and untreated Hallux Valgus is very variable
• Recurrence of deformity occurs in 8-15% patients
• There is very little good evidence with which to assess the effectiveness of either conservative or operative treatments or the potential benefit of one over the other⁽²⁾

Treatment in all other circumstances is not routinely commissioned and should not be referred unless clinical exceptionality is demonstrated and approved by the Individual Funding Request panel prior to referral.

Patient Information Leaflets: 

http://patient.info/health/bunions

http://www.nhs.uk/Conditions/Bunion/Pages/Introduction.aspx

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