Kessel-Bonney osteotomy operation: a guide for patients

The Kessel-Bonney osteotomy is used to manage moderate arthritis affecting the first metatarsophalangeal joint (big toe joint).

The surgery elevates the big toe, which increases the arc of movement at the joint.

The aim is to slow progression of the arthritic process, reduce pain, increase movement and extend the life of the joint.

However, the arthritic process may still continue and further surgery might be needed in the future.

The Kessel-Bonney procedure may be carried out in conjunction with a decompressive metatarsal osteotomy if the first metatarsal is too long.

About your operation

• An osteotomy is an operation where a bone is cut and repositioned into a corrected position.
• It involves removing a wedge-shaped section of bone from the base of the big toe bone. At the same time, any bony overgrowth is removed.
• The two bony surfaces are brought together and held in position by a wire or screw.
• The skin layers are stitched together with stitches that dissolve. Occasionally, if your skin is very sensitive, or you are prone to problem scarring you may need non-dissolvable stitches. These need to be removed at two weeks.
• Throughout the operation you will have a tight band around the ankle to keep the blood away from your foot. This can be uncomfortable, but is immediately released after the operation.

About day case surgery under local anaesthetic

Surgery is carried out under local anaesthetic as a day case. This means that you are awake during the operation, but a screen will prevent you from seeing the surgery.

To numb your foot, you will be given some injections around your ankle or behind the back of the knee. You can eat and drink on the day of surgery; there is no need for fasting.

The operation may take up to 60 minutes but you should be ready to be at the hospital for longer than this. You must have a competent adult at home for the first day and night after surgery.

If you decide on surgical management, you will be invited back for a pre-surgical clinic. A member of the nursing team will take your medical history. If you are on any medication, please bring a list with you. This is a good opportunity to ask questions or discuss any concerns you may have.

Recovery after your operation

The first two to three days

• You must rest with your foot elevated to hip level.
• You should restrict your walking to bathroom visits only, and if you have been given crutches you must use them in the way shown. You may be able to bear a little weight on the foot.
• You should take the prescribed painkillers. If you experience pain, it is usually worse for the first two days.
• If you are still experiencing pain after three to four days that is not relieved by the painkillers, you should contact the department directly.
• If you have any concerns over your foot you should contact the department directly
• The department is closed at the weekend. Out-of-hours, you should contact your GP or go your local A&E department.

Two weeks after surgery

• Two weeks after the operation you must visit for your stitches to be removed.
• You should no longer need a bandage and should be able to wear a normal shoe again. This shoe does need to be roomy because your foot will be quite swollen; ideally a running lace-up type trainer. If you do not have any you will need to buy some before the surgery. You do not need to spend a lot of money on this shoe.
• One to two days after the stitches have been removed you can start bathing the foot normally.
• At this stage, you can gradually and gently increase your activities. You will still need to rest between your activities.
• You will also be given a rigorous regime of exercises to regain strength and flexibility in the toe joint.

 Between two and six weeks after surgery

• During this time the foot gradually returns to normal and you may be able to vary your footwear.
• Sixty per cent of patients have returned to roomy shoes at six weeks, and ninety per cent in eight weeks.
• There will still be noticeable swelling, especially towards the end of the day. This is quite normal at this stage.
• You may also return to work after six weeks; depending on the type of work and footwear in which you are allowed to return. For some jobs this could be an unrealistic expectation.
• At six weeks you can usually return to driving. However, you must feel able to perform an emergency stop. Please check with your insurance company about when your policy covers you to drive.
• Although normal everyday activities will be possible, sporting activities are still restricted at this stage.

 Between six and 12 weeks after surgery

The foot should now be comfortable and returning to normal but there may still be some slight swelling. You can return to sporting activities/gym work at 12 weeks.

Six months after surgery

The residual swelling should now be very slight although the healing process continues for a year. You should be getting full benefit from the surgery.

Twelve months after the surgery

All healing is now complete.

Frequent or serious occurring risks

All operations carry a small risk of complications. In foot surgery, complications are uncommon and most are resolved without permanent disability or pain.

General and specific complications of this procedure include:

• infection (two in 100)
• delayed healing of the skin (eight in 100)
• non-compliance of patients (four in 100)
• prolonged swelling post operatively (four in 100)
• thick or sensitive scar formation (one in 100)
• loosening or movement of the screw or wire used to fix the bones (two in 100)
• the toe may become stiff (one in 100)
• non-union of bone (0.41 in 100)
• recurrence of the arthritic symptoms
• blood clot deep vein thrombosis (DVT).

Complications following foot surgery are rare but can happen. It is important to remember that if there is a complication, you will need to visit the hospital more frequently and there could be a significant impact on your recovery and return to work time. Foot surgery should be avoided if only for cosmetic gains.