Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in secondary care.
Surgery for asymptomatic bunions, for primarily cosmetic reasons, is regarded as a procedure of low clinical priority. These procedures are therefore not routinely funded and should not be referred onto Secondary Care.
Requests for the removal of symptomatic bunions will ONLY be considered where conservative methods of management have failed.
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, splints, insoles or shields
AND the patient suffers from:
- EITHER severe deformity (overriding toes) that causes significant functional impairment*
- OR severe pain that causes significant functional impairment*
- OR recurrent ulcers or infections and there is radiographic evidence of joint damage
*Significant functional impairment is considered as:
- Symptoms which prevent the patient fulfilling vital work or educational responsibilities;
- Symptoms which prevent the patient carrying out vital domestic or carer activities.
In addition to the above criteria, smoking cessation and weight management should be considered as an integral part of appropriate clinical management prior to consideration of any elective surgery (with referral to appropriate services if indicated).
Prior approval authorisation should be obtained by primary care clinicians before a referral is made for surgery. If referral is made for specialist opinion to secondary care, then prior approval authorisation should be obtained by secondary care before treatment.