Reviewed on : 2 Feb 2022

Reviewed by : Lucy Dyde IFR Support Manager ARDENIFR NHS COVENTRY AND WARWICKSHIRE CCG

Expires : 2 Feb 2024

Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in secondary care.

Requests for the removal of symptomatic bunions will only be considered if specific criteria are met, as detailed below.

Age, gender, smoking, obesity and co-morbidity should not be barriers to referral. Patients with significant co-morbidities (systemic or local) should have treatment which optimises these before referral.

Referral to Secondary Care

Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in secondary care.

Referral is based on the following criteria:

• Deteriorating symptoms
• Failure of appropriate conservative measures after 3 months (applying ice and elevating for pain and swelling AND optimum analgesia)
• Persistent pain and disability which has not responded to up to 12 weeks of non-surgical treatments (Wearing wide cut or specially altered shoes with increased medial pocket to minimise deforming forces AND externally fitted devices to improve alignment and reduce irritation, e.g. orthoses and bunion pads AND stretching exercises to improve / maintain joint flexibility) AND
• Prepared to undergo surgery

Conservative measures

Conservative Measures are defined as:

• Ice and elevation for pain and swelling AND Optimum analgesia.

Non-surgical treatments

Non-surgical treatments are defined as:

• Wearing wide cut or specially altered shoes with increased medial pocket to minimise deforming forces AND
• Externally fitted devices to improve alignment and reduce irritation, e.g. orthoses and bunion pads AND
• Stretching exercises to improve / maintain joint flexibility.

Patient MUST NOT be referred for surgery based on cosmetic reasons alone.