Reviewed on : 4 Jan 2024

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

Expires : 4 Jan 2026

Prior approval from the Integrated Care Board (ICB) 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

Eligibility is based on the following criteria:

• Deteriorating symptoms AND/OR
• Failure of appropriate conservative measures after 3 months AND/OR
• Persistent pain and disability which has not responded to up to 12 weeks of non-surgical treatments AND
• Prepared to undergo surgery

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

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB

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.