Policy number: SRP 029
Policy name: Bunion (Hallux valgus) Surgery
Status: Individual Funding Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Mid and South Essex ICB commissions surgery for Bunion Surgery on a restricted basis.
Funding requests for bunion surgery will only be considered when either of the following criteria are met:
Criteria 1
- The patient experiences persistent severe pain and significant functional impairment* that is interfering with the activities of daily living.
AND
- All appropriate conservative measures** have been tried over a 6-month period and failed to relieve symptoms, including up to 12 weeks of evidence based non-surgical treatments i.e. analgesics/painkillers/bunion pads/footwear modification.
AND
- There is radiographic evidence of joint deformity (at point of referral).
AND
- The patient understands that they will be out of sedentary work for 2-6 weeks and physical work for 2-3 months and they will be unable to drive for 6-8 weeks, (2 weeks if left side and driving automatic car).
Criteria 2
- There is an increased risk of ulceration or other complications – for example, neuropathy for patients with diabetes. Such patients should be referred for an early assessment.
*Significant functional impairment is defined as:
The patient complains of severe joint pain not relieved by extended non-surgical management and analgesics AND has severe impact on their ability to undertake activities of daily living.
**Conservative measures include:
- Avoiding high heel shoes and wearing wide fitting leather shoes
- Non-surgical, self-funded treatments such as bunion pads, splints, insoles or shields or exercise where appropriate.
A patient should not be referred for surgery for prophylactic or cosmetic reasons for asymptomatic bunions. Concerns about cosmetic appearance should be managed by the patient and not referred into secondary care or a Community Podiatric service.
Detailed documentation against the above criteria that are fulfilled is mandatory in the referral letter to secondary care. Clinically inappropriate referrals will be returned to GPs.
Follow up will be capped at one follow up unless there are exceptional circumstances.
Funding for patients not meeting the above criteria will only be made available in clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances