LLR Policy for Bunions (Hallux Valgus)

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Category

Threshold Criteria

Hallux valgus, commonly kown as bunions, can cause varying degree of pain with limitation of function and mobility as an effect of pressure from shoes over the medial prominence of the metatarsal head. Conservative management such as orthoses does not always help to recover from symptoms and improve the long-term outcome. Surgical intervention can bring significant improvements in symptoms and clinical parameters, but is not always without a risk.

In the first instance, conservative management techniques should be employed. These techniques include:

•           Avoiding high heel shoes and wearing wide fitting leather shoes which stretch

•           Non-surgical treatments such as bunion pads, splints, insoles or shields.

•           Simple analgesia.

ICBs will NOT ROUTINELY FUND surgery for asymptomatic bunions for cosmetic purposes

Surgical treatment of bunions is a day case service at Leicester General Hospital and community hospital  in Leicestershire

Eligibility

LLR CCGs will only fund this procedure if the following criteria is met
 
·       Conservative management has failed
 
·       Patient is fit for surgery with a BMI of <45
 
·       Patient is willing to have an operation which may stop them working or driving for 8 weeks
 
AND
 
·       The patient suffers from severe pain or deformity that causes significant functional impairment, including:
 
o   Symptoms which prevent the patient fulfilling work or educational responsibilities
 
OR
 
o   Symptoms which prevent the patient carrying out domestic or carer activities
 
 
Patients with a BMI of >45 need counselling for weight reduction measures followed by referral.

ARP 16 Review Date: 2026

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