Mr Francesc Malagelada is a consultant foot and ankle surgeon leading minimally invasive bunion correction across four central London hospitals. He holds a PhD in minimally invasive surgery, sits on the board of GRECMIP, and operates as a substantive consultant at The Royal London. Book a same-day consultation without a GP referral, and leave with an honest plan that recommends keyhole bunion surgery only when the evidence supports it.
Understanding your foot health
A bunion, known clinically as hallux valgus, is a progressive deformity of the big toe joint. The first metatarsal drifts inward, the big toe leans across towards the second toe, and the joint at the base of the big toe begins to protrude. The bump you see is not new bone growth - it is an existing bone in the wrong position. That is precisely why splints, gel spacers and over-the-counter toe correctors can ease symptoms but cannot reshape the foot. Only surgery can realign the bone itself.
Bunions are common across the UK. Population studies suggest around one in four adults has a hallux valgus deformity, and prevalence rises sharply after the age of 50. Women are affected three to four times more often than men. Genetics carries the largest weight, followed by foot mechanics - flat feet, ligament laxity or hypermobility - and decades of wear in narrow, pointed or high-heeled shoes. Most people manage a mild bunion comfortably for years. The tipping point is usually one of three things: pain when walking any meaningful distance, difficulty finding shoes that fit, or secondary problems beginning in the toes next to the big toe.
Modern keyhole bunion surgery looks nothing like the procedures patients remember from the 1990s. Mr Malagelada works through three or four incisions of just 2 to 3 mm, cuts and repositions the bone under live X-ray (fluoroscopic) guidance, and fixes the correction with one or two low-profile titanium screws. Because the soft tissues are barely disturbed, most patients have less post-operative pain and swelling, walk out of theatre the same day in a protective sandal, and end up with a near-invisible scar. Keyhole is not always the right answer — severe or complex deformities sometimes call for an open approach — and an evidence-led assessment matches the surgery to your foot, not the other way round.
Symptom Checklist
Bunions progress. They rarely stay still, and they never resolve on their own. The earlier we assess you, the more options remain on the table - and the smaller the surgery if you do eventually need one. Count how many of the six below apply to you.
Around one in four UK adults has a bunion. Not all of them need surgery, and an honest assessment is the only way to find out which camp you fall into.
Treatment Options
Not every bunion needs surgery. When it does, the right operation is the one that fits your foot - not the one that fits the surgeon's preference. Here is how Mr Malagelada will work through your case, step by step.
Most patients with a mild to moderate bunion start here, and many never need to leave. Mr Malagelada will review your footwear, prescribe custom orthotics if your foot mechanics are contributing, teach you targeted strengthening for the small muscles of the foot, and recommend anti-inflammatory medication for short flare-ups.
Custom orthotics
Anti-inflammatory medication
Targeted foot strengthening
When a bunion flares - typically because of an inflamed bursa over the joint, or a painful episode in an arthritic big toe - a precisely placed, ultrasound-guided injection can break the pain cycle and buy you time before any decision about surgery.
Ultrasound-guided steroid injection
Hyaluronic acid (joint-cushioning) injection
Mr Malagelada recommends surgery only when your pain is persistent, the deformity is genuinely affecting how you live, and conservative care has had a fair chance to work. He performs the operation through three or four 2–3 mm incisions, uses live X-ray throughout, and fixes the correction with one or two low-profile screws. The technique is matched to the deformity - not the other way round.
MICAMICA (Minimally Invasive Chevron and Akin)
Percutaneous distal osteotomy
Open Scarf and Akin (for severe or complex deformities)
LMS, PhD. Consultant Trauma and Orthopaedic Surgeon. Foot and Ankle.
Consultant at The Royal London
Board member, GRECMIP
Honorary Senior Lecturer, Queen Mary University of London
Mr Malagelada is a fellowship-trained Consultant Trauma and Orthopaedic Surgeon who treats foot and ankle conditions exclusively. He trained in Spain and the UK at The Royal National Orthopaedic Hospital and The Royal London, and completed a BOFAS-accredited Foot and Ankle fellowship at Windsor. He has been a substantive consultant at The Royal London since 2017, where he also teaches on the MSc in Orthopaedic Trauma Sciences at Queen Mary University of London. His PhD focused on minimally invasive techniques, and he is recognised internationally as one of the UK's specialist bunion surgeons for keyhole correction.
Testimonials
Real patients. Real outcomes. Independently verified on Doctify.
Most patients walk out of hospital the same day in a protective post-operative sandal. You can usually return to a normal trainer at 6 to 8 weeks, restart low-impact exercise from 10 to 12 weeks, and resume running or higher-impact sport at around three months. Some residual swelling continues for up to six months as the bone remodels - that is normal and expected. Your specific timeline depends on the severity of your deformity, how strictly you elevate during the first fortnight, and whether one or both feet were treated.
Most patients describe the discomfort as manageable with simple painkillers. Paracetamol and an anti-inflammatory for the first few days usually cover it, rather than stronger opioids. An ankle block performed during surgery keeps the foot numb for several hours afterwards, which covers the period when pain would otherwise peak. Strict elevation in the first week does more to control pain and swelling than any medication.
The total cost depends on which hospital you choose , the complexity of the deformity, your anaesthetic preference, and whether you treat one foot or both. We do not publish a single headline figure because quoting one risks misleading you about what your surgery will actually cost. After your consultation you receive an itemised, transparent quote covering surgeon, anaesthetist, hospital and follow-up. If you use private medical insurance, most costs are usually covered (see Q5).
If you are paying for your own care, you do not need a GP referral, and we can usually offer you a consultation within the same week. If you are using private medical insurance, most insurers - including Bupa, AXA Health, Aviva and Vitality - ask for an open referral letter from your GP before they authorise treatment. Our team will guide you through your specific insurer's process when you book.
Yes, for the vast majority of patients. Bunion surgery qualifies for cover when it is clinically indicated - meaning your pain or functional limitation has persisted despite conservative treatment. Insurers do not usually cover purely cosmetic correction of a painless bunion. Mr Malagelada is recognised by all the major UK insurers, including Bupa, AXA Health, Aviva, Vitality, WPA and Cigna.
Recurrence is uncommon when modern keyhole techniques are performed by an experienced surgeon. Current peer-reviewed data reports recurrence rates below 5% at medium-term follow-up. Your individual risk rises if you start with a severe deformity, if you have generalised ligament laxity (hypermobility), or if you return to narrow or high-heeled footwear. Mr Malagelada will assess your specific risk at consultation - which is part of why technique selection matters so much.
Yes. Bilateral keyhole correction in a single operation is well-established and can shorten your overall recovery. The trade-off is a more cautious first fortnight, because you do not have an unaffected foot to bear weight on. Whether bilateral suits you depends on the severity of each side, your home set-up, and who can support you during the first two weeks. Mr Malagelada will talk you through both options at your consultation.
Still have questions?
Click on the button on the right to send your enquiry through. A member of Mr Malagelada's team will reply within one working day.
Foot & ankle trauma care
