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Part 2 – Bunion revision surgery: Poor outcomes and treatment options

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The number one reason for patient dissatisfaction with a previous bunion surgery in my practice is a under corrected bunion deformity.  NOT ALL BUNIONS ARE EQUAL!  Each patient requires a procedure specific to their deformity.  There is not one procedure for all bunions.  Unfortunately, many surgeons fix every bunion with the same or similar procedure.  There are dozens of ways to fix a bunion, and one procedure cannot fix all deformities as every patient’s deformity is unique.

Most bunion surgeries require an osteotomy, or surgical bone break of bone to correct deformity.  Two screws are often used to maintain this correction.  For larger bunions, the osteotomy choice changes and in the most severe cases a joint if the middle of the foot called the first tarsometatarsal articulation should be fused.  This removes the angular deformity and after healing still allows normal physical activity. 

The most common poor surgical results and common repair techniques are as follows:

  1. Under corrected bunion –bunion bump may be smaller but it still remains and pain persists
    1. Treatment
      1.  removal of previous screws, and repeating a similar bone cut, just moving the bone to its appropriate corrected position              
      2. If toe deviation is only complaint a procedure in the toe itself called an akin osteotomy can be performed to correct toe deviation
  2. Hallux varus – an overly aggressive correction has caused the great toe point too far away from the little toes. This makes wearing shoes very difficult

 

  1. Treatment
    1. Removal of previous screws, and reversing bone cut to the previous  to align joint properly
    2. Performing a procedure in toe to realign toe and fix with small screw or tiny plate
    3. Special anchors are now available to reposition the
      allowing for faster healing
  1. Painful 2nd toe joint – your bunion is corrected but the ball of foot behind the 2nd toe hurts.  This occurs when the bunion procedure shortens the long metatarsal bone too much behind the two bones in your great toe and leads to increased pressure to 2nd toe joint. 
    1. In most cases shortening the second metatarsal bone behind the second toe and fixing with a screw(s) reduces or eliminates pain
    2. In some cases the shortened 1st metatarsal bone needs to be elongated with a bone graft with a metal plate and screws.

 

 

 

 

 

 

 

 

Images show appearance of left foot where the first metatarsal bone behind the two bones of great toe was shortened during bunion procedure.  This can cause pain in the second metatarsal head (the bone in image behind 2nd toe).

  1. Failed attempt at joint fusion – if treatment choice was to fuse great toe joint or fuse the joint at base of first metatarsal, delayed healing or a nonunion can occur.  Nonunion refers to a joint that did not heal to the adjacent bone (your lapidus failed, you fixed PT for her)
    1. Removal of non-healing bone at fusion site is required and placement of a bone graft and plate and screws

This list in no way encompasses all the treatment options for revision of a painful bunion surgery outcome.  As stated previously every bunion is different, and requires special evaluation of patient history x-rays, and physical exam. 

Part three of bunion revision surgery series will discuss recovery. 

 

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