Updated June 01, 2015.
Bunion surgery is generally a curative procedure for most bunions, but in some case the bunion may return. Bunion recurrence, is a bunion surgery risk, and is estimated to occur in 15% of bunion surgery cases. The definition of recurrence may be considered the return of the boney knobby area and/or deviation of the big toe.
A bunion is a boney knobby area at the base of the big toe, which is caused by the deviation of the big toe joint, and not a growth a bone.
In addition to surgery, there are a variety of other bunion treatments. The surgical treatment for a bunion is generally dictated by the size of the bunion. Smaller bunion surgery is commonly treated with bone cuts to realign a portion of the deviated bones. Larger bunion surgery is commonly treated with a bone mending procedure (fusion) to realign the entire deviated bones.
Bunions that recur, tend to recur slowly over many years. In a smaller subset of patients, they may return soon after the index operation. Patients who are considering bunion surgery should understand factors that may lead to recurrence to lessen the likelihood of return down the road.
Why Do Bunions Recur?
As a bunion surgeon who specializes in revision bunion surgery, I have found the most common reasons for recurrence are generally due to the following:
- Wrong Index Operation. While there are over hundred different operations described in the literature to surgically correct a bunion, nowadays surgeons generally use a few procedures based on the size of the bunions. There are procedures that are generally designated for small bunions and procedures for large bunions. As such, small bunions are corrected in a different manner than a larger bunion. Recurrence is more likely when a surgical procedure for a bunion is performed when its not best tailored for that specific bunion.
- Excessive Midfoot Motion. While bunions manifest at the big toe joint, the deviation of bones originate from a midfoot joint where the malorientation originates. The midfoot joint that, in some cases, become unstable is called the first tarsometatarsal joint. This excess instability is medically called medial column hypermobility and some surgeons believe this motion is the root of bunion formation, when present. Patients who have hypermobility may be more susceptible to recurrence. Some surgeons do not believe that the hypermobility is true pathologic problem.
How To Treat A Recurrent Bunion with Revision Bunion Surgery?
A Bunion that has come back after corrective surgery are treated differently than a bunion that would have surgery for the first time. In these revision cases the surgeon needs to identify what may have caused the bunion recurrence in the first place.
Most bunionectomies often have retained surgical hardware that often needs to be removed. Removal of the existing hardware (surgical wires, screws and/or plates) is not always necessary but in many cases new hardware may be needed to be placed and the existing hardware may impede the insertion of new hardware.
In just about all cases of revision bunion surgery, the surgeon needs to release and repair the ligaments to the big toe joint. This part of the surgery is usually in conjunction with additional bone procedures to achieve the overall correction.
Revision bunion surgery in most cases require new boney procedures. Remember that the existing previous bunion surgery may have structurally deformed the bones through bone cuts healed in the wrong position. The boney surgery either involves a new bone cut to a portion of the bone to achieve the proper correction and/or realigning the entire deviated bone through a bone fusion/mending procedure in the arch (called the Lapidus Bunionectomy). The Lapidus bunionectomy is a surgery that is commonly used for primary bunion surgery and is also the go to procedure for recurrent bunions. The Lapidus bunionectomy also addresses the excessive motion in the midfoot (hypermobility) that often is a contributing factor to recurrent bunions.
How To Avoid Needing Revision Bunion Surgery
The best way to limit bunion recurrence after bunion surgery is to choose the procedure that will best treat your specific sized bunion. Because smaller bunions are treated differently than large bunions, it may be beneficial to avoid a small bunion surgery procedure for large bunions - but of course this ultimately depends on a surgeons experience when recommending a bunion surgery. Additionally, patients with bunions are that to be due to hypermobility of the midfoot should consider bunion procedures that may best address this particular problem. While this article discusses recurrent bunions, it should be remembered that recurrent bunion surgery is not a common issue.