Most bunions can be treated without an operation, but sometimes surgical procedures are needed to relieve pain and deformity. Unfortunately, in some cases bunion repairs fail and the pain or deformity returns. There are multiple factors that can contribute to this challenging scenario. Bunions can recur because of medical conditions or non-healing of the bone after surgery. In some cases, there are technical aspects that can be improved to achieve the desired result with additional surgery.
The goal of correcting a failed bunion repair, using a procedure called revision surgery, is to relieve pain and deformity of the first toe that remains after the initial surgery. Sometimes arthritis develops after bunion surgery. This may require a different procedure than the first. It is important to figure out why the first surgery failed to prevent another failure.
Revision surgery is for those with deformity and pain after bunion surgery. The pain may be the same or different from that experienced before the first surgery. Your foot and ankle orthopaedic surgeon will examine deformities of bones and joints and their various angles around the first toe.
Revision bunion surgery is not advised for patients with poor blood flow or certain nerve conditions. Bunions should not be revised if they are painless and do not cause problems. No bunion surgery should be performed solely to make the foot look better.
Revision surgery typically takes a little longer to perform than the first procedure because it can be more complicated due to scar tissue and altered anatomy. Incisions are made around the first toe and by the arch of the foot. Special instructions may include wrapping, protection with boots or braces, and limited activity. Usually this is an outpatient procedure, meaning you can go home the same day as surgery.
There are numerous accepted methods of correcting a bunion. Some are treated with a bone cut of the first toe, while others require a fusion. Hardware in the form of plates and/or screws may be used to maintain corrections or hold fusions solid.
Recovery will take at least as long as the first surgery. After surgery, you will be placed in a brace or shoe. You will have to avoid putting weight on the foot or only put weight on the heel for a period of time determined by your surgeon. Sutures usually are removed two weeks after surgery.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Revision surgery is challenging and there is a greater risk of complications. The bone may fail to heal or may heal in a less than optimal position. The nerves closest to incisions may be damaged, creating numbness, burning or pain. There also is a risk
that another part of the foot will become irritated. Wound complications, infections, problems with blood flow and prolonged swelling are more likely. Hardware may become bothersome and require removal.
My bunion has started to come back but it doesn't bother me. Do I need surgery?
Generally, no. Bunion surgery is for deformity with pain. Surgery is not recommended if you feel well despite the bunion.
Original article by Adam Miller, MD
Last reviewed by David Lee, MD, 2018
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