The Center for Podiatric Care and Sports Medicine

Should You Get Revision Bunion Surgery? Considering Procedure Options to Correct Mistakes

Posted by on Friday, July 4th, 2014

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After all the discomfort and embarrassment of a large bunion, many patients are eager to undergo bunion surgery to be rid of the problem once and for all. Bunion correction is one of the most common types of procedure performed by podiatric surgeons, and a well-trained podiatrist has likely performed numerous corrections. In 85 to 90% of all cases, bunion removal works wonderfully and satisfied patients enjoy straighter toes with excellent mobility. However, as with any surgery, there are exceptions. Each surgery carries certain risks and even the best surgeon is wise not to make any guarantees.

Unfortunately, we see a lot of patients at The Center for Podiatric Care & Sports Medicine who have gone to other podiatric surgeons in hopes of a better life — only to wind up in our office asking for revision bunion surgery to correct mistakes made by someone else. The summer months tend to be busy with people taking their vacation time and undergoing elective bunion surgery — some for the first time, some for the third, fouth, or fifth time. We’ll talk about the murky world of bunion revision and help you decide whether it’s worth going through the whole process again.

bunionectomy
A Lapidus bunionectomy can often correct errors or complications from one’s first bunion surgery.

What Constitutes a Failed Bunion Surgery?

We consider failed bunion surgeries to have complications such as:

– Severe stiffness of the big toe joint

– A new structural toe problem (Hallux Varus)

– An excessively short big toe

– Arthritis in the big toe joint

– More pain

– Return of the bunion.

Why Do Some Bunion Surgeries Fail?

The Podiatry Institute mentions a few reasons why a bunion surgery may not be successful:

– All bunions are not created equal. There are many important decisions to be made before, during, and after a bunion surgery. This is what separates a skilled surgeon from a technician. There are more than 50 different procedures used to correct bunions, with no clear leaders in the pack. New innovations are coming about all the time, and a good surgeon must stay current.

– All feet are not created equal. Flexibility of the foot plays a big role in the success or failure of a bunion procedure. A foot that is too flexible is likely to have recurrent bunions. A foot that is too stiff may be more prone to the development of arthritis later. Assessing the condition of the first ray and choosing the right procedure will be crucial.

-Patient age can be an issue. We are seeing younger and younger patients come in for bunion removal. Joint fusions and implants generally fare better in older, more sedentary patients. An implant can only last for so many years, given all the stress placed on the joint, and fusions can only deliver so much mobility.

– Some doctors try too hard to please patients. No one wants to hear that their recovery requires six weeks of immobility in a cast, but sometimes those are just the facts. Other post-operative decisions, such as when to begin weight-bearing, when to return to shoes, and when to resume all regular activities can mean the difference between a healed foot and a non-union or loosened screws.

– Expectations for this type of surgery can be high. It is important that you understand exactly what bunion surgery recovery entails. You may notice some loss in range of motion immediately following the surgery. It could take several months of active rehabilitation to get back into the groove. Your big toe may never feel exactly like your other big toe. You will need to think about what “a new normal” means for you, prior to the surgery.

What Can a NY Podiatric Surgeon Do in a Subsequent Bunion Procedure?

So you may be wondering, “What can another surgeon do that the previous surgeon failed to do in the first place?” The answer depends upon many, many different variables, but we’ll run through a few possible scenarios for you. If you have…

– A recurrent bunion: Perhaps the previous surgeon underestimated the severity of your bunion or did not choose the right procedure, given the flexibility of your foot. A type of fusion called the Lapidus procedure can realign the bone in the worst of cases, while also treating excessive motion.

– Hallux Varus: Overcorrection of bunions can cause the big toe to drift away from the lesser toes, making it nearly impossible to cram the feet into shoes. Sometimes too much bone was removed, the sesamoid was removed, or the ligaments were over-tightened. To address the muscular imbalance, we will assess what was done previously and determine the best course of action. Sometimes revision bone cuts can correct the problem. Other times, the big toe joint may need to be fused in place.

– Severe stiffness: While some stiffness is to be expected post-surgery, we find casts and crutches often lead to worse-than-normal stiffness. That’s why most of our recovery programs are centered around active recovery and we try to get you into a walking boot as soon as possible. Treatments like stem cell or steroid injections may help in breaking down scar tissue. In severe cases, we can use arthroscopic surgery to clean up the joint.

– A short big toe: Shortening is a common side effect when bone cuts or fusions are involved, but it becomes problematic when the functioning of the foot is compromised and pain occurs as a result. We may be able to reverse the shortening effect with special bone-lengthening cuts or by adding a structural bone graft.

– Arthritis: Common causes of post-surgical arthritis include infection, bone death, or improper positioning of the bone. We may be able to remove a bone spur, realign the joints, or perform a fusion procedure that can give you some relief if stretches, exercises and other non-invasive therapies do not ease your suffering.

Bunion Revision Surgeries in New York

It’s time you found an experienced professional who understands all that you’ve been through and all that you need. The Center for Podiatric Care & Sports Medicine in New York City specializes in bunion corrections, whether it’s your first or a subsequent one. You have only to gain from a consultation with one of our podiatric surgeons to get a second opinion on your bunion problems. Book your appointment online today.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.