Revision Bunion Surgery


What Is Failed Bunion Surgery?

Failed bunion surgery, or a term I created is “failed bunion surgery syndrome” is condition characterized by any of the following after bunion surgery:

  • Return of bunion
  • New structural big toe problem (Hallux Varus)
  • Severe stiffness of big toe joint
  • Excessively short big toe
  • Arthritis of big toe joint (Hallux Rigidus)
  • +/- Pain

There are many reasons for a bunion surgery to be considered ‘failed’ and the above list accounts for the most common issues. Complications after bunion surgery occur for a variety of reasons, some patient related, some doctor related and of course sometimes simply bad luck.

In many cases, revision surgery may be able to correct the problem. Dr. Blitz specializes and performs revision bunion surgery after thoroughly identifying reasons that contributed to the failed surgery in the first place. Then, Dr. Blitz can recommend a treatment plan specifically tailored for you.

Each possible cause of failed bunion surgery will be outlined below, with possible treatment plans.

 

Return Of Bunion After Bunion Surgery

Recurrence of a bunion is a well-known possibility. Its not particularly deemed a complication but rather an unfortunate event. Recurrence can indeed occur over time. Though depending on the extent of return and timeframe from which the initial surgery was performed, it can be considered a failed surgery – that is if the surgery did not correct the bunion issue.

Two possible structural reasons for return of a bunion after bunionectomy are:

  1. Procedure selected did not address the severity of the bunion.
  2. Procedure did not resolve excessive motion on the foot.

While there are over a hundred operations described to surgically correct bunions, only a handful of techniques are used today. Most people think that bunions involve shaving of a boney bump, and this is particularly incorrect. While shaving of the boney prominence may be part of the procedure the main correction of bunion comes from realigning the displaced bones. This is performed with one of two methods – they are bone cut (osteotomy) or bone mending (fusion).

Depending on the severity of the bunion, the surgeon chooses a procedure that will not only shave down the bump but properly realign the foot bones into a proper position. Simple bunions require simple bone procedures whereas larger and severe involve more bone work attain the proper realignment.

Dr. Blitz finds that the most common reason for a return of a bunion after bunion surgery is due to a procedure being performed that did not adequately address the severity of the bunion. Secondarily, patients may have had a proper procedure but have too much flexibility in the foot, that cause the bones to spread open again – resulting in a recurrent bunion.

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How to Surgically Repair A Recurrent Bunion

After Dr. Blitz identifies the cause of the return of the bunion, he will recommend a treatment specific for your foot. In most situations, Dr. Blitz performs a Lapidus Procedure to realign the bunion bone at the apex (root) of the problem. The Lapidus procedure is bone mending surgery that does two important things with recurrent bunions: 1) properly realigns the bone, and 2) directly treats excessive motion.

Dr. Blitz is a leading expert authority on the Lapidus Procedure

  • Pioneered several advanced techniques on the Lapidus Procedure,
  • Mainstreamed the Early Walking after Lapidus Bunionectomy,
  • Published and lectured extensively on Lapidus,
  • Produced an instructional Lapidus surgical technique video,
  • Provisionally Patented and Surgeon Developer of Lapidus Plating System.

New Structural Big Toe Problem (Hallux Varus) After Bunion Surgery

Overcorrection of a bunion can lead to a new structural big toe problem where the big toe drifts inwards (away from the lesser toes), a condition called hallux varus. The toe could be painful and drift away from the foot – making fitting shoe gear near impossible.

Hallux varus represents a new muscular imbalance after bunion surgery pulling the big toe in wrong direction. It is almost always considered a failed bunion surgery, though the causes of its occurrence are not always directly attributable to a single issue.

In Dr. Blitz’ experience hallux varus comes from any or all of the following four technique related factors:

 

  • Too much bone was shaved away from the bunion.
  • An important small bone called a sesamoid was removed.
  • The ligaments were over tightened allowing for a muscular imbalance.
  • The bone procedures were over-corrected.
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How to Surgically Repair A Hallux Varus

After Dr. Blitz identifies the cause of hallux varus, he will recommend a treatment specific for your foot. Every case of hallux varus is different, and Dr. Blitz, most often, needs to performs surgery to undo what was done previously. This may involve simple soft tissue work to revision bone cuts to attain proper realignment. Long standing hallux varus may require the big toe joint to be fused in place. Dr. Blitz recommends treating hallux varus aggressively before secondary joint contractures occur so that s revision surgery can be less invasive.

Hallux Varus Case Before Hallux Varus Case After
hallux varus case study

 

Severe Stiffness Of Big Toe Joint After Bunion Surgery

Some degree of stiffness can be expected after surgery on any joint as its t he nature of joint surgery. Ball and socket joints, such as the big toe joint, are especially susceptible to stiffness. Moving the big toe joint after a bunion surgery can lessen this occurrence. Dr. Blitz’ finds that bunion procedures that place a patient in a cast and crutches lead to increased stiffness – that’s why Dr. Blitz has developed procedures to avoid casting with crutches.

Stiffness occurs from scar tissue formation in the joint. Sometimes arthritis can be the cause of limited motion. Also, its important to understands that larger bunion correction may not regain the same degree motion when compared to that of a smaller bunion correction, because the former joint has been dislocated in (bunion position) for a longer period of time (usually many years). As such, the big toe joint may not ‘bounce back’ to same degree.

 

How to Surgically Treat Stiffness of Big Toe Joint After Bunion Surgery

After Dr. Blitz identifies the cause of the stiffness, he will recommend a treatment specific for your foot. Sometimes the steroid injections can help stiffness by breaking down the scar tissue. When injections fail, a manipulation under anesthesia is an excellent method of releasing joint adhesions. Additional treatments may be to perform an arthroscopy to surgically remove scar tissue with small incisions and cameras to enter and ‘clean-up’ the joint. Open procedures are sometimes necessary. A more invasive option is to surgically stretch out the joint with use of device called an external fixator to distract the joint to pull apart the scar tissue.

 

Excessively Short Big Toe After Bunion Surgery

As part of any bunion surgery (involving bone cuts or fusion) shortening is expected to occur, but to a controlled amount. In some severe cases, more shortening may be necessary to correct the bunion problem all together. Shortening is problematic when it affects the ball of the foot, functioning of the big toe joint, and/pr the relationship of the big toe joint to the rest of the foot. Sometimes pain is present.

 

How to Surgically Treat A Short Big Toe After Bunion Surgery

Dr. Blitz provides a through investigation into the cause of the short toe. In many cases the index surgery that caused the shortening can be reversed. Each case is unique and Dr. Blitz will develop a plan to regain the length. There are various techniques to lengthen bone, which could be performed with:

  • Special lengthening bone cuts
  • Adding structural bone graft
  • Fuision procedure with bone grafts (ie Distraction Lapidus)
  • Growing bone (distraction osteogenesis)

The good news is that a short toe with problems can be surgically corrected.

 

Development of Big Toe Joint Arthritis Bunion After Bunion Surgery

An unfortunate uncommon occurrence after bunion surgery is the development of rapid onset of end stage arthritis of the big toe joint. While arthritis can occur many years after a surgery, the rapids development is not expected. Arthritis of the big toe joint is cartilage degenerating of the joint – characterized by pain, swelling, bone spur formation, clicking and/or grinding of the joint.

There are several causes of arthritis, but three common ones are, 1) from the positioning of the bone after the index surgery (biomechanical arthritis), infection, or 2) bone death (avascular necrosis)

Dr. Blitz carefully examines the cause of the arthritis and develops a treatment plan special for your particular problem. Treatments may be as simple as bone spur removal. Relaignment procedures may be needed. Severe cases can involve performing a fusion procedure of the big toe joint.

Home Preparation Tips for Revision Bunion Surgery

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