A bunion, medically known as hallux valgus, is a foot deformity where the big toe drifts toward the smaller toes, causing the joint at the base of the big toe to protrude outward and create a bony bump. This structural misalignment can lead to pain, inflammation, and difficulty wearing shoes. Surgical correction is often sought to alleviate discomfort and restore foot function. Patients considering this procedure often worry whether the deformity can reappear after the surgical intervention. This article explores the mechanics of the correction, the likelihood of a return, and the steps a person can take to maintain the corrected alignment.
What Bunion Correction Surgery Involves
Bunion correction surgery, or bunionectomy, is a complex procedure aimed at structural realignment of the foot, not simply shaving off the bony prominence. The visible bump is the head of the metatarsal bone protruding because the big toe has shifted out of place. Superficial removal of the bump, known as an exostectomy, is rarely done alone because it fails to address the underlying cause of the deformity.
The most common surgical approach is an osteotomy, which involves cutting and repositioning the metatarsal bone to correct the abnormal angle between the big toe and the rest of the foot. The surgeon uses hardware like screws, wires, or plates to hold the realigned bones in the corrected position while they heal. This realignment also helps rebalance soft tissues, such as the tendons and ligaments, that were pulling the toe into the wrong position.
The Likelihood of Bunion Recurrence
Bunions can recur after surgery, meaning the deformity is not always permanently fixed. Recurrence refers to the gradual return of the hallux valgus angle, where the big toe slowly begins to drift back toward the other toes. This is a slow failure of the structural correction, not a sudden reappearance of the bony bump.
Recurrence rates vary widely depending on the surgical technique used, the severity of the initial deformity, and the length of follow-up in studies. Rates after traditional bunion surgery are generally cited to be between 4% and 25%. A recurring bunion is typically defined by a hallux valgus angle of 20 degrees or more after the initial correction.
Reasons Why Bunions Return
Procedural Factors
Procedural issues include incomplete correction of the initial deformity, where the surgeon did not sufficiently address the abnormal angles in the bone. Technical errors, such as inadequate bone fixation or choosing an inappropriate surgical method for the severity of the bunion, can lead to failure. If the cause involves hypermobility in the midfoot, a procedure that fuses the joint, like a Lapidus procedure, may be necessary to stabilize the foot and prevent recurrence.
Patient and Lifestyle Factors
Patient-specific factors also play a large role in long-term success. Genetics can predispose an individual to recurrence if they inherited a foot structure that is inherently unstable or prone to the deformity. Continued stress on the repaired joint from lifestyle choices, such as wearing constrictive shoes, high heels, or footwear with a narrow toe box, can force the toe back into the deviated position. Failure to adhere to post-operative instructions, including premature weight-bearing or skipping physical therapy, compromises the healing of the bone and soft tissue, increasing the risk of the deformity returning.
Post-Surgical Steps to Maintain Alignment
Minimizing the risk of recurrence requires a long-term commitment to foot care and lifestyle adjustments following recovery. The most important action is avoiding footwear that compresses the forefoot or crowds the toes. Patients should choose shoes with a wide, deep toe box and a low heel to allow the foot to rest in a natural, aligned position.
Custom orthotics, or arch supports, are often prescribed to address underlying biomechanical issues like flat feet or excessive pronation that contributed to the original bunion formation. These devices provide necessary support to the arch and help maintain proper foot mechanics, reducing stress on the corrected joint. Physical therapy is recommended to strengthen the intrinsic muscles of the foot and retrain a proper gait, which helps sustain the corrected alignment.
Regular follow-up appointments with a specialist allow for monitoring of the foot’s alignment and early detection of any subtle return of the deformity.