Question:I had bunion surgery that seemed to go pretty well at the time. But now it looks like my toe is going back out. Does this happen very often?
Answer:Recurrence of hallux valgus deformities (the medical term for bunions) is not uncommon after surgery. But it doesn't happen to everyone.
Doctors aren't sure why this happens. Instability occurs at the metatarsocuneiform joint contributing to recurrence. This joint is located where the long bone of the first toe (the metatarsal bone) meets the cuneiform bone in the midfoot. Some experts think the joint must be fused during surgery to avoid this problem.
Several studies support the theory that low recurrence rates are linked with the type of corrective operation done. Proximal osteotomy of the first metatarsal is the recommended treatment. Osteotomy refers to removing a wedge of bone to help bring the joint into a more neutral position.
At the same time, realignment of the soft tissues around the joint must be done. Muscle, tendon, and ligaments may be released to decrease the uneven pull on the joint. In some cases, it may be necessary to remove the joint capsule as well.
There's no guarantee that these measures will prevent recurrence of the deformity. There may be other factors at play that we don't know about yet. Reported results are good using this surgical approach with low recurrence rates.Michael J. Coughlin, MD, and Carroll P. Jones, MD. Hallux Valgus and First Ray Mobility. In The Journal of Bone and Joint Surgery. September 2007. Vol. 89-A. No. 9. Pp. 1887-1898.
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