A majority of patients who pursue surgical correction of their bunion deformity are very satisfied with their outcome. Relief of joint pain and correction of the bunion deformity reestablishing normal joint function are the two goals of bunion surgery.
Complications after any surgical procedure are possible. Some of the most common complications associated with bunion correction include, joint stiffness, infection, delayed healing of bone, recurrence of the deformity and overcorrection of the deformity leading to hallux varus.
Hallux varus is an abnormal position of the first toe that is the reverse of the original toe position of the bunion deformity. Although the incidence of hallux varus related to bunion correction is very low its occurrence is alarming and can require surgical revision.
Surgical correction of the original bunion deformity involves releasing abnormally tight soft tissues around the big toe joint and repositioning the first metatarsal bone by cutting the metatarsal and moving it into its anatomic position. Moving the metatarsal bone too much during the bunion correction of over aggressively splinting the first toe during recovery can cause the toe to drift into hallux varus.
If the first toe looks “too straight” or has drifted into hallux varus after surgery splinting the first toe towards the second to may be helpful early in recovery.
Beyond the abnormal visual appearance of the first toe in hallux varus symptoms may include first metatarsal joint pain and arch cramping during walking. Hallux varus may be recognized immediately after bunion surgery or may occur gradually in the first few months after surgery.
Hallux varus revision generally involves releasing the tight soft tissues on the inside portion of the joint and possibly re-cutting the metatarsal bone to reposition back into its normal position. Very commonly the combination of soft tissue release and the transfer of a portion of the long extensor tendon to the toe into the outside of the proximal phalanx of the first toe provide a solid surgical correction. The partial tendon transfer provides a dynamic pull from the extensor tendon redirecting the first toe into its stable corrected position. The tendon is most commonly attached to the proximal phalanx with the use of a bone anchor with suture affixed to it to sew the tendon down to the bone.
Post operatively patients are often managed on crutches eliminating weight bearing for the first three weeks and then full weight bearing in a removable CAM boot for an additional two to three weeks. Maintaining flexibility in the joint after surgery with range of motion exercises and continued splinting of the first toe for the first few months after surgery is important to provide a successful outcome.