Failed Bunion Surgery
Failed Bunion Surgery usually means:
- the bunion is still there after surgery
- the big toe misalignment
- hallux varus (big toe drifting away from foot)
- no motion at joint or stiff toe
- cock-up toe or touch does not touch the ground
- new pain taking the place of the old bunion pain
Most modern bunion deformity surgeries involve the use of pins (K-wires) or screws. Some podiatrist believe that you don’t need to use these “fixation” devices. Your podiatrist must tell you if she is using or not using fixation devices. If you are told they are not going to be used, you should get a second opinion. Many podiatrists without residency training or who use the “minimally invasive surgery” technique.
Modern bunion corrective surgery involves the cutting and repositioning of bones. It will involve a screw or pin to keep the bones aligned. You will have an incision on the side or toward the top of the big toe joint called the “metatarsal-phalangeal joint.”
The 1st metatarsal bone is almost always cut (e.g., an “Austin” procedure) in the re-alignment. Sometimes one of the smaller bones in the toe has to be cut (e.g., an “Akin” procedure) as well. These are necessary to get the angled bones, and big toe, back into a more normal position. The bunion bump itself is cut off too.
A bunion can may return after surgery but usually many years later, if at all.
When a bunion is still present after surgery, or if it comes back weeks or a few months later, or if the big toe “drifts” away from the second toe (“Hallux Varus”), it is likely that something was not done correctly during surgery. When you contact me I will fully investigate your case and find the reason why you ad a poor outcome.
There are many techniques for surgically fixing a bunion. The Austin procedure involves a cut near the head of the 1st metatarsal bone. A “base” osteotomy involves a cut at the base or bottom of the 1st metatarsal bone, closer to the mid-foot. Some patients even need a fusion of a joint because their bones have too much of an angle or too much flexibility. These procedures are called “Lapidus” procedures.
One of the most fundamental principles of “bone correction” is the calculation of important angles and other measurements on your x-rays by drawing certain lines and measuring the angles formed by the lines:
- the intermetatarsal angle is the “splay” between your 1st and 2nd metatarsals. Bunion deformities almost always have an abnormally high splay angle.
- the hallux valgus angle measure the angle of the big toe where it joins the foot at the end of the 1st metatarsal. In bunion deformities this angle is also usually abnormal.
- The PASA and DASA, are measurements many podiatrists overlook. These measure how the cartilage covers the joint.
- The metatarsal protrusion distance measure how long your metatarsal bone is
What goes wrong when these angles are not looked at carefully?
- podiatrist simply “eye-ball” and “guesstimate” can make very bad decisions as what kind of surgery to do.
- podiatrists who rely on their experience only can also miscalculate and perform the surgery poorly.
- podiatrist who get a bad result have a hard time explaining when asked if the made these measurements.
The Old Fashioned Way of Fixing a Bunion?
An old method of bunion correction was the simple “shaving off of the bump.” If it is still used today it would be on the elderly patient. This procedure does not correct the real problem in most patients and is considered malpractice on some patients if that is all the podiatrist does.
Some podiatrists do not explain the details of the surgery and what they intend to do and just tell the patient “we will just shave some bone” when they are actually doing much more and use a pin or screw. The patient wakes up from the operation and learns a lot more surgery was done than what they were told. Telling the patient only this limited amount of information is malpractice. Technically, it is called “lack of informed consent” because the podiatrist is not giving the patient all of the accurate information before getting the patient’s consent to the surgery.
Is it really an Operative Report?
Many Podiatrists use a template or a standard form as their “operative report” for most of their surgeries. In most cases, when there is a problem during surgery, the operative report will make NO mention of the problem or complication. We find that the truth as to what really took place during the surgery will be found comparing the before and after x-rays.
Bone Cutting is Science – not Guesswork
If the bones are not cut correctly, the patient may wind up with
- a big toe which does not bend, so walking is extremely difficult
- a big toe drifts away from the second toe – hallux varus – and that can walking difficult
- the big toe is overly shortened from a miscalculation in the bone cuts and can easily cause more pressure on the other toes and make walking very painful and difficult. A painful condition known as “metatarsalgia” can develop from this over shortening.