Risks of Having Bunion Surgery

Bunion surgery is a common operation to get rid of a bunion, however, it’s not without its risks.  While a large majority of patients are pleased with their decision to have bunion surgery, some patients encounter post-operative problems that can interfere with the overall outcome. While it’s important to have properly executed bunion surgery, there are complications that can occur that can be lessened if you are actively involved in your recovery. 

1
Return of Bunion

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Bunions can return after bunion surgery and can be related to the method in which the bunion was fixed. Dr. Neal Blitz / BunionSurgeryNY.com

One of the most common concerns patients have with bunion surgery is if the bunion will come back.  While bunion recurrence is a possibility, it is something that tends to happen over a long period of time. Whether the bunion reforms often depends on the method used to correct the bunion as some techniques lend themselves to recurrence down the road. Simply “shaving bunions” doesn’t address the underlying cause of the bunion and recurrence is common with this approach.  Bunion surgeries that correct the boney malalignment that caused the bunion are better suited to have long-term success.  

How To Prevent Bunion Recurrence: The best way to avoid a recurrence is to have a bunion surgery that fully addresses how severe your bunion is. All bunions are not the same and therefore all bunion surgeries are not the same either. Techniques for small bunion surgery are different than techniques for surgery for large bunions, and having the best method to address the severity of your bunion is the best way to lessen the chance for bunion return.

2
Big Toe Joint Stiffness

Anytime surgery is performed on a joint, there is a risk for stiffness and restriction of motions afterwards. Scar tissue buildup inside the big toe joint is often the culprit.  Sometimes the final boney position of the bunion correction may also contribute to limited big toe joint motion.  Bunions that have been present for  many years may have some limited range of motion in the big toe joint after surgery because that joint was out-of-place for so long with the bunion, and even the realignment may not be able to restore the full motion. Big toe arthritis may be the cause of the stiffness.  

How To Prevent Big Toe Joint Stiffness:  Moving the big toe joint after surgery can keep the joint supple and limit scar tissue formation.  A dedicated physical therapy program can be advantageous as well. Bunion surgeons have different opinions on when to start moving the big toe joint and may be dependent on the type of bunionectomy you will have, so its important to follow your surgeon's advice.

3
Infection After Bunion Surgery

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Antibiotics are used with an infection after bunion surgery. Getty Images / Onur Döngel

Infection is a known risk with any surgery and an uncommon complication after bunion surgery.  The concern with infection after bunion surgery is that the bacteria can infect the surgical hardware that is used to stabilize the bone.  When bunion surgery infections do occur, they tend to be superficial skin infections that usually respond to oral antibiotics.  More advanced infections may require intravenous antibiotics. Rarely surgeons may need to surgically wash out the area. 

How To Prevent Bunion Surgery Infections: Surgeons take measures to limit or prevent infections in the first place by giving patients antibiotics directly into your bloodstream (intravenously) right before surgery.   Some surgeons may ask you to wash your foot in a special antiseptic prior to surgery.  One of the best methods to limit infection is to have a healthy immune system prior to surgery, so it's important to be well rested and optimize your overall health prior to surgery.  

4
Hallux Varus

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Hallux Varus (opposite moving toe) is a uncommon complication after bunion surgery. Dr. Neal Blitz / BunionSurgeryNY.com

Hallux varus is a new structural problem that uncommonly occurs after bunion surgery.  With hallux varus, the big toe deviates in the opposite direction and the big toe points in (away from the other toes).  The cause of hallux varus is often from a bunion overcorrection leading to muscular imbalance at the big toe joint. A hallux varus may occur rapidly after surgery but usually develops over time.  If left untreated a hallux varus could result in severe contractures of the big toe joints, arthritis, deformed looking foot and/or pain.

How To Prevent Hallux Varus: Unfortunately there is little a patient can do to prevent a hallux varus as since its due postoperative muscular imbalance.  Patients should be aware of its possibility and alert the surgeon to its possible presence if there is excessive space between the 1st and 2nd toe, and/or the big toe is very straight.  Splinting the toe towards the other toes may be a first-line treatment by the surgeon. Repeat surgery when identified may be recommended to prevent long-term structural problems.

5
Bone Healing Problems

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Bone healing problems (nonunion) risk is increased in smokers. Dr. Neal Blitz / BunionSurgeryNY.com

Since bunion surgery involves cutting or fusing bones to achieve an improved alignment, bone healing must occur and some people may have poor bone healing.  Bones typically take six to eight weeks to occur, and failure of healing after several months is medically called a nonunion. A symptomatic nonunion may demonstrate swelling, pain and/or redness.  Bone healing problems may be related to the actual surgical techniques and/or a person's overall medical health.

How To Prevent Bunion Surgery Nonunion:  Patients factors that can help limit bone healing problems is to have your overall general health maximized.  Avoid smoking and/or being around smokers as nicotine is known to interfere with bone healing.  Prolonged use of nonsteroidal anti-inflammatory medications (NSAIDs) has been suggested to increase the risk of nonunion, though this remains controversial.  Following your bunion surgeons postoperative weight bearing recommendations is important because bones require stability to heal properly.  

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