From the Guidelines
Recurrence of hallux valgus after bunion surgery can be caused by several factors, including inadequate surgical correction, technical errors, patient non-compliance, and biomechanical factors. To minimize recurrence risk, patients should follow all post-operative instructions carefully, wear supportive footwear with adequate toe box space, use prescribed orthotics if recommended, and attend all follow-up appointments to monitor healing and alignment. Some key factors that might contribute to the development of hallux valgus after successful bunion surgery include:
- Inadequate surgical correction of the initial deformity, where the surgeon may not have sufficiently addressed the underlying bone alignment or soft tissue imbalances 1
- Technical errors during the procedure, such as improper placement of hardware or insufficient bone resection
- Patient non-compliance with post-operative instructions, including premature weight-bearing or wearing inappropriate footwear before complete healing
- Certain biomechanical factors like hypermobility of the first ray, flat feet, or tight calf muscles can place ongoing stress on the repaired joint
- Genetic predisposition and underlying conditions such as rheumatoid arthritis or neuromuscular disorders may contribute to recurrence despite successful initial correction It is essential to note that the use of casts, insoles, or physiotherapy might be beneficial in some cases, but the evidence does not support their use in improving lower limb deformity associated with XLH 1. Early intervention at the first signs of recurrence may help prevent progression to a full deformity. Guided growth techniques have been gaining popularity and might be considered as a surgical strategy to correct deformity at the physis before significant diaphyseal deformity develops 1. However, the decision to perform surgery should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Possible Causes of Hallux Valgus after Successful Bunion Surgery
- Recurrence of the deformity: This can occur due to various factors, including incomplete correction of the deformity, inadequate postoperative care, or progression of the underlying condition 2.
- Malunion: This is a potential complication of bunion surgery, where the bones do not heal properly, leading to a recurrence of the deformity 2.
- Avascular necrosis: This is a rare but potential complication of bunion surgery, where the blood supply to the bone is disrupted, leading to bone death and potentially causing a recurrence of the deformity 2.
- Inadequate physical therapy: After bunion surgery, physical therapy is essential to restore strength, flexibility, and range of motion to the foot and ankle. Inadequate physical therapy can lead to a recurrence of the deformity or persistent symptoms 3.
- Preoperative radiographic severity: While radiographic severity of the deformity may not be directly correlated with symptom level or disability, it is essential to consider individual patient factors and radiographic measurements when planning surgery to minimize the risk of recurrence 4, 5.
Factors Influencing the Development of Hallux Valgus after Bunion Surgery
- Patient-reported outcomes: These are increasingly important in evaluating the success of bunion surgery, and radiographic measurements may not be well correlated with patient-centered outcomes 5.
- Radiographic measurements: While radiographic measurements are essential in evaluating the deformity, they may not be the only factor influencing the development of hallux valgus after bunion surgery 4, 5.
- Individual patient factors: Age, overall health, and individual patient characteristics can influence the development of hallux valgus after bunion surgery 4.