A common question patients ask is: “Will my bunion come back after surgery?
Generally speaking, the literature has reported high recurrence rates in the past, sometimes up to 20–30%, with procedures such as Scarf and Akin osteotomies and Chevron osteotomies, which were part of traditional open surgical techniques.
There are multiple reasons why a bunion deformity may recur after surgery. These may include:
- Patient factors
- Surgeon factors
- Surgical factors
- The type of procedure performed
- The severity and flexibility of the original deformity
- The stability of the midfoot and big toe joint
Understanding why bunions can recur is important when deciding which treatment is most appropriate.
Why Can Bunions Come Back After Surgery?
Bunion recurrence can happen for several reasons. In some patients, the deformity may be more likely to return because of the underlying structure and movement of the foot.
In others, recurrence may be related to the procedure selected, the amount of correction achieved, or whether there was instability or arthritis that required a different surgical approach.
Patient Factors That Can Increase the Risk of Bunion Recurrence
Patient factors generally include hypermobility, which means there is instability in the forefoot.
In some cases, there may also be genuine bad luck, where the deformity was progressive over time.
For example, the midfoot joint, known as the first tarsometatarsal joint, may appear corrected at the time of surgery, but the intermetatarsal angle can increase again over time. When this happens, the bunion can recur.
Surgeon and Procedure-Related Factors
Other factors may relate to the procedure performed.
For example, if there is significant instability of the midfoot, a fusion procedure known as a Lapidus procedure may have been more suitable. This type of procedure can help prevent recurrence in patients where midfoot instability is the underlying problem.
Similarly, if there is arthritis in the big toe joint, then a fusion of the big toe joint may have been more appropriate.
However, patient choice must also be taken into account. Some patients do not want a fusion procedure of any kind and may accept the risk that recurrence could occur.
Therefore, the choice of procedure may not always be purely a surgeon-related factor. It can also depend on the patient’s symptoms, expectations and preferences.
Undercorrection and Bunion Recurrence
Another surgical factor is undercorrection.
Sometimes the bunion deformity is not corrected enough during surgery. If the deforming forces remain in place, the soft tissue structures can gradually fail, and the deformity may increase again over time.
This is one of the reasons why achieving an appropriate correction during the original procedure is important.
Can You Reduce the Risk of Bunions Recurring After Surgery?
Yes. Even when there are both patient and surgical factors, there are things that can help reduce the risk of recurrence.
Using splints does not necessarily work in the long term. However, using supportive footwear, such as trainers with good arch support, or using orthotic insoles, can provide improved stability to the foot generally and may help reduce the risk of recurrence.
Supportive measures may include:
- Wearing trainers with good arch support
- Using orthotic insoles where appropriate
- Avoiding narrow or poorly supportive footwear
- Supporting the arch and hindfoot
- Maintaining good overall foot stability
- Following post-operative advice carefully
These steps may not guarantee that a bunion will never recur, but they can help support the foot after surgery.
Why Is There Less Risk of Recurrence With Minimally Invasive Bunion Surgery?
The technical aspects of minimally invasive bunion surgery allow for a greater correction of the deformity.
In the past, larger deformities were limited by the width of the metatarsal. Even if the midfoot was stable, the deformity sometimes had to be corrected more proximally by fusing the tarsometatarsal joint.
This was because the fixation methods, including screw fixation methods, did not always allow a standard Scarf or Chevron osteotomy to fully correct the deformity.
Greater Correction With Keyhole Bunion Surgery
With minimally invasive surgery, there is essentially no limit to how much the metatarsal can be moved.
The first metatarsal can be shifted towards the second metatarsal almost 100%, and more in some cases, while still providing stable fixation.
This allows a greater spectrum of intermetatarsal angles to be corrected, including higher-angle deformities.
Midfoot Stability and Recurrence Risk
There is also evidence that locking of the first tarsometatarsal joint in the midfoot can happen in cases where the deformity is fully corrected into varus.
This means the metatarsal cannot increase further after the procedure, which may allow a greater correction of the deformity and help reduce the risk of recurrence.
Can I Have Minimally Invasive Surgery If My Bunion Has Come Back After Traditional Open Surgery?
Yes. In some cases, it may be possible to have minimally invasive bunion surgery after recurrence following traditional open surgery.
However, due to the construct of the previous surgery, a hybrid procedure may sometimes be required.
This may involve removing some of the screws through a slightly open technique while also performing part of the correction using keyhole surgery.
I have often had good results in patients requiring this type of revision procedure.
However, in some patients, if this is not possible, a Lapidus fusion may be the only option.
Only X-rays and a clinical examination will allow this to be determined.
What Are the Recurrence Rates of Keyhole Bunion Surgery in My Practice?
In my practice, the recurrence rates of keyhole bunion surgery are less than 3%.
I find that keyhole bunion surgery allows for greater correction of the deformity. Over the years, I have been able to hone my technique to try to avoid an undercorrected deformity.
However, this is not always possible in every single case.
As a podiatric surgeon, I try to correct the deformity as fully as possible, and I believe this has helped reduce the risk of recurrence in my practice.
When Should You Seek Advice About Bunion Recurrence?
You should consider seeing a bunion specialist if:
- Your bunion appears to be coming back after surgery
- The big toe is drifting again
- The bunion bump is becoming more noticeable
- You are experiencing renewed pain or pressure
- Shoes are becoming uncomfortable again
- You previously had open bunion surgery and are worried about recurrence
- You want to understand whether revision surgery is possible
- You are considering surgery and want to reduce the risk of recurrence
A proper assessment with clinical examination and X-rays can help determine whether the bunion has recurred, why it may have happened, and what treatment options are available.
Can Bunion Recurrence Be Prevented?
Bunion recurrence cannot always be completely prevented, especially when there are underlying patient factors such as hypermobility or progressive deformity.
However, the risk may be reduced by:
- Choosing the correct procedure for the deformity
- Fully assessing midfoot stability
- Identifying arthritis before surgery
- Achieving adequate correction
- Using stable fixation
- Wearing supportive footwear after surgery
- Using orthotics where appropriate
- Following post-operative guidance carefully
The most important step is choosing a treatment approach that matches the patient’s foot structure, deformity, symptoms and long-term goals.
Book a Bunion Consultation
If you are worried about bunion recurrence or if your bunion has returned after previous surgery, it is important to have your foot properly assessed.
Mr Kaser Nazir, Consultant Podiatric Surgeon, specialises in minimally invasive bunion surgery and revision bunion surgery assessment.
A consultation, examination and X-rays can help determine why the bunion has recurred and whether minimally invasive correction, a hybrid procedure or another approach may be suitable.
