Bunion surgery is typically performed to relieve pain and deformity associated with the great toe and the corresponding first metatarsal joint. The goals of the surgery are to correct any angular and width deformities of the foot, as well as remove the bunion -- a bone spur that forms as a result of chronic pressure on the inner aspect of the first metatarsal joint and base of the great toe. Bunion surgery can involve the cutting of the first metatarsal bone to realign and narrow the foot. With all of the different aspects of bunion surgery, the risk of complications is real and should be taken seriously.
Infection
Surgical site infections, or SSI's, can be a catastrophic complication to any surgical procedure, including bunion surgery. According to the Centers for Disease Control, or CDC, over 2 million nosocomial, or hospital-acquired, infections occur annually in the United States alone. The infections occur as a result of many factors such as improper sterile technique, death or injury to tissue during surgery, compromised general health of the patient, infection elsewhere in the body and depression of the immune system to name a few. Infections typically occur when micro-organisms that normally inhabit the skin without problem, gain entrance into the body and multiply. Infections can lead to tissue destruction, prolonged hospital stays and high medical costs.
Nerve Damage
During the initial phase of bunion surgery, the incision is made over the medial, or inner, aspect of the foot along the head of the first metatarsal bone and big toe. A branch of a nerve called the first dorsal cutaneous nerve, which provides sensation along the inner border of the big toe and metatarsal joint at the toe, travels along the site where incision are typically made. While rare, there is a risk of injury or damage to this nerve during the incision, placing of pins or sutures during surgery and from pressure applied from tight-fitting dressings or casts.
Recurrence
If bunion surgeries are performed on feet that have some elements of deformity associated with the spur, such as angulation of the great toe or excessive widening, or splaying, of the foot and these issues are not addressed and corrected, there is a risk of recurrence of the bunion and deformities and surgical failure. A study published in a 2009 article in the Journal of Bone and Joint Surgery said that recurrence rates fell between 4 and 11 percent when the surgery was performed properly. These rates increased in patients where two small bones that set beneath the ball of the big toe, called sesamoid bones were not restored to their proper position and alignment during surgery. While there can be many reasons for recurrence, the most common is the patient's return to the activities that initially caused or worsened the condition, that being the wearing of improperly fitting footwear.
Prolonged Stiffness
While it is normal and expected that there will be some level of post-operative great toe joint stiffness with bunion surgery, the complication arises when the stiffness persists for an abnormally long period of time, or even permanently. Prolonged stiffness cane cause difficulty with walking and wearing shoes, as well as being uncomfortable.
Hallux Varus
Hallux varus is a term that describes a complication that can arise after bunion surgery. The situation involves the formation of an angulation deformity of the big toe that is opposite the original angular deformity, known as hallux valgus, or angling toward the smaller toes/outer border of the foot. Hallux varus can occur as a result of over-correction of the soft tissues and excessive bone spur removal, which creates a dynamic imbalance in the tissues and mechanics of the toe.
