I’ve been thinking and thinking about having surgery for my bunions. But so many people I’ve talked to say their’s was better but it came back. Does this really happen often, or am I just by chance talking with the few people who have had a bad experience?

Hallux valgus (bunions) is a condition that affects the joint at the base of the big toe. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint.

In reality, the condition is much more complex than a simple bump on the side of the toe. Interestingly, this condition almost never occurs in cultures that do not wear shoes. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one.

Unfortunately, recurrence of this problem is considered a common complication of the surgery. But new research indicates that this may not be absolutely true if the surgeon is careful to pay special attention to one particular area: the sesamoid bones.

The sesamoids are two tiny, pea-sized bones that sit just under the main joint of the big toe. They are embedded in the soft tissues and play an important role in how the foot and big toe work. If the sesamoid bones are not properly realigned after bunion surgery (called a bunionectomy), patients are at a greater risk of recurrence of the bunion deformity.

How can this be avoided? Surgeons investigating the matter suggest that complete complete reduction of the sesamoid bones is necessary and possible with improved surgical technique. Reduction means these two little bones are placed back in their normal, neutral position under the joint of the big toe. If that’s not the case, then the surgery must be modified until they are in the necessary alignment.

The surgeon may have to go back and release other soft tissue structures, including the capsule (fibrous soft tissue) surrounding the joint. X-rays must be taken during the operatino to confirm proper alignment before closing up the surgical incision.

Let your surgeon know of your concerns and ask some questions about how you can avoid recurrence of the problem. Sometimes people look for others who have had excellent results in their geographical area in order to find the surgeon that’s best for them. Look for patients who have a good to excellent result that is still satisfactory one to five years later.