What Can Go Wrong After Bunion Surgery?

Patients deserve an honest explanation of possible problems, how they develop, and what can be done to reduce the risk. No surgeon can guarantee that every patient will have an identical recovery or result. Anatomy, health, bone quality, procedure complexity, tissue response, and compliance all matter.

Joint Stiffness

Motion can decrease during the first several days due to swelling, inflammation, capsule tightening, early scar formation, and reluctance to move the toe. Patients with hallux limitus, arthritis, preoperative restriction, or a biological tendency toward stiffness require particular attention to early range-of-motion work. In selected cases, the joint may be locally anesthetized and carefully manipulated by the physician; patients should never self-manipulate forcefully.

Transfer Metatarsalgia

Uncommon in Dr. Moy's practice. Develops when the first ray no longer carries its proper share of weight and pressure shifts to the second metatarsal. Possible causes include inadequate restoration or hypermobility of the first ray, excessive shortening, elevation or valgus positioning of the first metatarsal, an elongated or plantarflexed second metatarsal, or retrograde pressure from an unstable second toe or hammertoe. Prevention requires evaluating the entire metatarsal parabola, not just the first ray in isolation.

Temporary Numbness

Common, and usually related to the long-acting anesthetic, swelling, and bandage pressure. A narrow line of reduced sensation may occur along the incision. Prolonged numbness directly related to surgery has been rare in Dr. Moy's experience.

Swelling

Expected, and commonly peaks around the third postoperative week, generally subsiding through weeks six to eight, though some patients remain swollen longer. Pitting edema, varicose veins, chronic fluid retention, venous problems, and certain medications can prolong swelling. Localized swelling over the fixation screw may indicate mechanical irritation, or, in a small number of patients, sensitivity to a stainless-steel component.

Hardware Irritation and Screw Removal

The vast majority of patients leave the fixation screw in place. A small percentage request removal, whether for preference, prominence, backing out, localized swelling, or shoe irritation. Dr. Moy developed a minimally invasive removal method using fine-needle localization and guide-wire tracking through the cannulated screw, removed through a very small opening with generally one stitch and a small dressing. Patients commonly return to a regular shoe the following day.

Infection

Extremely uncommon in Dr. Moy's practice; when it has occurred, generally mild and identified early. Concerning signs include spreading redness, increasing warmth, new sensitivity or pain, drainage, odor, wound separation, or systemic symptoms. Keep the dressing clean and dry, avoid touching or scratching the incision, and use the protective shower bag. Intense itching can represent contact dermatitis rather than infection; report it rather than self-treating by removing or probing the dressing.

Blood Clots

Extremely rare in Dr. Moy's bunion patients. Early protected walking promotes circulation and may help reduce risk, but cannot eliminate it. New calf or thigh swelling, tenderness, warmth, redness, or unexplained soreness requires prompt evaluation. Sudden shortness of breath, chest pain, coughing blood, lightheadedness, or fainting requires emergency medical attention.

Complex Regional Pain Syndrome (CRPS)

An uncommon condition involving pain disproportionate to expected healing, possibly with unusual sensitivity, swelling, skin-temperature or color changes, sweating abnormalities, stiffness, and loss of movement. Dr. Moy has encountered several CRPS cases related to traumatic injuries over his career, but none following one of his bunion procedures in more than 35 years. It is included here for completeness of discussion, not because it is expected.

The Evidence

Avoiding a complication entirely can never be promised. What we can show is how careful planning, evaluation, and technique are intended to reduce the chance of one, and how each of the issues above is actually recognized and managed when it occurs.