Recurrent Hallux Valgus

Abstract

Obtaining effective long-term results for the surgical correction of hallux valgus perhaps epitomizes most of any deformity within the foot and ankle, the adage that surgery is both art and science. The effective long-term correction of recurrent hallux valgus therefore adds levels of complexity and challenges both technically for the surgeon as well as expectation wise for the patient. Patients electing to undergo surgery for the correction of their painful bunion deformity have fairly basic desires. They would like the correction to look good, feel good, and be lasting with minimal disruption to their everyday life. By its very presence, the outcome of an index surgery that later necessitates a second intervention has failed all those patient desires. This heightens tremendously the importance of effective surgeon-patient communication and realistic appraisals by the surgeon as to their own personal skill set, knowledge base, and specifically those patient’s expectations. A viable outcome formula characterizing the interplay between these variables may be considered as outcome = surgeon knowledge multiplied by surgical execution divided by patient expectations. Clinical experience by the author has led to the additional surgical adages of a prudent reconstructive effort that seeks “to do the least possible and yet the most necessary” and the realization that “almost everything can work—incompletely, and almost nothing works—completely.”