Revision of failed foot surgery: a critical analysis

The purpose of this study was to consider the causes of patient dissatisfaction following foot surgery and review whether poor outcomes are more commonly associated with particular techniques. Two hundred forty-four patients who had previously undergone foot surgery were referred to a podiatric surgery service because of continued pain, disability, footwear-fitting problems, and cosmetic concerns. The majority of cases had previously undergone first ray surgery to correct hallux valgus. The most common reason for referral was transfer metatarsalgia followed by recurrence of hallux valgus and lesser digit deformity. Thirty-two patients were treated with conservative measures, including orthoses and cortisone injections. Eight patients (25%) were completely satisfied with conservative treatment, 20 patients (63%) were satisfied with reservations, and four patients (12.5%) were dissatisfied. One hundred seventy-six patients underwent revision surgery. High patient satisfaction was achieved with surgical revision with 123 patients (69%) completely satisfied at an average 5.6-month follow-up, 43 patients (24%) were satisfied with reservations, while 10 patients (6%) were dissatisfied. Complications occurred in 23 patients (13%) with nine cases developing a superficial postoperative infection. In reviewing this series of patients, it is apparent that poor surgical outcomes and the need for revision surgery could in many cases be prevented with selection of surgical techniques that avoid joint destruction, excessive shortening of single metatarsals, and digital amputation.