The clinician needs to know what operation was performed, where bone was cut or fused, what fixation remains, whether additional lesser-toe procedures were done, and how symptoms evolved. Immediate postoperative improvement followed by gradual drift suggests a different mechanism from pain that never resolved.
Examination assesses standing alignment, joint motion, flexibility, first-ray stability, callus pattern, nerve sensitivity, scar, lesser-toe stability and gait. Weight-bearing X-rays evaluate current angles, joint congruence, bone stock, fusion or osteotomy healing and fixation.
Obtain the original operation report where possible.
Compare preoperative, immediate postoperative and current weight-bearing images.
Localise pain precisely rather than attributing all forefoot pain to the bunion.
Use CT when union or complex three-dimensional bone anatomy remains uncertain.
Use ultrasound or MRI selectively for soft-tissue, sesamoid or other pathology.
Assess infection when there is drainage, unexplained inflammation, bone loss or fixation concern.
Why are the old X-rays useful?
They show the original deformity, the correction initially achieved and when alignment or bone healing changed. This can reveal the cause more clearly than the current X-ray alone.