BunionsWhat's unique about our approach to bunion correction? Do bunions ever return? When should I have my bunions corrected? Results of the Angulated (Tri-plane) Bunionectomy Comparison: Traditional vs the Angulated (Tri-plane) Bunionectomy What happens if I have arthritis in my joints? Excellence in surgical engineering What is my foot going to look like after surgery? Most of our patients experience minimal discomfort The majority of our patients are in shoes after two to three weeks What is a bunion?Bunions are primarily a hereditary condition and most often progressively worsen throughout life. They can affect anyone, although they are most common in women. Bunions will usually be visibly present for many years before they become painful. A change of shoes, activity, or body weight can cause previously non-painful bunions to become painful. A bunion occurs due to multiple factors which result in a mal-alignment of the bones with the big toe drifting toward the second toe. Additionally, there is an enlargement of the "bump" on the inner side of the foot, next to the big toe. As a bunion deformity progresses, the "bump" or bony enlargement increases in size. In addition, the big toe can rotate, and continues to move towards, often over-lapping or under-lapping the second toe. A bunion is a bone problem. It is not a skin problem or a cyst. As you walk more the symptoms become worse. As the bunion increases in severity it can cause other associated foot problems, such as hammertoes, arch pain, and painful calluses on the bottom of the foot. Pain is often the result of rubbing of the enlarged bunion against the inner side of a shoe. There may be pain from within the actual bunion joint or when the great toe presses against the second toe. The exact cause of bunions is unclear. Some of the causative factors include heredity, flat foot structure, ligamentous instability or laxity, muscular imbalance within the foot and birth defects. Improper shoes during childhood may contribute to the formation of bunions, but this is uncommon. Inappropriate shoes during adolescence and early adulthood may aggravate an existing bunion formation. Can lasers eliminate bunions?This much-publicized technique is misleading. It is impossible for a laser to cut bone or correct a bunion. Making precise bone cuts is the most critical and important part of a successful bunionectomy. Lasers are useful for very few foot procedures, and offer minimal benefits over traditional techniques. What's unique about our approach to bunion correction?In order to effectively correct a bunion and reduce recurrence, all of the foot changes must be addressed to ensure appropriate function after the surgery. Simply removing the visible "bump of bone" will rarely produce a long-lasting result, and does not address the internal structural problems. Unfortunately, inappropriate bunionectomies address only the "bump of bone." Our technique includes realigning the bone for proper function, and uses a surgical screw for the most reliable and stable bone alignment. The proper use of the surgical screw is technically more difficult than other methods, but is worth the additional time and effort. There are several other methods of fixation that can be used in performing a bunionectomy. The screw provides the greatest amount of compression, strength and stability. (Just like screws rather than nails are used in manufacturing excellent furniture, similar thinking is used in our bone fixation.) Some patients request the removal of the screw after the surgery. If required, the screw can be removed easily during a ten minute office procedure. This procedure may be performed three months after the surgery. The screw will not affect the security metal detectors at airports. |
| 1. Often done under general anesthesia and may require inpatient hospitalization. | 1. Performed under a local anesthesia, or with mild sedation (twilight sleep) on an out-patient basis (no overnight stay). |
| 2. Many times require a cast or painful steel pins which protrude through the skin. | 2. A surgical screw is placed beneath the skin. Nothing protrudes through the skin. There are no casts, crutches, or walkers after the surgery. Only a soft gauze dressing is used. |
| 3. Often minimal walking with crutches for months after the surgery. | 3. Most patients walk immediately after surgery without crutches, using only a surgical shoe or sandal. |
| 4. Patients cannot wear shoes for prolonged periods of time. Extensive pain medication is often required. | 4. Patients usually return to tennis shoes after two weeks, with minimal discomfort. Minimal pain medication usage is common. |
This is the surgical shoe that is worn for two weeks after the surgery. Casting is not required. Crutches, canes or walkers are rarely used.
What happens if I have arthritis in my joint?
The nature of a bunion is not just a bump. As the "bump" increases in
size, often the great toe pushes laterally toward the second toe. This is
generally the moderate stage of the development of a bunion. As the joint
continues to function out of alignment, the bunion deformity gets worse. Some bunion
deformities worsen more rapidly than others, but they all get worse with time.
In more
advanced stages, some patients also develop osteoarthritis
(wearing down of the bunion joint.) The longer the joint is crooked and the longer the joint is mal-aligned, the
greater the chance for the person to develop arthritis.
This x-ray on the left shows a foot with severe arthritis of the bunion joint (1st MPJ or metatarsophalangeal joint), and less arthritis of the smaller toe joints. Notice how enlarged the bunion joint has become due to the extra bone growth around the joint.
Traditionally, arthritic joints were destroyed or fused. These are not good alternatives for an active person who puts great demand on their feet. Why destroy a joint if you can save it? For many patients with severe arthritic bunions, a bunionectomy with joint replacement can be used. An MP joint replacement is similar to a hip joint replacement. The results are generally excellent for reducing joint pain and allowing increased activity. Using surgical engineering, we are able to get the big toe joint to bend again, saving many such arthritic joints.
Excellence in surgical engineering
The foot is an amazing mechanical apparatus. What’s surprising is how important the bunion joint really is. If the bunion joint doesn't function correctly, many people not only have foot pain, but often unconsciously walk awkwardly to avoid putting additional stress on the painful area of their foot. This is why so many people with big toe problems also develop knee and back pain.
Since the force on the big toe joint is horizontal, bending torque moment occurs when you walk. Bending torque moment measures the point of application of weight-bearing forces times the length of the metatarsal bone (lever arm) to the osteotomy location (bone cut). The application of Angulated Bunionectomy (at 1/2x) minimizes the bending torque moment. The illustration below shows the placement of the angulated osteotomy as compared to other traditional osteotomies:
As the osteotomies are moved farther away from the big toe joint, the bending torque moment becomes higher. Higher bending torque moment creates more stress in the area of the bone cut, which can prolong recovery time. Other bone surgeries are done similarly, but there is an advantage in performing surgery at the end of the bone to minimize torque. The quality of the bone is better closer to the joint. The better the quality of bone, the faster the bone heals. Our goal in creating the Angulated Bunionectomy was to minimize torque so that we can get you back to your activities as quickly as possible.
What is my foot going to look like after surgery?
While the Angulated Bunionectomy is performed to repair your painful joint, it is also used to repair unsightly feet. Many people with bunions are embarrassed by their appearance. The Angulated procedure has helped many people return to a life of open-toed shoes.
Before
After
Most of our patients experience minimal discomfort
This new bioengineering procedure, the Angulated Bunionectomy, is done on an outpatient basis. Historically, bunionectomies were performed in the hospital where patients stayed overnight, usually due to post-operative pain and their inability to walk.
Most of our patients stated that their discomfort was markedly less than they had anticipated, and required minimal medications for pain. Additionally, the surgical engineering approach stabilizes the bone allowing our patients to walk the same day as their surgery.
The majority of our patients are in shoes after two to three weeks
With traditional bunion surgery, a return to shoes has often been delayed by pain, swelling, and the inability to walk because of pins or bone instability. The use of a surgical screw significantly reduces pain and swelling. Security of the bone realignment usually allows for immediate weight bearing and ambulation without the need for any casting. Patients are generally ready to begin wearing shoes two weeks after surgery. (See Time Line for Bunion Surgery).
In the past, pins and wires were used to hold the alignment of the bones. The pins stuck out of the foot and prolonged the return to shoes by as much as a month or more. The surgical screw we use is placed beneath the skin and is far more stable than pins. To ensure the best possible results, patients often enter a program of vigorous rehabilitation to help with the healing process and increase the flexibility of the corrected joint.
