Bunions are primarily a hereditary condition and most often progressively become worse throughout life. They can affect anyone, although they are most common in women. A bunion occurs due to a mechanical instability in the foot, which results in a mal-alignment of the bones with the big toe drifting toward the second toe. Although poorly fitting shoes do not cause bunions, shoes can certainly aggravate an underlying condition. As a bunion deformity progresses, we begin to notice a large bump behind the inside of the big toe. As one walks more, the symptoms worsen. As the bunion increases in severity, it can cause other associated foot problems, such as hammertoes, painful calluses on the bottom of the foot and arch pain.
This much-publicized technique is often 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.
We feel that in order to effectively correct the bunion, all of the foot changes must be addressed to ensure appropriate function after the surgery and to reduce recurrence. Simply removing the visible "bump of bone" will rarely produce a long-lasting result, and does not address the internal structural problems. Our technique includes surgical engineering to realign the bone for proper function, and uses a surgical screw for the most 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. Screw fixation decreases post-operative pain, shortens the recovery time, allows for a more rapid return to regular activities and decreases the chances for a recurrence. If desired, the screw can be removed as a simple office procedure, a few months after the surgery. Once the bone has healed, the screw offers no additional benefits.
No surgeon can guarantee perfect results. Unfortunately, if the wrong procedure is performed, the recurrence rate can be very high. Many of the microsurgeries and laser techniques have a high recurrence rate because they generally cannot accurately realign the bones.
These types of procedures have become less popular recently due to the incidence of recurrence as well as other problems and complications.
If you have any of the following problems, your feet should be evaluated:
- Calluses on the inside of the big toe
- Pain around the big toe when wearing certain shoes
- Painful calluses on the bottom of your feet
- The big toe pushing on the second toe
- Difficulty wearing shoes or participating in desired activities, such as sports or dancing
- Increasing need to wear wider shoes
In the past, bunion sufferers have been subjected to an array of surgical procedures with mixed results. Pain, long-term disability, hospitalization and casting were the standards of care. Now we use a procedure which changes the traditional way in which bunions are approached. This bioengineering technique realigns the bones and maintains the correction securely and with generally minimal discomfort.
- Often done under general anesthesia and may require inpatient
- Many times require a cast or painful steel pins which protrude
through the skin.
- Often minimal walking with crutches for months after the surgery.
- Patients cannot wear shoes for prolonged periods of time. Extensive pain medication is often required.
- Performed under a local anesthesia, or with mild sedation (twilight sleep) on an out-patient basis (no overnight stay).
- 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.
- Most patients walk immediately after surgery without crutches, using only a surgical shoe or sandal.
- Patients usually return to tennis shoes after two weeks, with minimal discomfort. Minimal pain medication usage is common.
The nature of a bunion is a misaligned joint, not just a bump. 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 worsen over time.
Some patients with bunions also have osteoarthritis, or a wearing down of the joint. The longer the joint is crooked and the longer the joint is misaligned, the greater the chance for the person to develop arthritis.
This x-ray shows a foot with severe arthritis of the bunion joint (1st MP joint), and less arthritis of the smaller toe joints. Notice how enlarged the bunion joint has become enlarged due to extra bone growth around the joint.
That is why the surgical engineering behind the Angulated Bunionectomy is so important. The procedure is designed to restore proper alignment and function. Traditionally, arthritic joints were destroyed or fused. These are not good alternatives for an active person who puts great demands on their feet. Why destroy a joint if you can save it? In some instances, a plastic joint implant similar to a hip joint implant can be used. 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.
The foot is a highly mechanical apparatus. What's surprising is how important this joint really is. Try walking without bending your big toe, it's like trying to drive a car with a flat tire. This is why so many people with big toe problems have knee and back pain as well. 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 weightbearing forces times the length of the lever arm (length of bone) to the osteotomy (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 (bone cut) 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. This is our special ingredient in the Angulated Bunionectomy.
Not only do we minimize torque at the end of the bone, but the quality of the bone used 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.
The effects of bending torque moment are similar to bending of a pencil whose point is placed on the edge of a table. Applying a force near the tip of the pencil will not generally result in breaking the pencil, because bending torque moment is minimized. But, if one applies the same force near the eraser, the pencil will break much more readily.
While the Angulated Bunionectomy is performed to repair your painful joint, it is also used to repair unsightly feet. Many people with bunions are afraid to show their feet because they are embarrassed by their appearance. The Angulated procedure has helped many people return to a life of open toed shoes.
Most of our patients experience minimum discomfort.
The Angulated Bunionectomy is done on an outpatient basis. Traditionally, bunionectomies were done in hospitals where patients stayed overnight, usually due to postoperative pain and their inability to walk. Most patients stated that their discomfort was markedly less than they had anticipated, and required minimal medication 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 casting. Patients are generally ready to begin wearing shoes two weeks after surgery. Traditionally pins and wires have been 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 longer. The surgical screw we use is placed beneath the skin and is much more stable than pins. To ensure the best possible results, patients enter a program of vigorous rehabilitation to help with the healing process and increase the flexibility of the corrected joint.
There is no need to be afraid of bunion correction with our advanced techniques.
For more information about this procedure, link to Time Line for Bunion Surgery
Please e-mail us with your questions.