Are you suffering from a painful bunion, or have a painful bump along the inside aspect of your big toe joint, making exercise, shoe wear, and other daily activities difficult? Bunions, or hallux abducto valgus deformity, is a common deformity of the foot that causes many to suffer from chronic foot pain. A bunion can form from a multitude of reasons, usually in part to genetic predisposition, flattened arches, overpronation, or generalized foot instability such as ligamentous laxity. It may also be caused by external factors such as poorly fitting shoes or repetitive foot stress. Often bunions can be managed conservatively by means of wider fitting and better-accommodating shoes, padding, strapping, and orthotics. While this may provide relief for many patients, it is important to keep in mind that nothing can reverse the deformity and restore normal anatomy short of surgical correction.
Bunion surgery has existed in the medical literature for over a hundred years, and in that time well over a hundred different procedures have been described in search of the best way to correct this deformity. Procedure choice is typically determined based upon several factors, including patient expectations and desired activity level after surgery, bone mineral density, joint stability, ability for downtime following surgery, and overall severity of the bunion. This has typically resulted in two widely used procedures. The first being a distal metatarsal osteotomy, or correction made at the level of the big toe joint; and the second being a proximal metatarsal osteotomy or tarsal-metatarsal joint fusion, which are corrections directed more towards the level of the midfoot. It has long been customary to perform a procedure at the level of the big toe joint for mild to moderate bunions, while reserving the proximal, or generally more involved procedure for those of greater severity.
Despite years of research and many different approaches to bunion surgery, no standardized procedure or protocol has been agreed upon. Ultimately, the decision on procedure selection depends on the surgeon’s preference, training, and experience. While this is successful most of the time, there is a percentage of cases that, despite the best surgical efforts, may go on to develop prolonged stiffness, under correction and a recurrence of the deformity. Furthermore, in the past several years, there has been strong evidence in the medical literature that a large percentage of bunions involve a three-dimensional rotational deformity, rather than simply occurring in two-dimensions as conventional thinking had previously taught us. This may be a problem and possibly explain some of these complications, as most existing surgical procedures are only capable of providing two-dimensional correction.
Fortunately, in response to the abundance of recent studies suggesting that a different approach may be needed to better correct some bunion deformities, a new system has been developed known as the Lapiplasty procedure, which was designed by a team of surgeons with these concerns in mind. This was created to address these issues, including lack of a standardized approach, under correction of the bunion, and recurrence of deformity. The Lapiplasty procedure incorporates a standard procedural technique for triplane correction and fixation protocol using two small plates and screws to yield reproducible and consistent results for bunions of all severity levels. Another major advantage of this procedure is that in some patients it can allow a more rapid return to weightbearing, allowing them to begin walking in a boot immediately after surgery, versus the traditional 6-8 weeks non-weightbearing with similar procedures. The procedure is performed on an outpatient basis, meaning you will go in for surgery and come home on the same day.
While the Lapiplasty is amongst the latest in bunionectomy surgery and has so far shown very exciting and promising results, it is important to keep in mind that it may not be for everyone, and only a trained surgeon can determine which, or if any procedure, may be right for you. If you have bunion pain but have been hesitant due to concerns about having surgery or you’re just overwhelmed on where to begin, give the doctors at Kansas City Foot and Ankle a call at 816-943-1111 for a thorough consultation and to find out which procedure may be best suited for you and your individual needs.