Are you suffering from a painful bump along the inside aspect of your big toe joint, making exercise, shoe wear, and other daily activities difficult? You may have developed a painful bunion. Let’s discuss what a bunion is, how it is formed, and what can be done about one. We will also introduce Lapiplasty: the newest, most advanced technique in bunion surgery!
What is a Bunion exactly?
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. Additionally, a bunion may 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, better-accommodating shoes or padding, strapping, and orthotics. While these modalities may provide temporary relief for many patients, nothing can reverse the deformity and restore normal anatomy. That will require surgical correction.
Bunion surgery has existed in the medical literature for over a hundred years. In that time over a hundred different procedures have been described, searching for the best way to correct this deformity. Procedure choice is typically determined based upon several factors. these may include:
- Patient expectations
- Desired activity level after surgery
- Bone mineral density
- Joint stability
- Ability for downtime following surgery
- Overall severity of the bunion
This has typically resulted in two widely used procedures:
- Distal Metatarsal Osteotomy – correction made at the level of the big toe joint; and
- Proximal Metatarsal Osteotomy or Tarsal-Metatarsal Joint Fusion – corrections directed more towards the level of the mid-foot.
It has been customary to perform a procedure at the level of the big toe joint for mild/moderate bunions. The proximal procedure is typically used in cases with 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.
Recent Studies – Lapiplasty
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. This procedure was designed by a team of surgeons with the above concerns in mind. It was created to address the lack of a standardized approach, under correction of the bunion, and recurrence of deformity. The Lapiplasty procedure incorporates a standard procedural technique for tri-plane correction and fixation protocol. The procedure uses two small plates and screws to yield reproducible and consistent results for bunions of all severity levels.
A major advantage of this procedure is that in some patients it can allow a more rapid return to bearing weight, allowing them to begin walking in a boot immediately after surgery, versus the traditional 6-8 weeks non-weight bearing with similar procedures. The procedure is performed on an outpatient basis; you will have surgery, and go home the same day.
Lapiplasty is among the latest in bunionectomy surgery and has shown exciting and promising results, however, it may not be for everyone. 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.