Absolutely! With over 50 types of bunion surgeries discussed in medical literature, it should not be surprising that many, if not most, have not stood the test of time.
Technological advances touch almost every aspect of our lives on a daily basis. Thanks to modern research and development, medicine has seen incredible advances, and that includes bunion surgery.
Are outdated bunion surgeries still performed?
Unfortunately, just because many conventional bunion surgeries no longer offer acceptable outcomes, it doesn’t mean that they’re no longer performed. This happens for several reasons, including that some surgeons are simply not comfortable learning advanced surgical techniques and adopting new technologies.
It is very important to always remember that there is no such thing as a “best bunion surgery.” This is because each patient is different, as is their foot anatomy, bunion deformity, bone quality, lifestyle, and work demands. So, what may be perfect for one bunion patient could be terribly wrong for another.
Please note: we generally only recommend bunion correction surgery if conservative treatment options have failed. Learn more about non-surgical bunion treatment options here.
7 Bunion Surgeries that have outlived their usefulness
In the interest of educating the general public, here’s a summary of some of the better known deprecated bunion surgeries. We’ve also included our thoughts as to why these approaches are generally no longer used.
1. The Traditional Tightrope Bunionectomy
In this procedure, a thin metal wire is wrapped around the first and second metatarsals and pulled tight. This shifts the first metatarsal into parallel alignment with the second metatarsal, thereby correcting its outward drift.
Unfortunately, this procedure has an unacceptably high rate of failure and increased risk of fracturing the second metatarsal. Tightrope procedures are typically performed in patients with compromised bone quality due to vascular conditions, soft bones (osteoporosis), and smoking.
Today, our surgeons perform an improved variant of this procedure, but on a very limited patient population. Known as the Tightrope FT, this procedure begins just like the classic tightrope: by threading a thin fiber-wire around the first and second metatarsals and tightening it – forcing the big to toe properly realign. The new twist: the first metatarsal head is removed in order to decrease stress on the bone, provide added stability to its base, and accommodate soft tissue remodeling.
2. Shaft Osteotomies
This is another procedure that all podiatrists learn in medical school and involves making a bone cut (osteotomy) along the mid-shaft of the metatarsal (the long bone leading to the base of the big toe) in order to correct its angle. The two halves are then held in place with two screws while the cut bone heals.
The shaft cutting approach, known as the “Z bunionectomy”, has long been discarded as an effective procedure at the University Foot and Ankle Institute and the Bunion Institute. This is because of its higher potential for misalignment and failure resulting from inadequate hardware support.
3. Scarf Osteotomy
The scarf osteotomy involves making a Z-shaped cut along the shaft of the first metatarsal, splitting the mid-shaft of the bone in half along its vertical axis. (It’s kind of like slicing open a baguette.) Next, the upper half of the metatarsal is rotated inward (toward the little toe) to line up the first metatarsal head with the base of the big toe. Two screws are used to hold the halves of the metatarsal in their new position. Any bone protruding from the bottom part of the “baguette” is trimmed off.
The scarf bunion surgery, while very effective at achieving a stable correction, is technically challenging, thus riskier than some other procedures that offer equivalent outcomes.
Although our surgeons have not totally stopped performing the scarf osteotomy, it is only used for very large bunions in patients who are unable to comply with non-weight-bearing restrictions during recovery.
4. Closing Wedge Osteotomy
As its name suggests, “the wedge osteotomy” is an orthopedic surgical procedure that involves cutting a “pie wedge” from the side of the first metatarsal to force it into straight alignment.
Like the other obsolete procedures described here, there’s simply no reason to perform such an invasive procedure when we have better procedures with much better long-term outcomes.
“The Wedge Bunionectomy is a cheating procedure that was used in the old days to straighten out the joint at the base of the big toe so that it’s perpendicular to the first metatarsal, creating a straight line from the metatarsal shaft to the tip of the big toe,” says Dr. Bob Baravarian, co-founder of University Foot and Ankle Institute and the Bunion Institute.
Dr. Baravarian continues: “The truth is, if you move the first metatarsal over properly and rebalance the supporting ligaments, there is no need to make a wedge cut in the metatarsal bone. And in those rare cases when the big toe alone has drifted out of alignment, we can perform an Akin osteotomy to correct the big toe position so that it’s parallel to the second toe. In either event, removing a wedge of bone from the metatarsal poses risks to the nerves and circulation and makes little sense.”
5. McBride Bunionectomy
The McBride bunionectomy is only rarely performed, as it involves cutting the joint surface to change its slope. Because this approach avoids cutting and shifting the metatarsal bone, it doesn’t bring the bone into correct alignment.
Thus, the McBride is only used if the patient is a very poor surgical candidate who may not heal from a surgery where the bone is cut or a fixation device must be applied to bone. The McBride provides very limited correction when compared to other modern procedures, especially our miniBunion Minimally Invasive Bunionectomy™.
We call this procedure “the cheater’s attempt at bunion removal.” That’s because this procedure involves cutting the bony bump from the big toe joint and nothing else. Exostectomy alone is seldom used to treat bunions because it foregoes realignment of the involved bones and therefore does not correct the hallux valgus deformity. Even when combined with soft tissue procedures, exostectomy rarely corrects the cause of the bunion, so it quickly returns.
When performed today, exostectomy is just one part of a more comprehensive corrective surgery that includes a metatarsal osteotomy, as well as soft-tissue procedures. If a foot surgeon wants to perform an exostectomy without a metatarsal osteotomy, don’t let them.
7. Resection Arthroplasty
In this procedure, your doctor removes the damaged portion of the big toe joint and pulls the first metatarsal and toe into correct alignment. Once part of the original joint is removed, scar tissue fills the gap, creating a flexible pseudo-joint. Resection arthroplasty is reserved mainly for patients who are elderly, have had previous unsuccessful bunion surgery, or who have severe arthritis and want to avoid fusing the joint.
Because this procedure can change the “push off strength” of the big toe, which is critically important for walking, it is rarely recommended.
Why choose the Bunion Institute for your bunion care?
If you are experiencing bunion pain, we’re always here to help. At the Bunion Institute, our mission is to provide the best bunion treatments available anywhere, so that our patients can be pain free and back to their daily activities as soon as possible.
Our nationally recognized bunion specialists offer the most advanced bunion care and the highest success rates in the nation. That’s because our foot surgeons are leaders in developing surgical techniques and technologies that advance bunion treatment for patients everywhere.
We realize that our patients lead busy lives. That’s why our clinics can include their own MRIs, CAT scanners, and x-ray machines to facilitate prompt diagnosis with minimal inconvenience to our patients. What’s more, several of our clinics have in-house physical therapy facilities which give our therapists immediate accessibility to our doctors and gives our doctors the ability to very closely monitor their patients’ progress.
For more information or to schedule a consultation, please call (855) 814-3600 or make an appointment online now.
At the Bunion Institute, we take our patients’ safety seriously. Our clinics’ and surgery centers’ Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.
We are conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia California, to name a few.