What Type of Bunion Surgery Might be Right for You?
You may not know it, but you have many Bunion Surgery options…
The Foot and Ankle Specialists at University Foot and Ankle Institute try to avoid surgery whenever possible. Surgery is not something to take lightly, especially bunion surgery and we believe most caring and top-rated surgeons do too. But there are time when you may need to look at surgical options for correcting your bunion condition.
Your foot and ankle specialist could probably recommend surgery when conservative treatments aren’t working and you are still suffering from:
Walking that causes severe foot pain.
The inflammation and swelling are no longer responding to medication.
Non-invasive treatments, like orthotics, pads, and activity modification, haven’t helped.
Even doctor-recommended footwear is causing you pain.
You’re unable to bend or straighten your big toe.
The big toe painfully starts pointing towards the smaller toes.
Other toe deformities have developed.
What Can Bunion Surgery Do for You?
The goal of bunion surgery is to eliminate pain, correct the alignment of the great toe joint, and prevent the bunion from coming back.
Choose a bunion surgeon who’s right for you. There are many ways to correct a bunion and some surgeons choose the easy way for all patients. Although it may be sold as a cosmetic style correction or minimally invasive procedure to the patient, many of these quick fix cosmetic procedures will not last long term and may allow the bunion to re-develop.
Bunion Surgery Doesn’t Have to be Painful
Bunion correction technology and pain management have become much more advanced over the years. When you choose a bunion surgeon with extensive experience in the latest bunion correction techniques, your surgery and recovery can be virtually pain-free.
Post-surgical pain results from movement and swelling. If you can control these factors, you can control the pain.
A good bunion surgeon will control pain by:
Taking great care of the tissue with surgical precision. Never “hacking away” at the tissue. This takes years of training and effort to perform good dissection.
A stable fixation to immobilize the bones. Hypermobility in the bones is one of the main causes of swelling and pain after surgery. Through the use of screw(s) and/or staple or plates, the bone is held properly in the area of correction resulting in less movement, less swelling and ultimately less painkiller use.
A proprietary long-acting local anesthesia cocktail. The longer a person is numb, the better the chance for them to get in bed, relax and heal
Post-surgical anti-inflammation protocols and no major narcotics. In our hands, patients will rarely take more than one or two pain pills after surgery.
Fitting the patient with a stability boot to immobilize the foot. By holding the foot stable, there is less movement, resulting in less swelling and less pain.
Quality bunion surgeons shouldn’t rely on painkillers to keep their patients comfortable. Narcotics cause constipation and can be addictive. Unless surgery is extensive, our patients rarely take over two pain pills after surgery, and then need nothing more than Tylenol and an anti-inflammatory in recovery.
It is critically important to remember no one bunion surgery is right for everyone!
This is extraordinarily important to keep in mind when you are investigating bunion surgery options. If you meet a doctor that just does one type of bunion surgery, this is a big red flag and please do not ignore it! It is critical that your surgeon has plenty of experience and expertise on various bunion surgery techniques. This is one thing that virtually all top foot and ankle specialists agree upon
How Many Different Types of Bunion Surgeries Options Are There?
Believe it or not, there are at least 44 different types of bunion surgeries that have been performed over the years, but today there are only a handful that have been proven over time to be truly effective. They include:
The Austin Bunionectomy
Also known as a Chevron procedure or Long Arm Osteotomy, the Austin Bunionectomy is one of the most-performed bunion surgeries.
Osteotomy is the medical term for a bone-cutting procedure. In this surgery, a small incision is made, in our case on the side of the foot for aesthetic reasons. A V-shaped cut is made in the head of the first metatarsal just behind the big toe joint.
The metatarsal may then be shifted into alignment correcting the bone position and the big toe. One or two screws hold the bones in place. The surgeon may remove the screws later after the bone heals, but most times the screws remain to avoid recurrence of the bunion.
What Are the Benefits of Austin Bunionectomy?
Wearing regular shoes in 4-6 weeks.
Physical therapy can prevent scar tissue formation.
Minimally invasive technique avoids a large scar on the top of the foot.
Who Is Not a Good Candidate for Austin Bunionectomy?
The bunion deformity may come back as it is not totally corrected at the source of the deformity. This is a corrective surgery that works well in most cases but not in all cases and is often overused for all cases which results in some reoccurrence.
The younger you are, the less likely that this surgery can hold up for the rest of your life. Stresses on the foot every day may result in the bunion coming back.
Those with a severe or large deformity
Far too many of the surgeries performed by UFAI’s bunion surgeons are correcting surgeries done by other doctors, and the majority of them are Austin bunionectomy procedures that are done with the wrong surgery for the wrong foot and bunion case. This is not to say that the Austin is a bad procedure, but just because a surgery is the most popular does not mean it’s probably right for you. Your surgeon’s experience and skill, plus the right type of surgery, is the only way to ensure the best possible outcome.
The Lapidus Bunionectomy and Forever Bunionectomy
The Lapidus procedure, has been the “gold standard” of bunion surgery for the past five years. University Foot and Ankle Institute has further perfected version of this surgery trademarking it as the “Forever Bunionectomy”. By infusing the patient’s own stem cells and amniotic cells from the bone marrow during surgery, performing very stable fixation and correcting the deformity at the source, the patient often has speedy recovery, less down time, early weight bearing and reduced scarring.
For the right patient and with the right surgeon, these are the only procedures that offer a near zero percent of bunion recurrence.
The Lapidus Forever Bunionectomy are open surgeries, so they are slightly more invasive but the bone is not cut and is repositioned at the base of the bunion in the area of a loose joint which prevents the bunion from coming back since the loose joint is forever stabilized. This is the only procedure that truly fixes the bones into the correct position with screws and plates, thus enabling the bones to fuse naturally.
An incision is made along the top of the foot, and a tiny pie-wedge is removed from the medial midfoot joint.
The surgeon then shifts the 1st metatarsal toward the 2nd to bring it into alignment with the big toe, the bones are stabilized with two screws and/or a plate to facilitate fusion.
In severe cases, a second incision is made near the base of the toe, on the side of the foot to correct the ligaments of the great toe and also to correct the great toe alignment.
Why Choose a Lapidus or Forever Bunionectomy?
99% fusion rate. Although current literature suggests a 5% non union rate, our surgeons have an over 99% fusion rate
Virtually no risk of returning bunion. Correct the deformity at the source and the bunion will virtually never come back
Immediate weight bearing is possible with the procedure in our hands. The downside of the Lapidus procedure has been the long non weight bearing time. The advances with the Forever Lapidus Bunionectomy fixation by our surgeons allows immediate weight on the foot and faster healing.
Weight-bearing and cast time reduced from 8-12 weeks to as little as 2 weeks with the Forever Bunionectomy.
In addition, top surgeons will use CT scans to spot fusion (or issues) earlier which can guide recovery protocol. They will also use advanced Physical Therapy protocols to improves range of motion and reduce pain. At University Foot and Ankle Institute, we have tried to take the perfect bunion surgery, the Lapidus bunionectomy, and make it even better through our Forever Bunionectomy. From start to finish, we have thought of every step to make the procedure, simple, pain free and as easy and rapid a recovery as possible.
The MinVasive Bunionectomy
The MinVasive procedure is a trademarked system developed by UFAI. With MinVasive, you get the best of both worlds: the fixation of an open bunionectomy, and the small incision of minimally invasive techniques. Minimally invasive surgery has been gaining in popularity but the main problem has been poor fixation with these procedures. The lack of proper fixation results in poor outcomes, risk of failure and pain. The MinVasive allows us to use a very small incision of about 1 centimeter to cut the bunion bone but still place great fixation across the cut much like we would with a large open procedure.
How Is the MinVasive Procedure Superior to Traditional Minimally Invasive Bunionectomies?
The downside to most minimally invasive bunionectomies is the limited fixation options. Poor fixation can lead to malunion of the bone alignment, creating complications and bunion recurrence.
Thus we developed the MinVasive technique to correct the structural issues that cause bunions and provide adequate fixation, all using a minimally invasive approach.
In place of a weak small pin used in most minimally invasive procedures, the MinVasive technique uses screws and a small, unique plate that is placed through a tiny incision. This results in quicker recovery times, reduced scarring, and less pain.
How Is the MinVasive Procedure Superior to a Traditional Open Bunionectomy?
An ideal bunion surgery corrects the mal-alignment in three planes. The 1st metatarsal returns to its proper vertical position and rotated to sit over the sesamoids in the ball of the foot.
An open bunionectomy has correction in only two planes because the V cut does not allow rotation. The MinVasive cut allows three plane correction of a bunion and the addition of a custom-designed plate holds the bone in place until it heals.
What Are the Benefits of a MinVasive Bunionectomy?
Better bone fixation cuts down on mobility and reduces pain.
Tiny incision (1cm).
Immediate weight bearing in surgical boot.
Return to normal footwear in 4-6 weeks.
In some cases, there is such a severe shift of the big toe towards the 2nd toe that an adjunctive procedure needs to be performed. Once the main procedure has been performed, the surgeon will examine if the toe is straight enough and spaced far enough from the 2nd toe.
If more correction is needed, an Akin osteotomy is performed. This is done by removing a triangular wedge of bone through an angular cut into the to the toe bone. The big toe is then shifted away from the 2nd toe, closing the wedged bone cut. The bones are held into this new position with one small screw while the bone heals. This adjunctive procedure does not increase the healing time of the main surgery.
Are There Bunion Surgeries Techniques That Have Outlived Their Usefulness?
Yes, absolutely! As time, technology and research advance, we feel that certain types of bunion surgeries should no longer be performed. There are various reasons for each one but they all have been replaced by far better procedures that all have greatly improved long-term results. These include:
Traditional Tightrope Bunionectomy
Over time research has shown us that this procedure simply has too high of rate of failure. Tightrope Procedures were performed in those instances where patients had extenuating physical circumstance that involved worry about cutting the bone. This included patients with vascular conditions, soft bones and smokers.
Though not a common procedure, our surgeons now opt to perform a Tightrope FT in the rare case that it is still deemed necessary. During a tightrope FT, a thin fiber-wire is strung between the first and second metatarsal and tightened – forcing the big to toe properly realign. It is often performed with a head osteotomy and allows for soft tissue remodeling and added stability to the base of the metatarsal.
This is another procedure that has been deprecated by University Foot and Ankle Institute. The nature of this procedures leads to a higher potential for error and presents extraordinary difficulties when fixating the bones together.
The Scarf bunion surgery is a very useful surgery and very stable procedure but tough to perform and slightly more risky that some of the other procedures that are just as strong and stable. The same problems that occur for the Shaft Osteotomy are often true for the Scarf Osteotomy. Though we have not totally ceased performing this procedure, it is only used very large bunions that absolutely cannot be non-weight bearing.
Closing Wedge Bunionectomy
The Closing Base Wedge Procedure is another surgery that is no longer performed at UFAI. Like the other obsolete procedures above, there is simply no reason to perform this procedure when we have better procedures with much better long-term outcomes.
In many cases our surgeons will instead recommend the Forever Bunionectomy instead of any of the above procedures. UFAI’s surgeons are the creators of the Forever Bunionectomy, which is a procedure much like the Lapidus Procedure but has been further perfected with techniques to dramatically speed up recovery and virtually eliminate scarring.
About the Bunion Institute
The Bunion Institute website was developed by the University Foot and Ankle Institute to help educate the public about bunions and what to do about them. Our goal is to give people useful information they may not be able to easily find to make better medical decisions. Our goal here and in our practice, is to empower patients so they can protect their physical health and improve their lives to the very best of their abilities. And improving lives is why we became doctors in the first place.
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