Surgical Options for the Bunion ( Hallux Valgus)
One of the most common pathologies that any foot and ankle surgeon treats is the bunion. Daily we evaluate and educate patients on the treatment options for bunions. While conservative and surgical options are available, the focus of this article will focus on the recent change of how surgeons approach addressing this deformity.
There are over 100 documented and described techniques to surgically correct a bunion. Most foot and ankle surgeons are vastly trained on multiple different techniques to correct the bunion. Bunions come in varying degrees of severity which guides in making the procedure selection. Historically, surgeons would settle in on 1-3 procedure types that they preferred.
Recently, the bunion paradigm has shifted to the “3D bunion correction” and the “MIS” bunion (minimally invasive surgery). Research over the last decade has definitively concluded the bunion is a triplanar deformity. Meaning that the bone drifts, elevates, and rotates in space. Given this conclusive research, a tidal wave of surgeons have begun to exclusively use the Lapidus procedure as their “go to” procedure. Myself included. I can correct any bunion deformity with this procedure, with reproducible, predicatable outcomes. Additionally, this procedure virtually eliminates any inherent recurrence risk. So what’s the down side? Recovery time and return to full activity are both extended due to the complex nature of the procedure and healing process.
This recovery time has really driven the MIS market. Now I will admit, I was a huge skeptic of the MIS wave of surgery. But after further evaluation I decided that with appropriate patient and deformity selection, it is a highly viable surgical approach. Recent advances in surgical technologies allow for more stable fixation, allowing greater deformity correction and immediate functional ambulation.
Bottom line is there is no one sized fits all when it comes to how you should fix a bunion. Procedure selection is part of the art of practicing medicine. Your surgeon has to take into account countless variables to give you the mutually desired outcome. Extensive discussion and review of the options are paramount in allowing the patient to make the best decision for their health.
I would encourage any patient considering bunion surgery to review the educational material on these procedures. An educated patient is a good patient.