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A Bunion Surgery Conundrum

If doctors can’t agree on a pathology for bunions, how can they agree on a corrective solution? In the past century, over 150 different techniques have been developed to treat the hallux valgus deformity. Not one technique has worked to universal satisfaction, which makes patient’s pursuit of knowledge and understanding unusually difficult. A simple search online shows infinite results with unspecific, sometimes contradictory information.

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Why are there so many different bunion surgeries?

The simple answer is no one commonly-practiced bunion surgery has been able to satisfy both doctors’ and patients’ expectations.

A bunion is graded as mild, moderate, severe or extreme according to the angles and displacement of affected bones in the foot. The American Academy of Orthopaedic Surgeons proposes a matrix of numerous surgeries to suit different bunion severities along the spectrum.

Due to limitations and complications of each technique, surgeons are taught to believe there is no one-size-fits-all surgery. They are required to perform in 3-4 different techniques in order to manage all bunion severities. With a pool of 150 total and currently more than 15 commonly-practiced procedures to treat just one single condition, it’s common for patients to receive conflicting surgical recommendations when consulting different doctors.

There is perhaps no other surgical condition that elicits such diversity in opinions.

What are the types of Bunion Surgery?

The complexity of the bunion condition has bred complexity in surgical approaches, with surgeons exploring techniques that affect either the bones, joints or soft tissues of the foot.

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Bone procedures

An osteotomy is the original 'break-n-shift' concept that cuts and shapes the bone in different locations. A surgeon selects a cutting method depending on the severity of the bunion and his or her training. Strictly speaking, a bunionectomy cuts away the protruding metatarsal head, often including part of the normal big toe joint, to narrow the forefoot. An exostectomy only shaves down abnormal bone spurs without infringing on the normal joint. The more recent minimally-invasive techniques follows the same concept as osteotomy procedures, only the incision is smaller.

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Joint procedures

Arthrodesis, joint fusion, procedures are designed to realign and fix displaced bones by cutting out the joint (bones, cartilage and ligaments) in order to fuse its adjacent bones together. Most new procedures are interpretations of the Lapidus procedure, often introducing new instrumentation and implants to aid in shaping and fixing the cut.

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Soft tissue procedures

The McBride procedure was the first technique that attempted to correct the bunion condition by manipulating soft tissue only. It is often performed in support of other primary procedures. The Syndesmosis Procedure belongs to this minimally-traumatic category, although it’s the only technique that generates a new ligament to replace incompetent ones to prevent recurrence. Later the Tight-rope procedure attempted the same non-bone-breaking concept with a minimally-invasive technique that relies on artificial sutures for recurrence prevention.