Is Our Current Paradigm for Evaluation and Management of the Bunion Deformity Flawed?

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Is Our Current Paradigm for Evaluation and Management of the Bunion Deformity Flawed? A Discussion of Procedure Philosophy Relative to Anatomy
Paul Dayton, DPM, MS, FACFASemail, Merrell Kauwe, DPM, Mindi Feilmeier, DPM, FACFAS
The Journal of Foot and Ankle Surgery; Articles in Press

 

This article has not only hit the nail on the head but also the raw nerve of the conformity and tradition in medicine. I wonder if there is really need for another new osteotomy procedure even if it is in another plane, or maybe it is about time for us to “think outside of the osteotomy box”.

We all know why we need to re-align and re-stabilize the first ray in bunion surgery but why most surgeons are “willing to ignore” the fact that metatarsus primus varus is a product of soft tissue failure not first metatarsal bone failure is difficult to understand. Osteotomy procedures in orthopedic surgery have only been applied to re-align deformed bones (tibia vara, acetabula dysplasia ….etc.) not to reconstruct normal bones to compensate for soft tissue deficiencies (varus deviation of rheumatoid fingers, ACL instability of the knee ……etc.). Therefore, a non-osteotomy and non-arthrodesis procedure kind of soft tissue procedure would be the most ideal path for foot surgeons to embark on instead of continuing on the path of victimizing the innocent first metatarsal bone.

It sounds like a tall order but the technique has been existing and practiced although not discovered by most surgeons for more than 50 years. It is the osteodesis or syndesmosis procedure. Both can be found in this forum and google.

Daniel