Traditional bone-breaking surgeries

As all surgeons recognize that the primary reason for bunion deformity is tilting displacement of the first metatarsal bone and thus its alignment correction is the primary objective of all bunion surgeries. To do so, the most popular method has been the different "osteotomy procedures" which is to break and shift the first metatarsal to re-align it. More than 10 different bone break-n-shift procedures are available today and the reasons are their need to complement each other and cater to surgeons’ preferences by training.

Akin Procedure

Chevron Procedure

Hohmann Procedure

Wilson Procedure

Lapidus Procedure

Ludloff Procedure

Scarf Procedure

The Truth and Consequences

Tens of research papers are produced each year about results of the many existing and also new bunion surgeries. Satisfactory results were mostly reported but only questioned later with further modifications being proposed. Despite the seemingly satisfaction by surgeons, the unusually large number of different surgeries to correct one condition of same underlying cause and the obviously lack of consensus among surgeons makes one wonder if there is continuing skeptics today among patients and even some surgeons. Have bunion surgeons been barking up the wrong tree?

What have surgeons been saying lately about break-n-shift bunion surgeries?

“…… using a validated outcome score (MOXFQ)….the long-term results are worse than expected …, with 25.9% of patients dissatisfied ….” by Dr. A. Chong of Western Health Melbourne in Bone Joint J. 2015 Feb

“…… the simple fact that so many procedures exist, with so many modifications of these procedures, can be interpreted as a failure of our basic paradigm of metatarsal osteotomy …” by Dayton P of Des Moines University Iowa USA in J Foot Ankle Surg. 2015 Oct.

What have patients been saying?

“…… the numbers of participants in some trials remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved …” by Ferrari J in Cochrane Database Syst Rev. 2004;(1):CD000964

“Patient expectations differ from those of surgeons”, “ … the most important expectation was improved walking, followed by reduced pain over the bunion and wearing daily shoes.” and “improvement in appearance” was apparently not as important. by Tai CC of Barnet General Hospital UK in J Orthop Surg (HK) 2008 Apr