- What is a bunion?
- Do lasers get rid of bunions?
- What's unique about our approach to bunion correction?
- Do bunions ever come back?
- When should I have my bunions corrected?
- Results of the Tri-Correctional Bunionectomy?
- What happens if I have arthritis in my joints?
- Excellence in surgical engineering
- What is my foot going to look like after surgery?
- "The outcomes speak for themselves."
Bunions are primarily a hereditary condition. They can affect anyone. A bunion occurs due to a mechanical instability in the foot, which results in a malalignment of the bones with the big toe drifting toward the second toe. As this progresses, we begin to notice a large bump behind the inside of the big toe. As you walk more and more, the symptoms become worse. As the bunion deformity increases in severity it can cause many other associated foot problems, such as hammertoes, painful calluses on the bottom of the foot and arch pain. top
This much-publicized technique is severely limited because lasers are only used to cut soft tissue in bunion surgery, not to cut the bone. Making precise bone cuts is the most critical part of a successful bunionectomy. top
We feel that in order to effectively correct the bunion, all of the adaptive changes must be addressed to ensure appropriate function and reduce recurrence. Our technique includes surgical engineering to realign the bone for proper function, using a surgical screw for the most stable fixation. The proper use of the surgical screw enables us to reduce many of the potential hazards of bunion surgery. top
No surgeon can guarantee perfect results. Unfortunately, if the wrong procedure is performed, the recurrence rate can be very high. Many of the new micro-surgeries also known as lunch-time surgery, and laser techniques have a high recurrence because they generally cannot accurately realign the bones. top
If you have any of the following problems, your feet should be evaluated.
- Calluses on the inside of the big toe
- Pain around the big toe when wearing certain shoes
- Painful calluses on the bottom of your feet
- The big toe pushing on the second toe
- . Difficulty wearing shoes top
In the past, bunion sufferers have been subjected to an array of surgical procedures with mixed results. Pain, long-term disability, hospitalization and casting were the standards of care. Now the podiatrists at Encino-Tarzana Regional Medical Center and Medstar foot and ankle center, have pioneered a procedure which changes the traditional way in which bunions are approached. This bio-engineering technique realigns the bones and maintains the correction so securely with generally minimal discomfort, that our results have been impressive. top
Often done under general anesthesia
Many times requires a full-leg cast or steel rods which protrued from the toe (This is for severe bunions.)
Often minimal walking for as much as four months.
Patients cannot wear shoes for prolonged periods of time.
Performed under a local anesthesia on an outpatient basis.
Requires a surgical screw beneath the skin.
Most patients walk immediately after surgery without crutches
Most patients usually return to shoes within two weeks.
The nature of a bunion is a malaligned joint, it's not just a bump. As the joint continues to function out of alignment, the bunion deformity gets worse. Some bunion deformities worsen more rapidly than others, but they all get worse with time.
Special doctors called rheumatologists treat the many varieties. Generally, patients with bunions, have osteoarthritis, or a wearing down of the joint. The longer the joint is crooked and the longer the joint is malaligned, the greater the chance for the person to develop arthritis of the big toe joint.
Below: The joint on the left is arthritic. Cartilage should be intact, not worn out, and shiny & white like the joint on the right.
That is why the surgical engineering behind the Tri-Correctional Bunionectomy is so important. The procedure is designed to restore proper alignment and function. Traditionally, arthritic joints were destroyed, fused or implants where used. These are not good alternatives for an active person who puts great demand on their feet. Why destroy a joint if you can save it? Using surgical engineering, we are usually able to get the big toe joint to bend again, saving many such arthritic joints. top
The foot is a highly mechanical apparatus. What's surprising is how important this joint really is. Try walking without bending your big toe, it's like trying to drive a car with a flat tire. This is why so many people with big toe problems have knee and back pain as well.
Since the force on the big toe joint is horizontal, bending torque moment occurs when you walk. Bending torque moment measures the point of application of weight-bearing forces times the length of the lever arm (length of bone) to the osteotomy (bone cut). The application of Tri-Correctional Bunionectomy (at 1/2x) minimizes the bending torque moment. The illustration below shows the placement of the Tri-Correctional osteotomy (bone cut) as compared to other traditional osteotomies:
As the osteotomies are moved farther away from the big toe joint, the bending torque moment becomes higher. Higher bending torque moment creates more stress in the area of the bone cut, which can prolong recovery time. Other bone surgeries are done similarly, but there is an advantage in performing surgery at the end of the bone to minimize torque, which is our "secret" ingredient in the Tri-Correctional Bunionectomy.
Not only do we minimize torque at the end of the bone, but the quality of the bone used is better closer to the joint. The better the quality of bone, the faster the bone heals. Our goal in creating the Tri-Correctional Bunionectomy was to minimize torque so that we can get you back to your activities as quickly as possible.
The effects of bending torque moment are similar to bending of a pencil whose point is placed on the edge of a table. Applying a force near the tip of the pencil will not generally result in breaking the pencil, because bending torque moment is minimized. But, if one applies the same force near the eraser, the pencil will break much more readily. top
While the Tri-Correctional Bunionectomy is performed to repair your painful joint, it is also used to repair unsightly feet. Many people with bunions are afraid to show their feet because they are embarrassed by their appearance. The Tri-Correctional procedure has helped many people return to a life of open-toed shoes. During the procedure, sutures are closed with what is called a subcuticular stitch, with no 'Frakenstein' holes on either side of the incision. The incision is made on the side of the foot, as opposed to the top, because it scars less as the incision rubs against the shoe. Seri-Strips are used to support the skin as it heals, to prevent unattractive scarring, and to get the incision to heal as quickly as possible. top
Most of our patients experience minimum discomfort.
This new bioengineering procedure, the Tri-Correctional Bunionectomy, is done on an outpatient basis. Traditionally, bunionectomies were done in hospitals where patients stayed overnight, usually due to post-operative pain and the inability to walk. In a recent study, nearly 80 percent of our patients stated that their discomfort was markedly less than they had anticipated, and required minimal medications for pain. Additionally, the surgical engineering approach stabilizes the bone allowing our patients to walk the same day as their surgery.top
The majority of our patients are in shoes after two to three weeks.
With traditional bunion surgery, a return to shoes has often been delayed by pain, swelling, and the inability to walk because of pins or bone instability. The use of a surgical screw significantly reduces pain and swelling. Security of the bone realignment usually allows for immediate weight bearing and ambulation (walking), without the need for full-leg casting. Patients are generally ready to begin wearing shoes in ten days after surgery.
Traditionally, pins and wires have been used to hold the alignment of the bones. The pins stuck out of the foot and prolonged the return to shoes by as much as a month or longer. The surgical screw we use is placed beneath the skin and is much more stable than pins. To ensure the best possible results, patients enter a program of vigorous rehabilitation to help with the healing process and increase the flexibility of the corrected joint. Now there is no need to be afraid of bunion correction any longer.
Of course, no two people are the same. We would be happy to discuss your unique foot condition. top