|
|
|
Search
05/14/2013 Ed Cohen, DPM
Overlapping 2nd Digit Status Post Bunionectomy (Don Peacock, DPM)
If you have a 77 year old patient with painful corns between the big toe and the second toe along with a bunion (assuming the patient had sufficient circulation), a great procedure would be an MIS resection of bone from the medial PIPJ of the second toe and an MIS resection of bone from the lateral hallux distal hallux joint.
These procedures are very atraumatic and can dramatically improve the quality of life in this type of patient. My assumption is that this patient would be a poor candidate for any bunion surgery, even for a simple MIS modified McBride- Akin bunionectomy, which could be done with two stitches. The point is the goal of surgery is to eliminate pain and not put the patient at risk. This correction is not perfect but it could dramatically increase the patients ability to wear shoes and to ambulate.
Getting back to Dr. Peacock's case, he stated he felt uncomfortable do an MIS first metatarsal osteotomy on this patient. If we assume this to be a fact, his correction was an excellent surgery as seen by the pre and post-op x-rays. Dr. Kittay raises a good point that there was some distortion in the post op x-ray because there was some supination in the foot when the x- ray was taken.
It would be nice to see a photograph of this foot after surgery and another x-ray where the foot is not supinated. I am sure that Dr. Peacock will provide the readers of PM News with this information.
My contention is if this patient was not a good candidate for a first metatarsal osteotomy, Dr. Peacock performed a great surgery on this patient and significantly improved the quality of her life. I haven't seen the post-op picture and x- ray without supination and my view could change , but I feel this was a very happy patient and Dr. Peacock is extremely proud of this MIS surgery.
This brings me to my next point. If we assume this patient was not a good candidate for an MIS first metatarsal surgery, she certainly would not be a good candidate for a Lapidus surgery. As to the proposed Keller bunionectomy or fusion, I would make the same argument. I have had too many patients come into my office who have had Keller bunionectomies where the big toe sticks up and the big toe retracts.
I know the successful Keller bunionectomies generally don't come into my office, but as in this case, the 1st MPJ is fine and not painful and it always better to preserve a major joint than to destroy it. This is my same argument for also not fusing the 1st MPJ. Ed Cohen, DPM, Gulfport, MS, ECohen1344@aol.com
There are no more messages in this thread.
|
|
|
|