09/04/2013    Ed Cohen, DPM

Bunion With Overlapping 2nd Toe

A good point was raised about patient selection.
A person with a drug or alcohol problem should
be carefully screened and you might want to
limit these type of patients to the more simple
surgical procedures. It may be prudent not to
take this case.

Amputation of the second toe should be avoided
as it will leave a space between the first and
third toes which will eventually cause the
lateral deviation of the big toe and recurrence
of the bunion. Also, an isolated second
metatarsal head resection will ruin the
metatarsal parabola and cause transfer lesions
and a lot of pain during standing and ambulation.

This foot can be corrected using MIS surgery.
The advantages are immediate ambulation, minimal
surgical trauma, faster healing, and you
generally get a good functional and cosmetic
result. The second toe can be straightened with
a proximal second phalangeal base osteotomy and
another osteotomy at the neck of the proximal
phalanx. A flexor tenotomy and possibly a PIPJ
capsulotomy can be done along with a second
extensor tenotomy and second MPJ capsulotomy.

You will need to also do a second metatarsal
osteotomy along with a second Haspel metatarsal
osteotomy at the head metatarsal to correct the
dislocation of the joint. This Haspel procedure
is a great surgery because you preserve the
metatarsal parabola and you correct the
dislocation of the second MPJ. This procedure is
on the AAFAS website.

A third and possibly fourth metatarsal osteotomy
may also need to be done, along with third and
fourth digital osteotomies of the middle
phalanges and possibly the proximal phalanges.
Flexor teotomies and possibly PIPJ capsulotomies
can also be done to straighten the third and
fourth toes. The bunion can be corrected with a
Reverdin Isham bunionectomy. You will need to
widen the medial osteotomy cut to get a good
correction. You might also need a first
metatarsal base osteotomy, although I am finding
most of these bunions can be corrected without
doing the base osteotomy with using the
appropriate osteotomy procedures of the hallux
and metatarsal head.

Ed Cohen, DPM, Gulfport, MS, ECohen1344@aol.com

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