12/31/2020    Douglas Grimm, DPM

To Fuse or Not To Fuse (Allen Jacobs, DPM)

I think is a timely case study with the current
discussion of fusions versus non-fusions. I also
am finding colleagues that are performing Lapidus
procedures on almost every patient. I recently
had a 15 year old boy in the office that had a
bunionectomy in February 2020 and he was wanting
the other foot done as you can see for reference
the right foot shows he does have a very large
bunion for a 15 year old. He was pleased with the
appearance of the left foot after surgery as the
first ray was straight but they wanted to know
why the big toe joint has no motion and that he
can't play basketball 10 months after surgery.

I have subsequently done a MICA MIS bunionectomy
on the right foot which was completely pain-free
in five weeks. The patient is now looking to me
for more answers about what went wrong on the
left foot and how to fix it. I have fit him for
custom orthotics which have helped but he still
is unable to play basketball and jump due to the
pain of the big toe joint with only about 10
degrees of motion total in the left 1st MTPJ.
Any suggestions on what I tell this kid and how
to fix it.

Is a fusion at the 1st MTPJ the best outcome?
Won't a 1st Metatarsal distal and proximal fusion
really put some stressors on his ankle, knee and
other joints? Hemi-metallic joint implant?
Remember, he is only 15 years old and wants to
compete in sports. I really don't want to touch
the left foot and all I want to say is I would
never even have considered a Lapidus in a healthy
15 year old. Also note that I didn't evaluate the
left foot before the first surgery but the right
foot did not have a high degree of hypermobility.

Douglas Grimm, DPM, Round Rock, TX

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