When it comes to bunions. millions of Americans are painfully familiar with these symptoms. Swelling, redness, a telltale swelling next to the big toe. Corns and calluses are where other toes rub together. And the pain. Lots and lots of pain. Fortunately, when surgery is necessary, it is usually successful. But not all the time.
So researchers have come up with a new study that highlights key factors. That may determine the procedure, known as modified Lapidus surgery, will fail.
“We set out to find out if certain characteristics — patient or procedure-based. are associated with bunion surgery failure,” said Dr. Matthew Johnson. Assistant professor of orthopedic surgery at the University of Texas Southwestern Medical Center. in dallas
A bunion at the base of the big toe occurs when the long metatarsal. Bone moves inward and the phalanx bone angles toward the second toe. The soft tissue of the foot rubs against the shoe causing pain.
“Patients are unable to do their normal daily. Activities such as walking, other exercises . Even standing in some severe cases,” Johnson said.
One-third of American adults have bunions. Usually attributed to wearing poorly fitting shoes and/or genetics.
Patients can apply padding or reduce pressure. By using wide-toed shoes and/or arch support. But those aids don’t always do the trick.
When all else fails, Lapidus surgery aims to straighten, restore and fuse the bones of the big toe and arch. With the goal of improving patients’ daily function and mobility, Johnson said.
“Most studies have shown that only a small percentag. Of bunion surgery patients did not find the surgery beneficial,” he said.
About 10% of the time the procedure fails to achieve a healthy. And permanent bony union, leaving the patient. With persistent pain and disability after surgery.
In search of an explanation, Johnson and his colleagues studied. The medical records of 222 bunion surgery patients.
The vast majority were female (87%), with an average age of 51. Their average body mass index (BMI) – a measure of body fat based on height and weight – was just over 28. Meaning they were overweight.
About 1 in 10 people have had unsuccessful bunion surgery. Johnson said three patient characteristics increase. The risk that the bones won’t heal together. The first factor was weight: the higher the patient’s BMI, the greater the risk of surgical failure.
The risk of failure was also higher in patients. Whose bunions had a “larger preoperative angle,” meaning a relatively more severe-sized bunion.
Patients who had prior bunion surgery were also more likely to fail. (Bunions)
Yet, a history of smoking was not associated. With an increased risk, which surprised Johnson.
His hope is that surgeons will now take note of factors that reduce surgical success. So, that more realistic expectations can be set with patients considering surgery.
Dr. Raymond Monto, an orthopedic surgeon at Nantucket Cottage Hospital in Massachusetts. Found “no real shock factor” in a new analysis of the nearly century-old practice.
“The real message of this study is something most surgeons. Already know, but most of the public has been shielded from,” said Monto, who reviewed the findings. “Bunion surgery has the highest complication rate of any surgery.”
His advice: “If a patient has a painful bunion that cannot be managed with a more appropriate shoe. And is considering surgery, they are advised to have. An open discussion with their surgeon about the potential. For surgical complications and to be prepared for any procedure. . First, lose weight and stop smoking.”
Monto said caution should be exercised in any decision to launch an operation.
“As one of the great foot surgeons of the 20th century, Dr. Leonard Goldner, once told a bunion patient. ‘It would probably be better to operate in your shoes than on your feet,'” Monto said.