64-year-old female with increasing bunion pain, metatarsalgia sub 2 and 3, as well as valgus deformity of the lesser digits.
Procedures performed:
– Bosch Bunionectomy with Akin osteotomy and no lateral release or bong shaving
– 2nd and 3rd DMMO procedures to both shorten and rotate in a clockwise direction to redirect digits into rectus position with zero joint disruption
– 4th and 5th digit medially based wedge osteotomies to direct digits to rectus position
Post-op protocol:
– WB as tolerated in surgical shoe immediately
– Bandage changed at 1 week with KT tape applied directly to the skin to pull all lesser digits medially, repeated at weeks 2 and 3
– Pin removed and back into athletic shoe at 4 weeks
Commentary:
Minimally invasive techniques can be very powerful and fix advanced forefoot deformities in all planes with a variety of osteotomies and soft tissue procedures. Osteotomies can be very powerful and heal very quickly due to a lack of dissection. The ligaments, capsule, and periosteum can be left mostly intact preserving blood supply and reducing post-op stiffness and scar tissue. Using metatarsal osteotomies with a very long cut parallel to the weight-bearing surface can allow shorting/decompression of the lesser digits while also allowing for the osteotomy to be rotated in the transverse plane. This leaves the joint and all its surrounding structures intact. One of the primary goals of minimally invasive surgery is to fix the problem with as minimal trauma as possible. Osteotomies are a powerful way to realign joints and reposition the pull of tendons, leveraging the ability of the body to heal bone quickly, effectively, and without permanent damage.
Dr. Jordan Sullivan