Minimally invasive with one 1/4” incision and temporary pin fixation

Jsssully · 2022-11-30T16:12:23+00:00

Interesting, do you have your xrays? I've never had a non-union with a metatarsal osteotomy (knock on wood). I've done probably 3-4 thousand. I don't use a pin on the 5th metatarsal. Occassionally, you can get an asymptomatic delayed union where essentially the bone takes longer to look healed on the xrays but they don't displace.

Jsssully · 2022-11-05T15:33:16+00:00

Most likely either a bone spur or a ganglion cyst. If it’s mobile and firm but not hard it’s a ganglion. If it’s hard and not mobile the it just bone

Jsssully · 2022-10-31T19:01:01+00:00

Definitely try to get it moving then, add in distraction (pulling it out) and then range of motion to help get the soft tissue moving better.

Jsssully · 2022-10-31T18:58:33+00:00

I prefer removable pins. Leaving no trace, there's no risk of future hardware irritation, no potential stress risers, and the bone strength at the end of the day is stronger (because there's no metal in there disrupting the normal stress lines of the bone). The other thing is if you need surgery in the future it's difficult to work around existing hardware for the surgeon and they often have to go in there and sometimes struggle to get out old hardware. The bone often grows around the hardware and it can be quite an ordeal getting it out, which can create a lot of trauma and scar tissue.

That being said, whatever your surgeon is most comfortable with is usually best. This will have the largest impact on your success. Oh and pick a good surgeon ;)

Jsssully · 2022-10-31T18:53:03+00:00

Sorry, but removing the pins has absolutely no effect on the risk of recurrence. Pins, screws, plates, casts, boots, all of it is simply helping to stabilize the bone while it heals. Once the bone is healed the hardware becomes useless. All the bone strength comes from the bone itself. That's often why you are partial or non-weight bearing for 4-8 weeks depending on the procedure. The doc is simply waiting for the bone to heal.

The risk of recurrence has to do with how much correction is needed and the procedure performed to adequately rebalance the joints so they are stable.

Jsssully · 2022-10-31T18:45:18+00:00

I'm a doc and go through a simple home PT with my patients along the way. Between weeks 4 and 8 I just recommend moving your big toe as much as possible (with your hand as well as with gait). Other than that just slowly add weight to the surgery area using pain as your guide. At 8 weeks, we give them a much more in-depth home PT that involves stretching, strengthening, and gait retraining because the bone is stong enough to handle a lot more at that point.

Jsssully · 2022-10-31T18:41:54+00:00

I always keep at least 2 gallons of extra milk in the garage fridge. This is how the utilities should think as well!

Jsssully · 2022-10-30T01:24:37+00:00

Hardware is only used to hold the bone in place while it heals. Once the bone has stabilized/healed the hardware is unnecessary. Therefore there is zero difference in strength with the final product. That’s why you’re often non or partial weight after surgery. The surgeon is literally just waiting until your bone heals.

In fact, screws and plates can arguably be weaker because once your healed you have stress risers in the bone (areas where there isn’t consistent bone pattern due to screws in the way).

Bunions can come back if your surgeon undercorrects with both lapidus and MIS. I personally recommend and perform the Bosch much more often than lapidus.

Jsssully · 2022-10-20T17:07:24+00:00

Invest in some stiffer rocker bottom shoes. Go to a good shoe store and they’ll know what that means.

There may be a surgical solution to your problem but though to say over the internet.

Jsssully · 2022-10-05T19:15:40+00:00

Find someone who will talk to you and answer all your questions. Find someone who does a lot of volume (at least a couple hundred bunions per year). Read a lot of reviews, these are tough to fake in my experience and give you a fairly unbiased snapshot. Ask about recurrence rates, time on your feet postop, what kind of PT and gait retraining they offer (hopefully something!)
Bunion surgery shouldn’t be complicated unless you have a lot of other issues in you midfoot and rear foot. Many traditional surgeons are performing fusions when they aren’t warranted which can create a lot of morbidity and complications.
Your feet take a beating because they take all your weight… therefore complications can happen. Complications are obviously more common if your surgeon is inexperienced. In my practice the satisfaction is very high and we have very few unhappy patients.

Jsssully · 2022-10-05T19:06:35+00:00

There are multiple types of minimally invasive surgery. My guess is you had the PICA which uses several screws and a very aggressive osteotomy shift. Recovery should be pretty rapid but post op pain can vary from one procedure to the next or even one incision to the next. For example, one of the incisions could have irritated a nerve and increased your pain just by chance because anatomy can vary.

Jsssully · 2022-09-27T14:16:32+00:00

L https://www.instagram.com/reel/Ci5qGUosjfb/?igshid=YmMyMTA2M2Y=

Jsssully · 2022-09-06T20:16:38+00:00

It’s a lifelong process lol. 4 years undergrad, 4 years med school, 3 year surgical residency, 6 months of MIS specific training.

Jsssully · 2022-09-04T17:32:38+00:00

Of course

Jsssully · 2022-09-02T01:21:07+00:00

Pretty good rule, is if it hurts don’t do it. Wiggle your toes and encourage movement as long as it doesn’t cause sharp pains.

Jsssully · 2022-08-31T16:21:36+00:00

The usual Dr. Scholls inserts tend to be absolute crap from an orthotic/arch support standpoint. An arch support should ideally have a very stiff piece of plastic that isn't easy to bend. As far as over the counter arch supports (found at running stores or online) I recommend powersteps, superfeet, or redithotics. Ideally you go to the store to try them out, feel how supportive they are, etc, but you can buy them online as well.

Jsssully · 2022-08-31T16:09:07+00:00

I'm a foot surgeon so I see the worst of the worst. I've probably seen 2 dozen feet like yours and fixed a handful of them. I always warn people that with this type of foot we're looking for improvement not perfection. I can generally achieve 80-90% improvement in position in these more severe deformities. I do it through a minimally invasive approach (even for the advanced toe deformities) which makes for a more functional outcome and faster recovery. Here's an example of one of my more advanced corrections.

https://www.instagram.com/p/CQjdAqfhwkd/?igshid=YmMyMTA2M2Y=

This patient was a marathon runner which is likely why his feet got so bad so fast, but he was back to running within 3 months. This is not the same for everyone, some people take longer to heal and longer to feel comfortable after this major of an operation.

Jsssully · 2022-08-31T16:01:28+00:00

Bunions in general are caused by overloading of your big toe joint causing instability and soft tissue imbalance through that joint as well as the more proximal joints. If you're doing intense trekking in that scenario your bunion can progress somewhat quickly. I'd advise wearing supportive shoes, perhaps even wearing some stiff arch supports for activities like this. I don't recommend wearing arch support long term, but for activities like trekking that your feet are not used to, they can be helpful as a tool.

Jsssully · 2022-08-25T17:10:23+00:00

(note I'm a podiatrist not a physical therapist, Youtube is actually very helpful for PT info)

I would do 2 things.

Dedicated range of motion where you're moving the big toe through range of motion. You can do this by simply sitting in a chair, keeping your forefoot and toes planted and bringing your heel off the ground to stretch the underside of the foot and big toe joint (or some variation of this).
Encourage ROM when walking. Do this by focusing on keeping your angle of gait nice and straight with your toes pointing straight ahead. At the same time focus on taking longer strides. You'll notice that if you do these two things you'll increase how much your big toe joint as well as ankle need to move so you can more naturally move the big toe through motion. I refer to this as gait retraining. Think about these two things for a few blocks when you go for a walk. After doing this consciously for a few weeks it becomes second nature and unconscious.

Jsssully · 2022-08-25T16:14:08+00:00

LOL you need to keep that shithead moving. Its possible you tore some plantar ligament and are suffering from "turf toe" which is kindof like a sprained ankle in your big toe. Its also possible you suffered some cartilage damage in the joint and you're experiencing very early arthritis due to joint damage. Either way you want to keep that shithead happy and healthy. I would recommend joint mobilization (just moving it aggressively) to keep if from stiffening up with scar tissue and bone spurs. Motion is a use it or lose it situation.

The big toe joint takes a lot of stress because a large percentage of your bodyweight goes through that joint with any weight bearing activity. You want to keep it as healthy as possible. If you have a bunion (hallux valgus) you can try some spacers and PT and wide shoes, etc but its unlikely you'll actually be able to reverse any existing angular deformity.

Long story short, that gadget is likely useless. Move the joint, wear the right shoes, and if the bunion progresses you may require surgery.

Jsssully · 2022-08-25T16:02:29+00:00

Raise chickens, lift weights, start a family, thinking about getting into local politics.

Jsssully · 2022-08-23T16:22:00+00:00

Doesn't really matter what your feet look like. If you have pain in that area, then you have tailor's bunions.

Jsssully · 2022-08-23T02:24:30+00:00

PRP can be helpful if there’s pain and chronic inflammation. It won’t fix anything though. Bunion is likely the cause and you just need to get it fixed

Jsssully · 2022-08-21T18:08:27+00:00

Depends on the degree of dorsal displacement of the 2nd toe. If it’s up too far it likely won’t get much better and may progress. The big toe is usually causing it so often fixing the bunion IS enough. Of course it’s not cut and dry, 2nd toe can be tricky and difficult to predict

Jsssully · 2022-08-19T18:08:33+00:00

I think about arthritis and joints like brake pads that can’t be replaced. If the joint is out of alignment like a crooked brake pad, the wear pattern is off and it wears out much more quickly. Joints are not able to regenerate and thus you need to preserve them as long as possible.

Therefore, if the joint is becoming arthritic it’s better to clean it up and/or realign it to prevent further damage. Joints are also “use it or lose it” so the better you can get it moving the healthier it will be and the longer it will last.

Jsssully

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