Since surgical bunion correction was first described, there have been more than 100 different procedures developed to treat the deformity commonly known as hallux valgus.

Two of the most utilized procedures, Lapidus-type fusion and minimally invasive bunion surgery, have taken center stage in recent years due to advances in surgeon skill and technology, which have allowed physicians to treat the entire 3D plane of hallux valgus deformity.

But surgical bunion correction still has a long way to go, according to Dr. Ellis. 

“Bunion surgeries have been going on for years, and the fact that there are so many means there is not a perfect solution,” Dr. Ellis, said. “Most bunion corrections are good, but not perfect in terms of achieving and maintaining correction and patients being happy with the surgery.”

Read the full article at healio.com. 

“Because of the way the bunion correction is performed with MISB, there is a thought that it may not help stabilize the foot in the same way that the more extensive, open procedures performed at the midfoot do,” said study senior author Anne Holland Johnson, MD, a foot and ankle surgeon at HSS. “When someone has a flatfoot deformity, which is essentially a fallen arch, the idea is that fixing the bunion through this minimally invasive technique could make the flatfoot worse because we cut the bones closer to the toe. What we found is that it was quite the opposite—that fixing the bunion in a minimally invasive way caused no changes in the overall flatfoot dimensions.”

“Bunion” is an umbrella term describing a variety of painful deformities at the base of the big toe. In the most common type of bunion, called hallux valgus, the big toe turns inward from its normal position and angles toward the second toe. Hallux valgus often presents with secondary structural deformities such as flatfoot, which can be symptomatic or asymptomatic (causing no symptoms).

All techniques for treating bunions involve cutting the bones and repositioning them with metal screws. The minimally invasive chevron and akin bunionectomy (MISB) fixes the bunion by cutting the bones through tiny incisions in the skin. “The advantages of doing the surgery through small incisions include minimal to no pain after the surgery; immediate weight bearing, so you can walk normally on the foot; and faster return to day-to-day activities and sports,” said Dr. Johnson.

The researchers conducted a retrospective study using a patient registry at HSS. In the registry, they identified patients who were over 18 years of age and were diagnosed with a bunion deformity between 2016 and 2021. Of this cohort, patients were included in the study if they underwent a MISB procedure to correct a hallux valgus deformity; reported their outcomes for at least one year and up to two years, as recorded by a patient-reported outcomes tool known as PROMIS; and had x-rays before and three months after surgery, at minimum. Using preoperative x-rays, the team identified individuals who had evidence of flatfoot; using a chart review, they also identified those with an asymptomatic flatfoot. These reviews yielded a study group of 35 patients with asymptomatic flatfoot and 47 patients without flatfoot.

“We collected PROMIS surveys on all our patients. These are a series of questionnaires that have been validated for use in foot and ankle research and ask the patient about their function, pain, and mental health,” said Rami Mizher, lead author of the study and a research assistant in the Department of Foot and Ankle Surgery at HSS. The researchers found that MISB resulted in similar improvements in the two groups in physical function, pain interference (how often the pain interferes with daily life), pain intensity, and global physical health (overall patient health), as measured by the PROMIS survey. There were no significant preoperative to postoperative changes in PROMIS global mental health and depression measures in either group.

A chart review showed there was no difference in complications in the two study groups.

The researchers also examined pre- and post-operative x-rays to clinically assess how well the surgery corrected the bunion deformity and if it changed any of the flatfoot-related measurements. In both groups, there was a similar correction of the bunion deformity. In terms of the flatfoot outcomes, the researchers looked at three different parameters: calcaneal pitch, or the height of the foot arch; Meary’s angle, which measures how much a foot sags; and talonavicular coverage angle, which measures how much the foot turns outward. The first two measures didn’t have any significant changes, while the talonavicular coverage angle improved in the flatfoot group.

“Our research shows that you can fix the bunion with this comparatively easier procedure and not make the flatfoot worse,” said Dr. Johnson. “It proves that minimally invasive bunion correction is a viable option for patients with flatfoot.”

 Authors: Rami Mizher, BS; Lavan Rajan, BA; Jaeyoung Kim, MD; Syian Srikumar, BS; Elizabeth Cody, MD; Anne Holland Johnson, MD; Scott Ellis, MD (HSS)

“We are dedicated to providing outstanding medical care to elite athletes, and our designation as a FIFA Medical Centre of Excellence by the Feder the Fédération Internationale de Football Association recognizes our expertise and enthusiasm in treating professional soccer players,” said Dr. Williams. “With the new members of the medical team, we will continue to provide the high level of care Red Bull players depend on to be their best on the field and to get back in the game if they sustain an injury.”

A nationally recognized leader in cartilage repair and restoration, Dr. Williams specializes in knee, shoulder, and elbow surgery at the HSS Sports Medicine Institute. Along with the Red Bulls, Dr. Williams serves as medical director and head team physician for the Brooklyn Nets (NBA), Long Island Nets (G-League), and New York Liberty (WNBA), and as a team physician for USA Basketball.

The new members of the medical team are highly specialized in treating a wide range of orthopedic injuries.

Danyal H. Nawabi, MD, an orthopedic surgeon in the HSS Sports Medicine Institute, specializes in knee, shoulder, and hip surgery, including arthroscopic procedures and joint replacement.

Orthopedic surgeon Andrew J. Elliot, MD, treats conditions of the foot and ankle, including athletic injuries, bunions, tendon tears and ruptures, hammertoes, osteochondritis dissecans, fractures and arthritis.

Benedict Nwachukwu, MD, is an orthopedic surgeon and specialist in hip, knee and shoulder surgery at HSS. Along with the Red Bulls, Dr. Nwachukwu serves as a team physician for the New York Liberty and medical consultant for the National Basketball Players Association.

About the New York Red Bulls

The New York Red Bulls are one of 27 teams in Major League Soccer (MLS). RBNY, one of the ten charter clubs of MLS, have competed in the league since its founding in 1996. The Red Bulls play home matches at Red Bull Arena (RBA) in Harrison, New Jersey.The three-time MLS Supporters' Shield Winners are owned by the Austrian beverage company Red Bull for which the team is named. The New York Red Bulls offer one of the nation's premier youth soccer development programs, from local soccer partnerships across New York and New Jersey to Regional Development Schools and the Red Bulls Academy teams.