People who have the misfortune of developing bunions generally look down at their feet and see a bump growing on the side of the foot and a big toe pointing towards the second toe. If only it were so simple! All kinds of gadgets, gizmos and fallacies exist that are for the most part, minimally effective. The treatment spectrum for this deformity is wide and broad, but can be basically divided into two categories; conservative and surgical.
First, a brief discussion about surgical correction of HAV deformity. Surgical procedures have evolved, with different trends having come and gone over the years, each with their own pros and cons. Technology has advanced greatly in the 40 plus years since I was first trained in foot surgery, primarily in fixation of osteotomies, instrumentation, imaging techniques, and post operative management. Much greater precision and predictability is available today than in years past. Nonetheless, there is still a place for conservative treatment in many, if not most, cases of Hallux Abducto Valgus.
Mentioned above is the perspective of the patient in looking at their “ugly feet”. Perhaps, more important is what the patient does not see. The surgeon's perspective is knowing if you “stake the head” and create a “peek-a-boo” Tibial Sesamoid you surely will experience the (dis)pleasure of dealing with Hallux Varus, or an over-correction of the deformity. So why is that? The unseen aspect of HAV is the frontal plane deformity present. The valgus rotation of the sesamoid apparatus is often a major deforming force in the creation of bunion deformity, and unless it is addressed in some fashion, success in treatment is far less likely to be achieved.
So the question then becomes “What is success in treating HAV?” If success is measured in eliminating a protruding bump and straightening the big toe, then surgery is the only viable answer. However, success could also be measured by creating an effective propulsive mechanism with enough active plantarflexion against the ground and passive dorsiflexion of the Hallux in reaction to the weight bearing surface, to create push off. Effective biomechanical control, via a functional orthotic device, of the ground reactive force against the 1st metatarsal-phalangeal joint may achieve that objective, or it may not, in which case surgery would still be a later option. Each case stands on its own, multiple variables exist, so having knowledge of the nuances of the deformity, as well as a thorough examination and evaluation of the particular patient will likely guide the treatment plan towards a successful outcome.
Successful outcomes is what KevinRoot Medical is all about!
