Black Hills Doctor Redefining Bunion Treatment
Oct 23, 2019 08:00AM
By MED Magazine
Lapidus bunionectomy has long been a mainstream protocol for treating bunions (hallux valgus). But, even though it can often provide effective and long-lasting correction of the most common forefoot deformity, many patients who needed it chose not to have it.
“It was a great procedure with a low rate of recurrence but it carried a lot of baggage,” says Rylan Johnson, DPM, a board certified foot and ankle surgeon with Regional Health.
The Lapidus procedure fuses the joint between the first metatarsal and the small bone in the midfoot called the medial cuneiform. Cartilage surfaces are removed from both bones and hardware is placed to facilitate fusion. The problem is that putting any weight on the foot in the first two weeks after surgery can significantly lower the odds of success.
“If a patient walks prematurely, the union rate goes down,” says Dr. Johnson. “The previous non-union rate was usually around 8 to 10 percent. So we had to select candidates very carefully. It excluded a large portion of the population.”
That’s why about a year ago, Johnson became the first in the state to begin using a new procedure involving a patented titanium biplanar plating system developed by Treace Medical Concepts, Inc. With the new Lapiplasty 3D bunion correction system, patients can bear weight immediately and can be out of a walking boot and back into shoes in 6 to 8 weeks. That’s about the time many Lapidus patients were just putting their walking boot on.
“There is some load to the joint, but that spurs on healing like an external fixator would,” explains Johnson. “We are healing almost by secondary boney union.”
The system is called ‘3D’ bunion correction because it allows the surgeon to correct the problems on three different planes instead of just two. Research shows about 87 percent of bunions are misaligned in all three dimensions.
“The results are more predictable, precise, and reproducible,” says Johnson.
Although the 3D bunion correction system is more expensive and time-consuming, the superior results have made it Johnson’s go-to procedure for all patients with bunions, regardless of age, mobility, etc.
“The fusion rates are much better and there is less chance of recurrence,” he says. “Previously, you would still have this somewhat angular metatarsal. Now we are able to go back and actually get an anatomical correction, restoring better function and range of motion.”
“I think this is going to become the benchmark. It has redefined how I treat bunions.”