There are many bunions out there in NYC and in the country at large, and perhaps as many treatments available for a bunion deformity. These treatments can generally be divided into two categories – surgical and non-surgical. Non-surgical treatments may be effective at relieving pain on a day to day basis, but do not address the underlying bony deformity and will not ultimately restore the joint to a more congruent anatomic position. Among surgical treatments, many techniques are available based on the type and severity of deformity, patient desire and lifstyle and, ultimately, surgeon preference and experience. Today I would like to touch on incision placement and its impact on healing.
As a brief review, a bunion is a bone prominence at the side of the big toe joint that forms as the toe turns outward toward the other toes and the metatarsal bone turns inward. This is usually hereditary and can be exacerbated by activity and shoe pressure. Surgery aims to remove the extra bone, restore the big toe joint to a more anatomic straight position, and accomplishes three goals: relief of pain, restoration of function, and improved cosmetic appearance – in that order. The first skin incision can generally be placed in one of two places: dorsal, or on top, of the joint, or medial, or on the inside of the joint facing the other foot. A dorsally placed incision does allow slightly better exposure for certain procedures, however a medial incision can give a surgeon great exposure for a bunionectomy, and can be far more attractive to a patient. After all is healed, which can take 6 months or more, this incision placement will generally result in an inconspicuous scar, and in ideal cases, it can be hard to tell a procedure was even performed, except of course for the very well aligned and pain free joint.
Since forming my NYC podiatry practice over 9 years ago, I have chosen to approach bunion surgery as I was trained – using a medial incision. So far the outcomes have been overwhelmingly favorable, and this is consistent with the results achieved by other surgeons who employ the medial approach. And this group includes some of the leading foot and ankle surgeons across the country.
So if you are concerned about a bunion, stop in for an intial evaluation, and if conservative treatment fails, a medial approach bunionectomy might be the right technique to relieve your pain and restore function in a more cosmetic way.
To see an actual video of my cosmetic approach to a bunionectomy, click here. Please use discretion as this is an actual surgical video.
See you in the office.
Dr. Ernest L. Isaacson