Do you have onions? Key factors to know if the surgery will work for you

By Alan Mozes Health Day Reporter

MONDAY, Feb. 6, 2023 (HealthDay News) — When it comes to bunions, millions of Americans are painfully familiar with the signs: swelling, redness, a telltale bulge on the side of the big toe. Corns and calluses where other toes rub. And the pain. Lots and lots of pain.

Fortunately, when surgery is needed, it’s usually successful. But not always.

The researchers therefore intensified a new study highlight the key factors that can determine the procedure, known as modified Lapidus surgery, will be unsuccessful.

“We investigated whether certain characteristics – patient-based or procedure-based – were associated with bunion surgery failure,” the study author said. Dr Matthew JohnsonAssistant Professor of Orthopedic Surgery at the University of Texas Southwestern Medical Center at Dallas.

Bunions form at the base of the big toe when the long metatarsal bone moves inward in the foot and its phalanges tilt toward the second toe. When the soft tissues of the foot rub against the shoes, pain results.

“The patients [are] unable to perform normal daily activities such as walking, other exercises or even standing in some severe cases,” Johnson said.

Up to a third of American adults have bunions, which is usually due to wearing ill-fitting shoes and/or genetics.

Patients can apply padding or try wider toe shoes and/or arch supports to relieve pressure. But these aids do not always do the trick.

When all else fails, Lapidus surgery aims to straighten, realign and fuse the bones of the big toe and arch of the foot, with the goal of improving daily functioning and mobility for patients, Johnson said.

“Most research has shown that only a small percentage of bunion surgery patients did not find the operation beneficial,” he said.

About 10% of the time, the procedure fails to achieve a healthy, permanent union of the bones, leaving the patient with ongoing pain and disability after surgery.

Looking for an explanation, Johnson and his colleagues studied the medical records of 222 bunion surgery patients.

The vast majority were women (87%), with an average age of 51. Their average body mass index (BMI) – a measure of body fat based on height and weight – was just over 28, meaning they were overweight.

Almost 1 in 10 have unsuccessful bunion surgery. Three patient characteristics appeared to increase the risk that the bones would not heal together as expected, Johnson said.

The first factor was weight: the higher a patient’s BMI, the higher their risk of surgical failure.

The risk of failure was also higher in patients whose bunions had a ‘larger preoperative angle’, meaning a relatively more severe form of bunions.

The likelihood of failure was also higher for patients who had previously had bunion surgery.

However, a history of smoking was not linked to increased risk, a finding that surprised Johnson.

He now hopes surgeons will take note of the factors that seem to hinder surgical success, in order to set more realistic expectations with bunion patients considering surgery.

Dr AS Montant Raymondan orthopedic surgeon at Nantucket Cottage Hospital in Massachusetts, found “no real shock” in the new analysis of a procedure that has been around for nearly a century.

“The real message of this study is something most surgeons already know, but most of the public have been shielded from,” said Monto, who reviewed the results. “Bunion surgery has one of the highest complication rates of all surgeries.”

Her advice: “If a patient has a painful bunion that cannot be managed with more accommodating footwear and is considering surgery, they would be well advised to have a frank discussion with their surgeon about the potential for surgical complications and to prepare for any procedure by first losing weight and quitting smoking.

Caution should guide any decision to undertake the operation, Monto said.

“As one of the great foot surgeons of the 20th century, Dr Leonard Goldneronce told a bunion patient, “It would probably be better to operate on your shoe than on your foot,” Monto said.

SOURCES: Matthew Johnson, DPM, assistant professor, orthopedic surgery, University of Texas Southwestern Medical Center, Dallas; Raymond Monto, MD, orthopedic surgeon, Nantucket Cottage Hospital, Nantucket, Mass. ; Journal of foot and ankle surgeryJanuary 31, 2023

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