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Bunions straightened without cutting bone

Posted May 26 2010 12:00am - A less invasive, surgical treatment for bunions known as the Mini TightRope procedure is being used at Rush University Medical Center to correct bunions, or hallux valgus, a common, often painful deformity in which the big toe is angled in toward the smaller toes.

The new procedure, developed by orthopedic surgeon Dr. George Holmes, head of the foot and ankle program at Rush and assistant professor of orthopedic surgery at Rush University, uses a special suture material called fiberwire to bind together the first and second metatarsals, the bones in the foot in the big toe and second toe. This pulls the first metatarsal into proper alignment.

Traditionally, people suffering from pain bunions require an osteotomy bunionectomy in the first metatarsal to correct the deformity. This requires a surgeon to break the bone or cut into the bone and reposition the first metatarsal, which can lead to a long recovery period of six-to-eight weeks, during which patients cannot bear any weight on the foot and must use crutches.

“Why should we break the bone in the foot if we do not need to do so to correct the angular deformity?” said Holmes. “This is the genesis of the new technique.”

“This new procedure decreases the degree of postoperative pain and greatly reduces the potential of postoperative complications,” said Holmes. “It also decreases the recovery time, causes less scarring, and patients are able to go home the same day.”

During the Mini TightRope procedure, tiny holes about one millimeter in diameter are drilled through the first and second metatarsal bones in the foot. Then, two sets of fiberwire suture, made of a strong, hair-thin mesh and wire-like material, are threaded through the openings, anchored on either side of the metatarsals, and after the sutures are in place, they are tightened to correct the position and alignment of the big toe.

Afterwards, patients wear a postoperative shoe or short walking boot. Stitches are generally removed in two-to-three weeks. Most patients are pain-free within two-to-three weeks.

Bunions are a common type of deformity that develops when weakened muscles and ligaments holding the first metatarsal bone in place shift away from the other toes. At the same time, the big toe slips to the inside and causes the angular deformity.

The joint at the base of the big toe pushes out and causes the formation of a bump along the inner edge of the foot. This bump can become red and swollen and rub against the side of a shoe, which can cause considerable pain when standing, walking or running. In some cases, the bump can be so large and painful that a patient is unable to wear shoes.

An estimated 200,000 bunion correction surgeries are performed in the U.S. each year. About 10 to 30 percent of patients, who have bunion surgery, experience significant complications. One-third of women in the U.S. have bunions. The most common cause of bunions is wearing tight, poorly fitting or high-heeled shoes.

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