Our Summary

This research paper is about a comparison of two different methods of treating a foot deformity called hallux valgus, which is often known as a bunion. The two methods compared are the use of a special kind of plate and screw (dorsomedial locking plate with intercuneiform compression screw construct) versus a more traditional method of using crossed screws.

The study looked at 56 patients who had 64 total feet treated with one of these two methods. They found that patients who were treated with the plate and screw method had 100% fusion of the joint by 10 weeks after the operation, with no cases of the joint not joining together properly (non-union), and only one case of a deep vein thrombosis (a dangerous blood clot).

On the other hand, patients who were treated with the crossed screws method had 2 cases of non-union, one of which didn’t cause any symptoms but the other needed another operation.

The study also found that both methods improved the angle of the big toe and the angle between the first and second toes, which are both problems in hallux valgus. These improvements were seen in X-rays taken 10 weeks and 1 year after the operation.

Furthermore, scores on a foot and ankle surgery rating scale improved from before the operation to 1 year afterwards for both methods.

The study concludes that the plate and screw method is better at maintaining the correction of the angle between the toes at a follow-up point. However, both methods showed similar rates of the joint fusing together, cases of non-union, cases of broken hardware, need for hardware removal, cases of deep vein thrombosis, nerve inflammation at 1 year after the operation, and another toe deformity called hallux varus.

FAQs

  1. What are the two methods compared in treating hallux valgus?
  2. What were the results of the study when comparing the dorsomedial locking plate with intercuneiform compression screw construct method and the crossed screws method in treating hallux valgus?
  3. Did both methods of treating hallux valgus improve the angle of the big toe and the angle between the first and second toes?

Doctor’s Tip

A doctor might tell a patient considering joint fusion that using a dorsomedial locking plate with intercuneiform compression screw construct may lead to better fusion rates and maintenance of correction compared to traditional crossed screws. It is important to discuss these options with your doctor to determine the best treatment plan for your specific condition.

Suitable For

Patients with hallux valgus, also known as bunions, who have not had success with conservative treatments such as orthotics, physical therapy, and shoe modifications are typically recommended joint fusion. Joint fusion is also recommended for patients who have severe pain, deformity, and difficulty walking due to their bunions. Additionally, patients with arthritis in the big toe joint or other deformities that cannot be corrected with other methods may also be candidates for joint fusion.

Timeline

Before joint fusion, a patient may experience pain, swelling, and difficulty walking due to the foot deformity. They may have tried conservative treatments such as orthotics, physical therapy, or pain medication without success. The decision to undergo joint fusion surgery is typically made after consulting with a orthopedic surgeon and discussing the risks and benefits of the procedure.

After joint fusion surgery, the patient will undergo a period of immobilization and physical therapy to aid in the healing process. They will experience some pain and swelling initially, which can be managed with medication. Over the course of several weeks to months, the bones in the joint will gradually fuse together, resulting in a stable and pain-free joint. The patient will gradually increase their activity level and may need to modify their footwear to accommodate the changes in their foot structure.

Overall, joint fusion surgery can provide long-term relief from the symptoms of hallux valgus and improve the function of the foot. With proper post-operative care and rehabilitation, patients can expect to return to their normal activities with improved foot alignment and reduced pain.

What to Ask Your Doctor

Some questions a patient should ask their doctor about joint fusion for hallux valgus include:

  1. What are the potential risks and complications associated with each method of joint fusion?
  2. How long is the recovery time for each method?
  3. Will I need to have hardware removed at a later date with either method?
  4. How likely is it that the joint will fuse properly with each method?
  5. What are the long-term outcomes and success rates of each method?
  6. How will the angle of my big toe and the alignment of my first and second toes be improved with each method?
  7. Will I need physical therapy or rehabilitation after the surgery?
  8. How soon can I return to regular activities and exercise after the surgery?
  9. Are there any specific factors that make me a better candidate for one method over the other?
  10. What is the expected level of pain and discomfort during the recovery period for each method?

Reference

Authors: Abben KW, Sakow CF, Sorensen T, Chang HC, Boffeli TJ. Journal: J Foot Ankle Surg. 2023 Mar-Apr;62(2):347-354. doi: 10.1053/j.jfas.2022.09.002. Epub 2022 Sep 20. PMID: 36272952