I am going to start posting quick case studies of interesting foot surgery and other foot problems as they come in. These posts will be shorter than my more education posts and just present the complaint, physical findings, diagnosis and treatment.

The first case study is a severe bunion. This is one of the largest bunions I’ve operated on in my ten years of practice (since 2000).

This patient had severe pain in both of her feet with bunions. The right bunion was bad but the left bunion was really severe.

Here are preoperative pictures. (Click any picture make larger.)

You can clearly see the great toe is under the second toe and how large her bunion is.

Below are the pre-operative x-rays:

You can clearly see the large bunion with the first metatarsal severely angulated.

I decided to do an opening base wedge osteotomy (inserting bone graft to move the metatarsal) . Her first metatarsal was a bit short and if I had done a closing osteotomy (taking out bone to move the metatarsal) it would have shortened it even more, so I didn't do the closing wedge surgery. After I did the base wedge osteotomy I released the soft tissue contractures at the great toe joint.  Then I removed the bump of bone at the first metatarsal joint. Then I did an Akin osteotomy in the toe bone because the first toe was still turned toward the second toe. Then I corrected for the extra skin after moving the bones. After all of these procedures the correction was amazing.  There was a new foot!  See below.

I called the patient the night of surgery and again the next day and she reported that she had little to no pain even with all the work that I did!

I did surgery two days ago so I don’t have and long term postoperative pictures yet but I did have one of the OR nurses take a picture while still on the operating table at the end of the surgery. I also have immediate postoperative fluoroscopy pictures.

Below are the before and after pictures of this bunion surgery: I will add more long term pictures in the future.

Come back in the future to see pictures of the healing process. I will update below…