Bunion Pictures

Pre and Post op Clinical Pictures and X-rays Status Post Medial Approach Bunion

with first metatarsal head osteotomy

Preop and Postop Clinical Pictures and X-rays Status Post Bunionectomy with First Metatarsal Osteotomy

During surgical correction of the bunion a v-shape bone is made in most cases to translate the head of the 1st metatarsal laterally which creates an overhang of bone from the previous position of the bone (pictured left). The overhang is remove and the new position of the bone is held with some type of fixation which varies from screws, staples, or pins which is the case here. The pin is buried left in permanently (pictured right).

 

X-rays demonstrating correction of bunion deformity with the great toe deviated laterally (left image) and notice the position of the sesamoid bones which are the small round bones near the joint. The post-surgical film (right image) depicts alignment of the great toe significantly improved and the position of the sesamoids is underneath the 1st metatarsal head where it should be. This is a case where two surgical screws were used to fixate the correction.

 

Pre and Post op Pictures and X-rays Bunionectomy with 1st metatarsal osteotomy

Preop and Postop Pictures and X-rays at 8 weeks Post-op

Pre and Immediate Postop Bunionectomy and Neuroma Excision

Pre and Immediately Post-op Bunionectomy

Preoperative and Postoperative Photos and X-rays Status Post Bunionectomy with First Metatarsal Osteotomy

Immediate postop Pic and X-ray

Pre and Postop Pics and X-Rays after Recurrent Bunion performed by other surgeon.

Correction performed with McBride-Akin Bunionectomy

 

Post-op X-rays

 

 

 

 

 

 

 

 

Picture of first metatarsal osteotomy for bunion correction

X-rays demonstrating correction of bunion deformity with the great toe deviated laterally (left image) and notice the position of the sesamoid bones which are the small round bones near the joint. The post-surgical film (right image) depicts alignment of the great toe significantly improved and the position of the sesamoids is underneath the 1st metatarsal head where it should be. This is a case where two surgical screws were used to fixate the correction.

Bunion deformities, as a results of multiple factors such as genetics and abnormal mechanics, cause the great to shift towards the lesser toes which leads to pain, difficulty with walking and daily activities, as well as difficulty with wearing shoes (left). Correction of the bunion with surgery results in straigtening of the great toe and removal of painful bump (right).

   

During surgical correction of the bunion a v-shape bone is made in most cases to translate the head of the 1st metatarsal laterally which creates an overhang of bone from the previous position of the bone (pictured left). The overhang is remove and the new position of the bone is held with some type of fixation which varies from screws, staples, or pins which is the case here. The pin is buried left in permanently (pictured right).

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X-rays images also depicting abnormal position of the great toe which can also lead to devlopment of arthritis at this area because of attempted daily and/or athletic activity on an abnormally positioned joint whic can be seen with changes such as bone spurring, joint space narrowing the remodeling of the shape of the bone (below left). Surgical correction allows for re-alignment of the bone structures to function more appropriately during activities (below right).

  

Chondrolysis of 2nd MPJ arthritis before and after microfracture

There is damage to the articular surface cartilage which can occur either from an acute injury or more commonly after repetative injury and/or wear and tear. If the the bones at the joint in questions are not aligned properly then this mechanically adds to the wear the the joint receives with activity and increases the propensity of this occuring. Pictured below is linear damage to the articular surface of the 2nd metatarsal head.

The following pictures are debridement of damaged cartilage that is abnorml in appearance and/or loose. This is removed completely to expose the subchondral (underneath cartilage) bone plate.

Drills holes are then placed through the bone plate to allow bleeding in the area which will aide in healing of the cartilage surface with fibrocartilage which is a kind of scarring of cartilage.

Bunion & Hammertoes

The following is depicting a bunion deformity of the great toe that has worsened a hammertoe contraction of the second toe. The outside deviation of the great to cause underriding of the second to which leads to increased dorsal (upward) dislocation of the toe.

Post-operative repair of the bunion and hammertoe deformities which straightens the great to utilizing a combination of bone cuts and soft tissue releases of the great toe and second toe to correct abnormal position of the toes and significantly improve pain with activities and use of shoes.

Below is a photograph a a severe overlapping bunion and hammertoe deformity. At this point in he mechanical process, the digits especially the second digit is dislocated from its articulation with the longer bone in the foot called the metatarsal. Severity of these deformities is multi-factorial involving genetics, altered mechanics with soft tissue contractures, and bad shoegear.

Below is a photograph of the top view of the same deformities that is pictured above.

Pictured below is the same foot after surgical correction of the bunion deformity of the great toe and hammertoe correction of the second, third and fifth toes. The plastic balls at the top of the second and third toe are covering wires that hold the position of the second and third toes into the longer bones (metatarsals) of the foot so that the soft tissue contractures heal in the correct place. Depending on the deformity, the wires will stay in place for a period of 4-6 weeks and then are removed.

 

 

 

 

 

 

 

 

 

Status post bilateral bunions with 1st metatarsal head osteotomy with pin fixation

 

This is a before and after of a patient who had a bunion performed by a different surgeon and developed arthritis of the big toe joint.  We removed the joint and replaced it with a total 1st MPJ implant.

Preop

Post

This is a intraoperative picture after bunionectomy

Intraoperative Picture of cartilage damage of the 1st metatarsal head during bunion surgery before and after removal of the bad cartilage and subchondral drilling (Below)

 

 

Intraop pictures during hemi-implant for hallux limitus

 

Osteochondral Autograft Transfer System (O.A.T.S.)

    

Intraoperative pics of a bunion correction with a bone cyst in the first metatarsal. The cyst is curreted and autogenous bone graft from the bunionectomy is morselized and packed into the bone cyst.

  

 

 

Intraop pic of cartliage damage inside big toe joint that was cleaned up and then drilled to stimualte cartilage regrowth (below)

  

Pre and Post Op X-rays of head osteotomy for bunion correction with K-wire Fixation

 

  

This is a pre and postop X-ray of a 1st mpj fusion for a severe bunion. The patient also had a subtalar implant to correct her flatfoot at the same time. On the lateral x-ray (from the side of the foot) the titanium implant can be seen (similar to a thimble elevating the arch). The lateral view is the first two pics before and after surgery.

 

The fusion is held in place with a plate and screws as seen below.

  

Intraop series of pics during bunionectomy

Intraop pic of the deviated first metatarsal head and the medial incision prior to osteotomy

The V osteotomy (Chevron) of the first metatarsal and sliding of the head to correct the bunion

The osteotomy after the medial excess bone is removed and prior to pin fixation

First metatarsal osteotomy with pin fixation

Intraop Pic before and after subchondral dr