When Bunion Surgery Fails

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What To Include In Patient Consent Forms

I am sure your surgical consent form is similar to mine. I write out the name of the proposed surgery (i.e. Austin bunionectomy) and describe it in lay terms. I am going to shave bone, cut bone, reposition bone and use internal hardware. I also have a paragraph for all patients stating that, “I will do any additional surgery or modify the proposed surgery if necessary to obtain the best possible result.” I feel it is important to do whatever it takes to get the surgery done right.

As long as the additional surgery is reasonable, there is nothing to worry about regarding your consent form. For example, I have done an opening base wedge osteotomy and needed to add a Reverdin osteotomy to get a congruous joint. I have also obtained patient consent for an Austin procedure and then realized that I needed to do an Akin procedure (which was not included on the consent form). That is completely acceptable.

Certainly, there is a limitation to what you can do without consent. For example, it would not be appropriate to obtain consent for an Austin bunionectomy and then decide to do an arthrodesis of the joint. To address that potential problem, I will often obtain patient consent with an “either/or” procedure. For example, I may obtain patient consent for an Austin or a closing base wedge osteotomy. Certainly, the postoperative protocol is different. I will tell patients they may wake up with a soft dressing on their foot with a surgical shoe or a cast. They are prepared to be non-weightbearing after surgery if necessary.

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Author(s): 
By William Fishco, DPM, FACFAS

   For cases in which there is arthritis in the great toe joint, don’t forget about an arthrodesis for bunionectomy. A fusion can correct even large bunions and of all the different bunionectomy options out there, this is the one in which you can have the greatest confidence that the bunion will not come back. Just like any other fusion that we do, position means everything. With a properly positioned great toe, patients can run and wear most shoes without any limitations.

In Summary

Bunion surgery will fail and we all have to address it, whether it is our own failure or due to someone else. Take the time to figure out why the bunion surgery failed and make an extra effort not to “reinvent the wheel,” but ensure that the same mistake does not happen twice. I personally do not think there is a perfect type of bunionectomy to perform but whatever you do and however you cut the bone, make sure the metatarsal head is repositioned over the sesamoids and that your joint is congruent. How do you know that the joint is congruent? The medial base of the proximal phalanx rests in the sagittal groove of the metatarsal head.

   Dr. Fishco is board-certified in foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery. He is in private practice in Phoenix. Dr. Fishco is also a faculty member of the Podiatry Institute.

   Dr. Fishco pens a monthly blog for Podiatry Today. For more info, visit www.podiatrytoday.com/blogs/william-fishco-dpm-facfas .

Reference
1. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010 Sep 27;3:21.

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Dr.Adam Katzsays: October 12, 2013 at 8:08 pm

Nice article on bunion surgery and yes it can fail! But surgical correction should always in my book be the last resort. Too many treatments to utilize before putting someone under the knife. Please stop by our blog at www.premierpodiatrygroup.com .

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