The 1st metatarsal bone is almost always cut (e.g., an "Austin" procedure) in the re-alignment. Sometimes one of the smaller bones in the toe has to be cut (e.g., an "Akin" procedure) as well. These are necessary to get the angled bones, and big toe, back into a more normal position. The bunion bump itself is cut off too.
A bunion may return but usually many years later, if at all. When a bunion is still present after surgery, or if it comes back weeks or a few months later, or if the big toe "drifts" away from the second toe ("Hallux Varus"), it is likely that something was not done correctly during surgery.
There are many techniques for surgically fixing a bunion. The Austin procedure involves a cut near the head of the 1st metatarsal bone. A "base" osteotomy involves a cut at the base or bottom of the 1st metatarsal bone. Some patients even need a fusion of a joint because their bones have too much of an angle or too much flexibility.
One of the most fundamental principles of "bone correction" is the calculation of important angles and other measurements. The podiatrist makes these calculations on the pre-operative x-rays by drawing certain lines and measuring the angles formed by the lines.
The common angles the podiatrist looks at are the intermetatarsal angle, the hallux valgus angle, the PASA, the DASA, and the metatarsal protrusion distance. Some podiatrist who do not make these measurements claim they simply "eye-ball" the x-rays which is another way of saying they guess the measurements. They also say that they have performed hundreds of surgeries and no longer need to precisely measure the angles. These podiatrists usually have a difficult time explaining how their bone cuts were off or why the patient came out worse after surgery. It is just like a contractor saying he has built hundreds of buildings before and doesn't need building plans anymore.
An old method of bunion correction was the simple "shaving off of the bump." It is used on the elderly if used at all these days. This procedure does not correct the real problem in most patients and is considered malpractice on some patients if that is all the podiatrist does. However, some podiatrists do not explain the details of what they intend to do and just tell the patient "we will just shave some bone." Telling the patient only this limited amount of information is malpractice. Technically, it is called "lack of informed consent" because the podiatrist is not giving the patient all of the accurate information before getting the patient's consent to the surgery.
Many Podiatrists use a template or standard form as their "operative report" for most of their surgeries. In most cases, when there is a problem during surgery, the operative report will make NO mention of it. In that case, before and after x-rays will usually show what happened.
Two serious problems may happen after bunion surgery. The patient may get a big toe which does not bend, so walking is extremely difficult. Or the big toe may drift away from the second toe, and that too will make walking difficult. Both can cause considerable pain and both may be permanent conditions. Another common problem is that the bone cuts are not made properly and the big toe is overly shortened. This can cause more pressure on the other toes and also make walking very painful and difficult.
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Lance Ehrenberg, Esq., and The Law Firm of Lawrence M. Karam, PC, represent individuals throughout New York City and Long Island, including Manhattan, Queens, Long Island, Brooklyn, the Bronx, Staten Island, Yonkers, White Plains and the communities in Westchester County, Nassau County and Suffolk County.
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