Bunion surgery that’s “a piece of cake”

Ann Coolidge wanted her life back.

Accustomed to going to the gym and walking four or five miles daily along the Cape Cod Canal, Coolidge, 67, had a painful bunion on her left foot. On a recent trip to Italy, the Bourne resident had to stop every so often to take off her shoe and sock and massage her toes.'

But on April 29, she had a new kind of bunion correction surgery, called Lapiplasty, performed by Orthopedic Surgeon James Boyle, M.D., at Cape Cod Hospital. And now she’s looking forward to walking comfortably through Ireland in August during an upcoming trip.

The surgery was “a piece of cake,” she said. “I recommend it to so many people.”

Bunions are painful, bony bumps that develop at an unstable joint in the foot, the metatarsophalangeal joint, according to the American Association of Orthopedic Surgeons. They are reportedly named after the Greek word for “turnip” because of their red, lumpish shape. They are related to hallux valgus, a condition where the big toe drifts toward the other toes and causes a prominence on the inside of the foot.

Bunions often alter the mechanics of how sufferers walk, are painful, and make shoe shopping very tricky. They tend to be hereditary and can develop in both feet, according to the AAOS. And, they are far more common in women than men, perhaps being aggravated by high heels and other not-so-practical styles.

“I sometimes have patients stand on a piece of paper and trace the outline of their foot and put their shoe inside the outline,” Dr. Boyle said. “That makes them realize what they are doing to their feet.”

What is Lapiplasty?

Dr. Boyle said Lapiplasty is revolutionary because it corrects every plane of alignment and is more than cosmetic; it is functional.

“A lot of other procedures claim to be less invasive, but patients really need to look and see if these surgeries are going to create a foot that’s going to be functional in the long run or just look pretty,” he said. “In my opinion, this really is a completely new technique, not just a new twist or gimmick.”

Treace Medical, the company that developed the Lapiplasty technique, compares traditional bunion surgery to straightening the Leaning Tower of Pisa by trimming off the side, as opposed to solving the true structural issue, which is at the base.

Until now, bunion correction often involved a surgeon dividing the angulated bone and then shaving and shifting the bony outcropping until it’s in line with the rest of the bone, straightening out the bunion. But using Lapiplasty, the surgeon rotates the entire bone back into normal alignment and then uses small titanium plates, and more recently “Speed Plates,” which do not require screws, to stabilize and secure the joint, according to Boyle. Once corrected and secured, the patient’s body does the rest by knitting the two bones together and making the correction permanent.

“This is the first bunion surgery technique that is really an anatomical procedure,” Boyle said. Lapiplasty not only has a quicker healing time than traditional bunion surgery – which can require 6 to 12 weeks with at least modified weight-bearing – but also has a lower recurrence rate, he said. He estimates that 75 to 90 percent of his bunion patients qualify for the new technique.

“The idea of getting your life back at two weeks is encouraging and easier to deal with,” he said. “Once this is realigned, there’s no limitation on how they can use their foot.”

Getting Her Life Back

The day surgery itself was not too painful, except for the first 24 hours after the nerve block wore off, Coolidge said. Within 48 hours, she was only taking Tylenol.

She prides herself on being a good patient and thinks that helped her do well.

“I followed the orders to a T,” she said. “I had my foot raised up on the pillow that the recovery room gives you. I didn't walk around, except to go to the bathroom and to get something to eat. It took me 10 days before I went outside to get an ice cream.”

But she was putting weight on her left foot within about 10 days of surgery, albeit in a supportive boot and with a walker. True to form, she figured out how to use the walker as an exercise tool, supporting her as she did leg lifts, for example. By late June, her foot still had a bit of swelling, her big toe was a little stiff, and she was wearing an ankle brace for added support. But she was back at the gym doing four or five miles on the stationary bike. And she’s been cleared to start physical therapy six weeks after surgery. She’s looking forward to her left foot being in good shape for her tour of Ireland.