From the Research
Lapiplasty is a recommended surgical procedure for correcting bunions, as it addresses the root cause of the deformity at the metatarsal bone level, offering advantages over traditional bunion surgery, including potentially lower recurrence rates, faster recovery times, and better long-term correction of the deformity. When considering treatment options for hallux valgus, it is essential to prioritize morbidity, mortality, and quality of life as outcomes. According to the most recent and highest quality study, 1, conservative treatment should always be initiated first, and proper footwear, such as shoes with an adequate length, wide toe box, cushioned sole, and a lowered heel, can help alleviate symptoms.
Key Considerations
- Personalized 3D printed customized toe spreaders may be applied in patients with hallux valgus, improving symptoms and bringing pain relief 1.
- Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the hallux valgus development, preventing or at least controlling the condition's progress 1.
- Dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures 1.
Treatment Options
- Lapiplasty uses specialized instruments to realign the entire metatarsal bone in three dimensions, securing it with titanium plates, effectively correcting the rotational deformity that causes bunions while stabilizing the joint at the base of the toe.
- Recovery typically involves wearing a surgical boot for about 6-8 weeks, with most patients able to bear weight on the surgical foot within days after surgery.
- Physical therapy is often recommended after boot removal to restore strength and mobility, as discussed in 2.
Evidence-Based Recommendations
- The most recent study, 3, suggests that orthosis with a toe separator has the best effect of correcting the hallux valgus angle, and the orthoses design with a toe separator or an element that allows for the foot anatomic alignment is critical for reducing the hallux valgus angle and relieving foot pain.
- Another study, 4, found that a reduction in pain appears more likely than improvement in hallux valgus angle with the use of foot orthoses, night splints, dynamic splints, manual therapy, taping added to foot exercises, a multifaceted physical therapy program, and Botox injections.
- A 2-year follow-up study, 5, demonstrated that nonoperative treatment using foot orthoses decreased pain in patients with hallux valgus, with the effect of treatment maintained up to 2 years with a relatively high degree of patient satisfaction.