Minimally Invasive Osteotomy for Symptomatic Bunionette Deformity Is Not Advisable for Severe Deformities

Abstract

Bunionette, or tailor's bunion, is a painful protrusion on the plantar and/or lateral aspect of the fifth metatarsal head. Until recently, there have been very good results reported in literature when minimally invasive therapy is used to treat this deformity. In this study, the authors critically review the outcome of patients operated by the minimal invasive technique. A total of 31 feet were retrospectively reviewed with a mean follow-up of 52 months (range 14-106 months). The results were related to the preoperative severity of the bunionette deformity. The mean intermetatarsal angle IV/V was reduced from 12° to 7.5° postoperatively. The American Orthopaedic Foot and Ankle Society score showed good and excellent values (80-100 points) at follow-up in 16 (12 type I, 4 type III) feet. Fourteen (2 type I, 5 type II, 7 type III) feet were rated as satisfactory (60-80 points) and one (type III) foot with fair (56 points). Nine patients (5 type II and 4 type III) indicated that they would not undergo the operative procedure again. Our results show inclusive evidence that minimal invasive osteotomies have a good clinical outcome in the treatment of high-grade deformities. The best future option is to consider the classification of the deformity before a minimally invasive operation is to take place.

The Reverse Ludloff Osteotomy for Bunionette Deformity

“…good for high-grade bunionette deformities. 24 We believe this is because the minimally invasive techniques, including distal osteotomies, do not address the pathology responsible for more severe deformities, which include lateral bowing in cases of type II deformities and an increased 4-5 IMA in cases of type III deformities. 1,2,5 One common concern about proximal fifth metatarsal osteotomies is the tenuous metatarsal blood supply.…”

“…3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Recently, minimal invasive treatment has been increasingly used with generally good published results, but a recent study has questioned these findings especially for types II and III deformities. 13,20,[22][23][24] The purpose of this study was to report the results of the reverse Ludloff osteotomy for the treatment of types II and III bunionette deformities in a cohort of patients.…”

Bunionette

“…After evaluating abstracts and full-text reviews, 9 articles were included in this review, for a total of 327 feet in 249 patients, with a mean age of 45.35 years and a male-female ratio of 37:212. [27][28][29][30][31][32][33][34][35] The mean follow-up time was 51.95 months. All studies had a level of evidence of IV.…”

“…Only 1 study reported differences between bunionette classification and clinical and radiographic results, reporting inferior results in feet with stage II and III deformity than in type I classification with distal osteotomy (subcapital from lateral-proximal to medial-distal). 34 The authors suggested that a diaphyseal osteotomy should be done in type II cases.…”

“…The lowest satisfaction rate was reported in the study with the longest follow-up time. 28 Waizy et al 34 reported that at the final follow-up (52 months), 29% of patients would not undergo surgery again.…”