Adam Katz, DPM, FACFAS, Board Certified in Foot Surgery, American Board of Foot and Ankle Surgeons talks about a new bunion surgery.
Interview conducted by Ivanhoe Broadcast News in September 2018.
A lot of people are dealing with bunions. How many people would you estimate are living in this country with bunions? Does it happen to a lot of people?
Dr. Katz: Yes it does. There’s definitely a genetic predisposition towards it. You see it in mothers and daughters and grandparents so it runs in the family. Your shoe gear definitely plays a role in it. You might see two sisters; one gets it really bad from wearing all the high heels and narrow pointy toe shoes. But the conservative treatments are really just accommodating it and not really doing anything to make it go away. And they are progressive deformities that usually get worse over time.
What are bunions exactly, a lot of people think it’s like a bump or something but what is it?
Dr. Katz: It’s actually a lot more than a bump. The first metatarsal is shifting out away from the second metatarsal and so it definitely protrudes but it’s really doing a lot more than that. It’s rotating, a lot of times it’s elevating so traditional bunion surgeries have poor success rate and part of that is they weren’t really correcting it in all three plains. And that’s what the labiaplasty does: we correct all three plains. We de-rotate it, we move it back over and we bring it back down when necessary and then we lock it in at the joint where it’s occurring from. So it’s not stable now. That joint where it really occurs from is unstable with a lot of the traditional bunion surgery so over time they reoccur. For that reason there’s a high reoccurrence rate and a lot of patients were unhappy, unsatisfied with a lot of the traditional bunion surgeries that are out there.
Right and probably scared them away from doing it.
Dr. Katz: Right.
Is it a painful condition and how does it affect patients daily?
Dr. Katz: Everybody is different. I see patients that have huge bunion deformities and they live with it eight- eighty five years old and they’re willing to wear these big orthopedic shoes and they don’t have pain. And then I see some patients that come in, in their eighties that have these bunions that are sorry they did not do it earlier. They wish they took care of it because they’re not a good surgical candidate any more. But most patients tend to start to get pain as it really gets out there.
Shoes can make it worse.
Dr. Katz: Well yeah, it definitely restricts the shoes that they can wear as it progresses.
Exactly, with the pointy toes or the high heel shoes those can really be painful.
Dr. Katz: Yes, absolutely.
Can bad shoes cause it?
Dr. Katz: Both, both, yep, bad shoes can definitely cause it. There’s definitely a genetic predisposition. Sometimes you can do nothing wrong and you’re not wearing pointy shoes and you still get a bunion deformity. But a lot of times when you start to get flat feet. Even just walking barefoot a lot and not wearing a good supportive shoe can play a role in it as well.
And it happens to both men and women?
Dr. Katz: Yes it does.
You might see little things in the store that fixes your bunions, these things don’t fix bunions do they?
Dr. Katz: None of them fix bunions. They’re all devices that try to accommodate to make you more comfortable: they’re hit or miss. Most of the times patients aren’t really satisfied with those accommodative types of devices.
And you mentioned before that surgery that was being offered up until recently people would back away and be scared because it didn’t really fix the problem for good and then the recovery period was very long. How would the recovery be in years past?
Dr. Katz: There’s different categories of bunions, it depends, but in a severe bunion deformity if you did this similar type of procedure in the past, it would be two months of non weight bearing.
So that’s two months you’re out?
Dr. Katz: Yeah.
Now tell us about this new procedure and what makes this different? What makes what you’re doing now and what you did with Carrie different?
Dr. Katz: In the past when I elected to do a labatus bunionectomy I would reserve it for severe bunion deformity because it required such a non-weight bearing period and patients didn’t want to go through that. In the past I would be free handing my cuts, it was technically more difficult. The plating system wasn’t what it is today. So what treace is they made it so that we can dial in our correction very precise in all three plains, we lock it in exactly where we want it and they then have a little cutting guide that goes in there. So we’re making precision cuts and it’s very reproducible and then their plating system is state of the art. It allows for early weight bearing, almost immediate weight bearing. By two weeks my patients are walking with a boot afterwards.
That’s a huge difference between two months and two weeks. And like you said you’re not up and running at two weeks but the point is you’re in a boot.
Dr. Katz: We’re protecting it.
Before, they were shaving the bunion?
Dr. Katz: Right. In the past like the real old timers all they would do is just treat it like a bump and try to shave off the bump. And they would tighten the soft tissue on one side and release soft tissue on the other side. And that had a very high recurrence rating. The base of the metatarsal that’s shifting out that joint is unstable. They’re not doing anything to secure that. Even nowadays the majority of the bunions are done with what we call a head type of chevron procedure where they’re cutting through the head and they’re sliding part of the bun over and then fixating that. So they have this crooked bone they’re correcting it in one transverse plain but it still has an unstable joint at the base that could reoccur and then not correcting any of the frontal plain motion. They’re not getting that joint back in alignment. There’s a high end sense of arthritis down the road and decreased motion at that first MPJ where the deformity is.
Like you’re saying you can have arthritis down the road and instability. With the Treace procedure what is it called, what do we call this procedure?
Dr. Katz: We call it a labiaplasty. Treace is the company that came out with it it’s called the labiaplasty procedure.
Labiaplasty procedure so this is what you would ask for if you needed it?
Dr. Katz: Yeah.
How long is the procedure and then just take us through the recovery period briefly.
Dr. Katz: Typically it’s an outpatient procedure, it’s maybe an hour and a half in the operating room. You go home the same day, initially the first two days are usually the worst. The first few days you may have to take pain medication by two days most of my patients are off pain medication. And usually I see a patient about three days after the surgery. I’m just making sure there’s no sign of infection or anything like that. And then I see them back about a week or so later. It’s about ten to fourteen days post-op. The stitches come out and they’re pretty much walking around in a walking boot.
How long on the walking boot?
Dr. Katz: About another six weeks in a boot and until we signs of fusion on x-ray.
No physical therapy nothing like that? This is just a recovery period.
Dr. Katz: Most people don’t need that.
Then can they wear the shoes they want to wear afterwards? Are they basically cured, what’s the recurrence rate with this?
Dr. Katz: I don’t know what the statistics are but I expect it to be no recurrence because you’re fusing that joint where it’s occurring from so there is no recurrence with this really. As far as shoe gear, yeah they can wear anything they’re comfortable with afterwards. I mean I don’t ever recommend real high heel shoes and stilettos and pointy shoes to anyone, it’s not good. But I’ve done bunionectomies like this, patients that ran in races afterwards and do all kinds of stuff.
This is considered a medical condition so it’s covered by insurance.
Dr. Katz: Absolutely. If you have a painful bunion it’s covered by insurance.
You wouldn’t do two at once?
Dr. Katz: I only do one foot at a time, I don’t believe in doing bilateral foot surgery. You always want to have one good foot to stand on.
The procedure itself, so what you’re doing is really fixing the problem.
Dr. Katz: At the apex of the deformity we like to say, where it’s occurring from. In the past we weren’t at the apex we were going higher up because they thought it would get the patient weight bearing quicker or it was easier for them to do. But treace made it easy for pretty much any foot and ankle surgeon to do. And I think that just about every foot and ankle surgeon should be trained in this and should be doing this from like ninety percent of the bunions out there. But unfortunately that’s not the case yet. I’m actually one of the first guys in this area that really adapted this procedure as my go to bunion procedure now.
And patients are responding really well?
Dr. Katz: Yes, yes absolutely.
Carrie went thirty five years without getting it fixed because of the fear. She didn’t want to be out of commission for months and most people think bunion surgery is going to be like that. What do you want to say about the procedure?
Dr. Katz: Well I’d say this is a great procedure, it’s better to have a bunion now than in the past. If you’re going to do it it’s better to do it sooner than later when your circulation is good and you’re young and healthier. And before you do real damage to that joint, take care of it if you have this bunion and it bothers you.
Any risks with the procedure?
Dr. Katz: There are risks and complications to every surgery. There’s risk to anesthesia but obviously we evaluate you thoroughly, we’re going to check your circulation. The key it comes down to circulation. If you’re a heavy smoker I’m not going to want to do this procedure on you. We get medical clearance. I mean if you’re not a good surgical candidate we don’t want to do the surgery.
And this surgery or procedure has been available for how long?
Dr. Katz: This version of the procedure for a couple of years now.
You want to give web sites if people want to learn more? You want to give your site?
Dr. Katz: Yes my web site is http://www.premierpodiatrygroup.com/
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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