Percutaneous Surgery for Tailor's Bunion: A Comparative Study

Abstract

Objective To analyze and compare the clinical and radiographic outcomes of bunionette correction using two percutaneous surgical techniques: the Sponsel technique and the medial wedge osteotomy of the distal metaphysis. The results were evaluated individually and comparatively using the American Orthopaedic Foot and Ankle Society's Lesser Metatarsophalangeal-Interphalangeal Scale (AOFAS), Visual Analog Scale (VAS) for pain assessment, and radiographic measurements of the intermetatarsal angle IV-V (AIM4–5) and metatarsophalangeal angle of the fifth ray (AMF-5).

Methods This was a retrospective study conducted from May 2011 to February 2022. A total of 32 feet were operated on, with 12 feet undergoing the Sponsel technique and 20 feet undergoing the medial wedge osteotomy of the distal metaphysis of the fifth metatarsal.

Results Both surgical techniques showed significant improvement in the correction of AIM4–5 and AMF-5 angles (p < 0.001). However, there was no statistical significance when comparing the two techniques. In terms of AOFAS and VAS scores, both techniques yielded satisfactory results. Nevertheless, the medial wedge osteotomy demonstrated significantly better outcomes compared with the Sponsel technique (p < 0.001).

Conclusions Both percutaneous techniques employed for bunionette correction resulted in significant improvement in radiographic angles and evaluated scores, with a low complication rate, making them viable options for treating this condition. When compared, the medial wedge osteotomy appeared to yield better clinical outcomes.

Keywords

bunion - metatarsal bones - bunion, tailor's/diagnostic imaging - bunion, tailor's/surgery - treatment outcome

Work carried out at the Orthopedics and Traumatology Service of the Municipal University Hospital of Taubaté, Taubaté, SP, Brazil.

Publication History

Received: 09 January 2023

Accepted: 28 July 2023

Article published online:
05 December 2023

• Referências

• 1 Sponsel KH. Bunionette correction by metatarsal osteotomy: preliminary report. Orthop Clin North Am 1976; 7 (04) 809-819
• 2 Roukis TS. The tailor's bunionette deformity: a field guide to surgical correction. Clin Podiatr Med Surg 2005; 22 (02) 223-245
• 3 Martijn HA, Sierevelt IN, Wassink S, Nolte PA. Fifth metatarsal osteotomies for treatment of bunionette deformity: a meta-analysis of angle correction and clinical condition. J Foot Ankle Surg 2018; 57 (01) 140-148
• 4 Coughlin MJ. Treatment of bunionette deformity with longitudinal diaphyseal osteotomy with distal soft tissue repair. Foot Ankle 1991; 11 (04) 195-203
• 5 Ajis A, Koti M, Maffulli N. Tailor's bunion: a review. J Foot Ankle Surg 2005; 44 (03) 236-245
• 6 Bertrand T, Parekh SG. Bunionette deformity: etiology, nonsurgical management, and lateral exostectomy. Foot Ankle Clin 2011; 16 (04) 679-688
• 7 Michels F, Van Der Bauwhede J, Guillo S, Oosterlinck D, de Lavigne C. Percutaneous bunionette correction. Foot Ankle Surg 2013; 19 (01) 9-14
• 8 Isham SA. The Reverdin-Isham procedure for the correction of hallux abducto valgus. A distal metatarsal osteotomy procedure. Clin Podiatr Med Surg 1991; 8 (01) 81-94
• 9 De Prado M, Ripoll PL, Golano P. Cirugia percutanea del pie. Tecnicas quirurgicas, indicaciones, bases anatomicas. Barcelona (Spain): Masson, Elsevier; 2003: 129-148
• 10 Lara LCR, Ribeiro GA, Leite MS, Szulman S. Estudo radiográfico e morfológico de pés assintomáticos numa amostra populacional. J Foot Ankle 2011; 5 (01) 8-14
• 11 Delgado DA, Lambert BS, Boutris N. et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018; 2 (03) e088
• 12 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
• 13 Bishop J, Kahn 3rd A, Turba JE. Surgical correction of the splayfoot: the Giannestras procedure. Clin Orthop Relat Res 1980; (146) 234-238
• 14 Boyer ML, Deorio JK. Bunionette deformity correction with distal chevron osteotomy and single absorbable pin fixation. Foot Ankle Int 2003; 24 (11) 834-837
• 15 Castle JE, Cohen AH, Docks G. Fifth metatarsal distal oblique wedge osteotomy utilizing cortical screw fixation. J Foot Surg 1992; 31 (05) 478-485
• 16 Catanzariti AR, Friedman C, DiStazio J. Oblique osteotomy of the fifth metatarsal: a five year review. J Foot Surg 1988; 27 (04) 316-320
• 17 Friend G, Grace K, Stone HA. L-osteotomy with absorbable fixation for correction of tailor's bunion. J Foot Ankle Surg 1993; 32 (01) 14-19
• 18 Kaplan EG, Kaplan G, Jacobs AM. Management of fifth metatarsal head lesions by biplane osteotomy. J Foot Surg 1976; 15 (01) 1-8
• 19 Vienne P, Oesselmann M, Espinosa N, Aschwanden R, Zingg P. Modified Coughlin procedure for surgical treatment of symptomatic tailor's bunion: a prospective followup study of 33 consecutive operations. Foot Ankle Int 2006; 27 (08) 573-580
• 20 Redfern D, Vernois J, Legré BP. Percutaneous surgery of the forefoot. Clin Podiatr Med Surg 2015; 32 (03) 291-332
• 21 Del Vecchio J, Ghioldi M, Dalmau-Pastor M, Uzair A, Chemes L. Sliding Distal Metatarsal Minimally Invasive Osteotomy (S-DMMO) for the Treatment of Tailor's Bunion. Tech Foot Ankle 2018; 19 (01) 1 . Available from: https://www.researchgate.net/publication/323900819
• 22 Ferreira GF, Dos Santos TF, Oksman D, Pereira Filho MV. Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction. Foot Ankle Int 2020; 41 (07) 811-817
• 23 Lui TH. Percutaneous osteotomy of the fifth metatarsal for symptomatic bunionette. J Foot Ankle Surg 2014; 53 (06) 747-752
• 24 Laffenêtre O, Millet-Barbé B, Darcel V, Lucas Y Hernandez J, Chauveaux D. Percutaneous bunionette correction: results of a 49-case retrospective study at a mean 34 months' follow-up. Orthop Traumatol Surg Res 2015; 101 (02) 179-184
• 25 Lima AFV, Baumfeld TS, Braga BM, Baumfeld DS, Cordier G, Nunes GA. Minimally invasive bunionette treatment: clinical and radiographic results. J Foot Ankle 2020; 14 (02) 148-152