Bunionplasty℠ (Aesthetic Bunion Surgery)

The Wall Street Journal features Dr. Blitz’ Bunionplasty℠ procedure (January 2013).

Dr. Blitz is the creator of the Bunionplasty℠ procedure, a cosmetic (or aesthetic) approach to bunion surgery where the incision is hidden on the inside of the foot regardless of the size of the bunion.

His techniques get patients back on their feet fast (without the need for casts and crutches) no matter the size of the bunion.  “Dr. Blitz created a plating system about a year ago that he says allows patients to put weight on the foot soon after surgery. The technique involves inserting a titanium surgical implant and six screws into the foot to hold the bone into proper position.”  – WSJ

What Is A Bunion?

Dr Neal Blitz Huff Po Bunion Blog Pic 1 FinalA bunion, (medical term: hallux abductovalgus) is a condition resulting in boney prominence at the inside of the foot at the big toe joint. A bunion occurs when the big toe begins to deviate toward the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While that may be true in very few people, the bunion really represents a dislocation of the big toe joint as it bulges against the skin.

Symptoms Of Bunions

Most patients complain of pain directly on the bunion area, within the big toe joint, and/or on the bottom of the foot. The bunion may become irritated, red, warm, swollen and/or callused. The pain may be dull and mild or severe and sharp. The size of the bunion doesn’t necessarily result in more pain. Pain is often made worse by shoes, especially shoes that crowd the toes. While some bunions may result in significant pain, other bunions may not be painful at all.


Causes Of Bunions

Hereditary and shoe gear are probably the most likely causes. Tight pointy shoes (and high heels) may promote the formation of a bunion. A bunion may develop rapidly or develop slowly over time. Some people have bunions in their teens while others only develop a bunion later in life.

Bunions come in a variety of sizes – from small to severe. In some cases, the big toe may push against the second toe, and may result in pain and a hammer toe, or progress onto a severe disfiguring foot deformity. Depending on your overall health, symptoms and severity of the bunion, the condition may be treated conservatively and/or with surgery.


When to Seek Bunion Treatment

Common reasons patients seek treatment for bunions are:

  • Bunion pain
  • Interference with walking/activities
  • Difficulty fitting shoes
  • Enlarging bunion
  • Pain at the ball of the foot
  • Unsightly appearance
severity scale

Non-operative Treatments for Bunions

Non-surgical methods for bunions are aimed at decreasing symptoms (i.e., pain and/or calluses) and/or limiting the progression into a larger bunion.

Simple treatments patients can do are:

  • Wear supportive shoes
  • Use an arch support
  • Wear shoes with a wide toe box
  • Modify activities
  • Spot stretch shoes

Non-surgical treatments Dr. Blitz can add:

  • Anti-inflammatory Medicines: Prescription strength medicines to decrease pain and inflammation.
  • Physical Therapy: To strengthen poorly functioning muscles and stretch tight muscles that may be exacerbating the bunion. Special ultrasound techniques may reduce inflammation.
  • Custom Foot Orthotics: Dr. Blitz creates am orthotic with an exact mold of your foot to better align and support the foot to ease current discomfort and prevent future progression.
  • Bunion Splints or Pads: Specific pads may prevent pressure and physical irritation in shoes. Bunion splints and toe spacers physically realign the big toe and can lessen pain and halt or stall bunion progression.
  • Injections: Cortisone injections are strong anti-inflammatory agents to decrease pain, and swelling directly at the bunion region. Injections only treat the symptoms.


Bunion Surgery (Bunionplasty℠)

Depending on the severity/size of a bunion, there are several methods to surgically correct a bunion. In general, the surgery involves removing any prominent bone (“shaving the bunion”) and realigning the deviated bones.

How Are Bunions Surgically Corrected?

Bunion Procedures Dr BlitzThe basis for bunion surgery (or bunionectomy) has classically been centered on the method with which surgeons use to realign the deviated bones. Bunionplasty (cosmetic bunionectomy) refers to the method with which the skin is handled (or managed) to limit scarring for a more aesthetic result.

While hundreds of bunion surgery operations have been described, surgeons generally correct bunions using one of two methods to realign the malaligned bones – they are bone cut (osteotomy) or bone mending (fusion).

  • Bone-cutting procedures involve creating a surgical ‘break’ (medically called an osteotomy) in the deviated metatarsal bone to realign only a portion of the bone. A variety of shaped cuts can be performed to treat varying sizes of bunions. Common surgical names for these procedures are Austin Bunionectomy, Scarf Bunionectomy, or Base Wedge Osteotomy. Dr. Blitz believes bone-cutting procedures are best for small or mild bunions.
  • Bone-mending procedures realign the entire deviated bone at the root of the problem, where the deviation originates. The name of this procedure is called the Lapidus Bunionectomy. Dr. Blitz typically recommends the Lapidus procedure for patients with moderate, large, severe or recurrent bunions.
postop dressing

Bunion Surgery Recovery
Recovery after bunion surgery generally depends on the method of surgery performed. In all cases, bone healing takes about 6 weeks in healthy people and there is no way to speed up that process. Patients often return to normal activities and shoe gear by 6 weeks to 3 months. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

Note: Dr. Blitz’ Bunionplasty℠ patients go home in a simple dressing isolated to the foot.  Dr. Blitz’ revolutionary techniques DO NOT use casting or large boots for any size bunion.



Walking After Bunion Surgery

Journal of Foot & Ankle Surgery Cover pageWalking after bunion surgery is strongly dependant on the method (procedure) surgeons choose to correct the bunion and the techniques used to stabilize the bones while they mend.

Dr. Blitz’ advanced techniques and protocols, published in the Journal of Foot & Ankle Surgery, have revolutionized bunion surgery because it allows patients bear weight immediately after surgery in a stiff soled surgical shoe.

  • Small or mild bunions: Nearly all surgeons allow for immediate walking in a stiff soled surgical shoe. This is because the technique for correcting a small bunion is relatively simple, and the pressure of walking is less likely to displace the correction.
  • Moderate to large bunions: Dr. Blitz’ developed a provisionally patented medical device that holds the bones steady during the healing process, which has allowed nearly all patients to bear weight on the foot immediately after surgery. This technique has been called the “Early Walking Lapidus Bunionectomy.” Historically, larger bunions called for casting and crutches, but Dr. Blitz’ techniques and protocol have allowed patients to get back on their feet fast (without the need for crutches or casting).


What Is A Bunionplasty℠?

Dr. Blitz is the creator of the Bunionplasty℠ procedure. A Bunionplasty℠ is a cosmetic (or aesthetic) approach to bunion surgery where special plastic surgery techniques are used to hide, minimize or limit incisions. As with any plastic procedure emphasis is placed on the visual appearance of the end result, and in the case of the Bunionplasty℠, involves both the skin aspect and how the bones are realigned.

It is important to have the proper bone realignment procedure, and not to sacrifice smaller incisions to achieve less scarring. Surgeons who specialize in Bunionplasty℠ can provide a both proper bone realignment while keeping incisions to a minimum or hidden.

The three types of skin procedures for Bunionplasty℠ involve:

  • Minimal Incision: Here small incisions are used to reach the bone. Dr. Blitz does not recommend this particular method for his patients because there is limited ability to manipulate the bones as they are poorly visualized, and therefore the bone correction is limited.
  • Hidden Incision: Rather than placing incisions on the top of the foot (like most bunion surgery, Dr. Blitz performs Bunionplasty℠ procedures on the inside of the foot. This way the incision is not visible when looking down on the foot. Additionally, the incision is strategically placed along the demarcation line where the skin from the top of the foot meets the skin on the bottom of the foot – a great place to hide incisions. Historically, only smaller bunions have been managed with this technique, but Dr. Blitz utilizes this technique for large and severe bunions where the incision is larger and uses the provisionally patented medical device he developed to hold the bone stable during the healing period.
  • Plastic Surgery Closure: Special plastic surgery techniques are applied to incisions on the foot the limit scarring for a more aesthetic result. Surgeons use deep sutures to hold the sin together, and run a fine suture within the most superficial layers of skin to keep the ends of the skin super close together so the incisions will be as minimally visible as possible. Dr. Blitz incorporates a plastic surgery closure into his Bunionplasty℠ technique.
Traditional Bunion Surgery vs Bunionplasty

Laser Bunion Surgery

While laser surgery is a popular approach for plastic surgery as its touted to have less scaring and improved recovery, it does not offer any advantage for bunion surgery. Laser is effective for soft tissues (not bone), and since much of bunion surgery involves properly realigning the bone, laser is not effective. For cosmetic approach, patients should look for surgeons experienced in Bunionplasty℠.



What Anesthesia Is Needed For Bunion Surgery

It is often outpatient surgery – this means you go home the same day. The surgery can be performed under a local, regional, spinal or general anesthetic. Local and regional blocks, with monitored anesthesia care are most commonly performed. This means that the foot will be numbed with an anesthetic, and an anesthesiologist will provide intravenous medications to relax and provide sedation (often referred to as twilight).

Is Hardware Implanted Into The Foot With Bunion Surgery?

Lapidus Plating SystemIn order for surgeons to fix your bunion, metallic surgical hardware is needed to stabilize the bone. Common hardware involves screws and a plate. Either surgical stainless steel or titanium is used.

Dr. Blitz’ commonly performs Bunionplasty℠ surgery using the titanium implant he developed in conjunction with a leading orthopedic device manufacturer. Dr. Blitz’ holds a provisional patent on the device. This product (Contours Lapidus Plating System – www.contourslapidus.com) is used by surgeons nationally because of its unique features, innovative design, and ability to get patients moving faster.

Surgically hardware can remain in your foot permanently. Some patients choose to have the hardware removed simply because they want it out, or if it is irritating the skin from underneath. Dr. Blitz’ innovative Lapidus Plate was designed to avoid irritating foot, and hardware removal is extremely uncommon.

What Are The Risks Of Bunion Surgery and Bunionplasty℠

There are general risks of bunion surgery (or any surgery) and the use of anesthesia. Complications may occur and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.

Bunion surgery complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, disability, recurrence, hallux varus, metatarsalgia, unsightly scar, stiffness, shortness of toe, weakness in big toe, hardware problems, need for revisional surgery, and/or catastrophic loss.

Why Choose Dr. Blitz As Your Bunion Surgeon?

  • Overall Experience: Dr. Blitz has over 12 years of major experience in the field. He is considered an international expert in bunion surgery.
  • Board Certification: Dr. Blitz is Board Certified in Foot Surgery and Reconstructive Foot Surgery by the American Board of Podiatric Medicine (ABPS).
  • Peer-reviewed and General Publications: Over that past decade Dr. Blitz has published dozens articles, case reports, and letters in scientific journals on a variety of topics. Dr. Blitz has published in the Journal of Foot & Ankle Surgery, Achieves of Plastic Surgery, Clinics in Podiatric Medicine & Surgery, Podiatry Today, Huffington Post and the Mount Sinai Journal of Medicine.
  • Lecturer: Dr. Blitz has a solid history of lecturing on bunion surgery.
  • Innovator: Dr. Blitz is an innovator for bunion surgery as he has holds a provisional patent of a commercially available medical implant (www.contourslapidus.com) that is used by surgeons throughout the country.
  • Internet Research: A simple method to learn about your surgeons professional activates outside of his/her website.
  • Patient Feedback: Please visit Dr. Blitz’s Patient Comments page, or his Facebook page.
  • In The News: Dr. Blitz has been on various media outlets as an expert in foot surgery. See Dr. Blitz on ABC news for bunions

Home Preparation Tips For Bunionplasty℠