Ludloff Osteotomy for Moderate-To-Severe Bunions

Sometimes surgery is needed to correct a condition called hallux valgus, otherwise known as bunions. With good results, the patient has reduced pain and improved function. The toes are lined up better. The foot has a more pleasing look cosmetically.

One popular method for repairing this problem is the Ludloff osteotomy. Dr. K. Ludloff reported the first results using this technique more than 100 years ago. The first intermetatarsal angle is corrected by cutting a portion of the main bone in the big toe and rotating it back toward the foot.

The procedure has been modified over the years. The incision is now made along the inside medial portion of the foot (instead of along the bottom of the foot). The new approach includes the use of two screws to hold the bone in its new place. The use of hardware to hold bony parts together is called internal fixation.

In this study, the intermediate-results of a modified Ludloff osteotomy were reported. The operative technique was described in detail with drawings and X-rays to show the steps in the procedure. There were 125 feet having bunion surgery included. All patients had painful bunions and a first metatarsal angle of 15 degrees or more.

Results were reported using before and after measures of function, motion, and X-ray results of alignment. Two age groups were compared (over 60 years, 60 and younger). Using 60 as the dividing point for age between the two groups was arbitrary and not used because of some significant factor.

The authors report that both groups reported pain relief and improved function. They were pleased with how the foot looked cosmetically. The use of pain relievers and antirheumatic drugs was decreased for 86 per cent of the patients by the end of four weeks.

Overall, younger patients had a better outcome compared to the older adults. They were more likely to form a healing callus at the surgical cut on the bone. The callus is a combination of cartilage and bone cells. These two new tissues grow in size until they cross the gap in the two bones.

Older adults took longer to heal. Delayed union with a gap in the bone at the osteotomy site was more common in older patients. As a result of this study, the surgeons advise using X-rays early on after the operation for the older patients. This step will help evaluate the healing process.

Anyone with low bone mass should avoid putting full weight on the operated side until callus formation is seen. Weight bearing is avoided until enough bone callus is seen at the surgical site.

Reference: 

H. - J. Trnka, MD, et al. Intermediate-Term Results of the Ludloff Osteotomy in One Hundred and Eleven Feet. In Journal of Bone and Joint Surgery. March 2008. Vol. 90. No. 3. Pp. 531-539.

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