Bunion Correction: "Rotation, Rotation, Rotation!”
Unless you’ve been under a rock, you've heard, "rotation, rotation, rotation" when it comes to hallux valgus correction.
But, does it really matter?
We simply don’t know. Proponents argue true anatomical correction will allow for long-term maintenance of correction, better function, and a lower rate of complications. The counter argument, if hallux valgus correction has been done for 100 years without de-rotation, then what's really the issue?
In their study "Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux Valgus," Matthew Conti, MD, et al. show for the first time coronal rotation correction in 39 consecutive patients who underwent a modified Lapidus procedure was associated with improved patient reported outcomes and reduced recurrence rates.
Specifically, PROMIS scores at a minimum of two years on postoperative weightbearing CTs were significantly higher by 7.2 points, with reduced loss of first metatarsal rotation.
Let's Think Bigger Picture
If coronal rotation does matter, then the next question becomes: Does it matter where it's done – distally via MIS bunion correction or proximally with first TMTJ fusion?
Food for thought.