A bunion is an enlargement of bone at the great toe joint that can cause your great toe to touch, under-ride or over-ride the second toe. This deformity, if left alone, can often lead to debilitating pain and difficulty wearing shoes. Podiatric/Orthopedic Foot & Ankle surgeons have long used the tried and true method of surgical correction by using a bone cut known as an osteotomy to realign the bone to a more straightened position. This cut is then fixated with a screw and done in combination with appropriate soft tissue release to complete the surgical correction. These osteotomies have names to it, such as the common Austin to the Juvara (base wedge osteotomy). Other osteotomies that have been used are the SCARF, Logriscino, and Reverdin. All of these procedures have their own criteria on their use and often are used in conjunction with other procedures to fully correct the bunion. In severe cases, a joint fusion may be needed, which is a procedure called a Lapidus.

With any open procedure, there is some convelescense with it. In most of these procedures, patients can be weight-bearing immediately after with a protected walking boot or surgical shoe. Some will require almost 6 weeks of non-weight bearing with cast immobilization and crutches. As people's lives become busier, patients needing bunionectomies are looking for other alternative procedures to allow them to recover faster and return to work quicker. One company has taken that concept and developed a new device that not only will correct the bunion with minimal dissection, but offer a quicker return to work and activities. This device is known as the Arthrex Mini TightRope.

Here's the overview of the procedure: three small incisions are used. First incision is used in the first interspace to release the tight lateral structures. Second incision is medial right over the bunion and used to resect the medial eminence. Third incision is just lateral to the second metatarsal to allow tightening of the tight-rope. After releasing the lateral structures and resecting the medial eminence, appropriate drill holes into both the first and second metatarsals are prepped for insertion of the tight-rope. The tight-rope is then inserted and tightened to preference through the third incision. All incisions are closed and dressed. Protected weight-bearing for four weeks in a walking boot or stiff-soled surgical shoe. (Click here if you want to watch the video of the Arthrex Mini TightRope procedure.)

Sounds easy enough ... Makes sense to use the tight-rope device to pull the deformity back into the corrected position, right?

Early results show promise of this procedure due to its ease and quick recovery. My hesitation with this procedure is the long term effects. Will the tight-rope hold up long term with normal exercise? Will the rope lose its tension over time? More importantly, will the right-rope cause stress fracture in the second metatarsal at the thin part of the shaft? There are already documented patients that have had this complication and with not much relief of pain from the original bunion pain. Some have needed to convert to the open procedure to either remove the device and/or go to the traditional osteotomy.

I personally have not had much experience with the procedure. The concept of it makes sense, but my only reservation is the long-term effect and the potential issues with the second metatarsal. I still recommend to my patients the traditional osteotomy for the moderate to moderately severe bunion and use the fusion for the more severe bunions/revisional bunions. In my hands, these have given me excellent results with high satisfaction rate from my surgical patients. My advice is to speak to your surgeon regarding his or her expertise on this new procedure and make your own informed decision. Seek second or third opinions if necessary. Do what you feel is best for you.


-Dr. Peng has been with Advanced Foot & Ankle Center for more than 4 yrs. To make an appointment to see him or any of the other doctors in the group, please call 805-496-2383.