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Multiple Services With A Single Focus: Your Success © Copyright 2014. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved. 4040 Embassy Parkway, Suite 100 • Akron, OH 44333 Martha Bethea • Ronald Pavlovich 330.668.6500 • www.cbiz.com n Efficiency reengineering n Financing structure and negotiations n Reimbursement methodologies – risk sharing – bundle payment n Structure for related businesses n Medical practice merger, acquisition, integration n Financial statement preparation and analysis T HE HALLUX VALGUS, or bunion deformity, can result in pain as well as a compromise of either function and/or gait stability in the geriatric patient. Choosing the best procedure for deformity correc- tion in this patient population can be challenging. Realignment osteotomies performed around the great toe joint are common in the younger patient. However, these procedures require adequate bone stock or density for good hardware purchase as well as a period of zero or minimal weight-bearing on the foot to allow the surgically-repaired bone to heal together in the corrected position. Often bone quality and/or the strength needed to protect the operated foot during recovery is compromised in the older patient. Thankfully, other corrective options exist for this patient group. The first option is a resection arthroplasty with or without joint implant. This involves removal of the base of the great toe phalanx and a relatively short healing period of two to three weeks, during which the patient fully bear weight on his or her foot. While realignment of the great toe joint is possible with this procedure, the great toe can often be unstable during gait. If the overall activity level of the patient is low, then this procedure may be appropriate. The second option is a great toe fusion. This joint-elimination procedure provides the more active geriatric patient with a very stable great toe for gait. In fact, Yu wrote extensively about the corrective and stabilizing power of the appropriately positioned great toe fusion. 1 Finally, given that modern fixation devices, such as locking plates, span the joint fusion site with multiple points of bone engagement, early weight-bearing, even in patients with some degree of osteoporosis, is very realistic. Dr. Jeffrey Whitaker is Board Certified in Foot and Ankle Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor-Podiatric Surgery at Kent State University College of Podiatric Medicine in Independence, OH. 1. Yu GV, Gorby PO. First metatarsophalangeal joint arthrodesis. Clin Pod Med Surg. 21(1): 65-96 (2004). ■ by Jeffrey M. Whitaker, DPM, FACFAS in the Geriatric Patient of ++++++++++++++++ +++ + +++ + ++++++++++++++++ PODIATRY Surgical Management Hallux Valgus 2 0 1 5 M A R C H /A P R I L ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 3