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BUNIONECTOMY PROCEDURES ARE one of the most common surgica l pro- cedures performed by podiatrists and other foot/a nkle surgeons. There a re cu r rent ly 100+ su rg ica l procedu res described in the medical literature aimed at cor recti ng t he bu n ion defor m it y. Interestingly enough, the bunionectomy procedure rarely becomes the seasoned foot/ankle surgeon's favorite procedure to perform. This is due in large part to the technical precision of the procedure, as well as the relative unpredictability of outcomes. Until recently, most bunionectomy procedures centered around first meta- tarsal osteotomies and some level of soft tissue re-balancing around the first MPJ. These procedures were primarily aimed at correcting the obvious transverse and sometimes sagitta l pla ne deformities that are easily eva luated with standard plain-film radiography of the foot. It is now known that the bunion deformity is a tri-plane deformity, with significant amounts of coronal plane involvement. 1 Surgeons a re now rea lizing that the traditiona l metatarsa l osteotomy pro- cedures are not correcting the apex of the deformity, but are instead deforming the f irst metata rsa l in a n attempt to "ožset" the rea l deformity (Fig. 1). A paradigm shift has been noted in the specialty, in an attempt to address this concern. Many surgeons now recognize the significant impact of first metatarsal pronation/external rotation on the devel- opment of a bunion deformity. Because of this, the aim of bunionectomy procedures has transitioned to correction of the apex of deformity, which is typically located at the first metatarsal-cuneiform joint. The f irst met-cuneiform a r throdesis, or Lapidus Bunionectomy, is the procedure of choice for addressing the apex of the HAV deformity (Fig. 2). This procedure a llows for tri-pla na r correction, a nd potentially more predictable and longer lasting results. There are downsides to the Lapidus procedure. This is a technically more challenging procedure, especially for the novice surgeon. Usually, a more prolonged non-weight bearing period is required in the post-operative phase for patients, and the inherent risk of non-union and poten- tia l rev isiona l surger y a re noted a s compared to traditional distal metatarsal osteotomy procedures. All of these factors are currently being studied and debated amongst the foot/ankle community. Dr. Duane Ehredt is board qualified in Foot and Reconstructive Rearfoot/Ankle Surgery by the American Board of Foot and Ankle Surgery, and an Associate of the American College of Foot and Ankle Surgeons. He is an Assistant Professor in Foot and Ankle Surgery at Kent State University College of Podiatric Medicine in Independence, OH. ■ Reference 1. Dayton , P., Kauwe, M., and Feilmeier, M. Is our current paradigm for evaluation and management of the bunion deformity flawed? A discussion of procedure philoso- phy relative to anatomy. J Foot Ankle Surg. 54: 102-111. 2015. BY DUANE J. EHREDT JR., DPM, A ACFAS 1 6C L I N I C A L S E C T I O N : P O D I A T R Y BUNION SURGERY: Are We Really Straightening Out the Problem? Figure 1 Figure 2 1 6