New techniques employed at WVU Medicine make use of the latest technology to correct the long-time bane of the human foot: bunions.

Treating bunions can be as simple as taking over-the-counter pain medications, applying pads to the affected area, or wearing flat, comfortable shoes. Sometimes these conservative measures are not enough. If severe pain persists despite wearing sensible, wide toe-box shoes, or if the deformity of the big toe starts affecting the small toes (causing hammertoes), surgery might be needed.

This is where a new bunion procedure known as Lapiplasty is gaining popularity. According to Dr. Santrock, this surgery is designed to address the problem in ways very different from methods employed during the past 100 years or so. These older surgeries were often done on the presumption that bunions were external growths rather than internal bone deformities. 

"The surgeries have been traditionally designed to either shave off what is perceived as a bump, not addressing the malalignment, or to correct the alignment in sort of a ‘cheating way’ — by cutting and shifting the bones just so it can look like the bump goes away," he explained. "That method of surgery is non-anatomic, meaning they're not putting bones back in the correct position. They're just shaving or cutting the bones to make them look straight on the outside, when on the inside the bones are really crooked, and there is the problem. Leaving the bones in the wrong position makes the bunion come back."

On the other hand, Lapiplasty is anatomic, so the bones are realigned back into their natural position. New technology, including weight-bearing three dimensional CT scanners, allows physicians to see the shape and alignment of the bones during the repair process, leading to better outcomes for their patients.

Santrock said the original surgery to repair bunions, the Lapidus procedure, pioneered by Dr. Paul Lapidus in the 1930s, did not incorporate the same bone rotations as the newer Lapiplasty. As a result, the procedure was more primitive and extremely challenging.

"I teach hundreds of different types of procedures to orthopaedic surgery residents every year, and in my 16-year career, the one procedure I would not let a resident do is a Lapidus procedure because it was technically very challenging," he said. "We wanted it (Lapiplasty) to be a reproducible technique with all corrections done before any bone cuts were made so you would be less likely to make a mistake."

Another perk of Lapiplasty is that it allows immediate weight bearing for the patient. Santrock said that wasn't the case with the Lapidus procedure; patients had to be in a cast or on crutches for three to four months, which is extremely inconvenient, particularly for working-age patients and those doing physical labor.

Santrock and his team at WVU Medicine has helped to design hardware that is somewhat flexible with the bones themselves, allowing healing of the bones post-surgery while the patient is weight-bearing. Santrock said this fine-tuned hardware cannot be found at other institutions in the region. However, WVU-trained physicians in Huntington will soon be offering it as well.

Santrock, along with three other foot and ankle surgery experts, designed the hardware and instruments and developed the patented procedure. Lapiplasty has been utilized at WVU Medicine since late 2015.  

He has taught many surgeons around the nation, and now there have been several thousand Lapiplasty procedures performed with revolutionary results. The data shows a 96.7 percent success rate, even with immediate weight bearing right after surgery. 

What's more, Santrock said most bunion surgeries such as Lapiplasty are covered by most health insurance policies since it's a mechanical deformity of one's foot.