Advances in Surgical Interventions for Aging Patients with Bunions

Hallux valgus, more informally known as a bunion, is an incredibly common condition that impacts almost 25% of American adults.1 Though bunions are often recognized by patients as a large bump on the side of the big toe, they are far more complicated internally. The deformity occurs due to bones in the mid-foot sliding out of alignment and can lead to a marked decrease in quality of life, including debilitating pain and loss of physical activity.2

Bunion prevalence increases with age, even though any person can develop them regardless of lifestyle.3,4 Recognizing this prevalence is especially important in the case of patient safety, as bunions are associated with a decrease in gait and balance and are considered an independent risk factor for falls in older adults.5,6

Initial recommendations from physicians typically consist of nonsurgical interventions, including changes to footwear, usage of medication to help manage pain, icing the affected area, and even padding and usage of specialized soles. If nonsurgical approaches fail to alleviate pain and discomfort, a patient suffering from bunions may require surgery.7

For both patients and physicians alike, surgery is often seen as a last resort due to long recovery processes and highly variable outcomes associated with treatment options of the past.8 In addition, increased age is linked to a greater risk of surgical complications due to higher rates of comorbidities and longer recovery times. However, advancements in medical technology have expanded surgical options for older patients suffering from bunions.

Some procedures address the root cause of bunions through tri-plane correction, correcting foot deformities in the sagittal, coronal, and transverse planes.9 In the case of severe bunions, some surgeons opt to utilize tri-planar first tarsometatarsal (TMT) arthrodesis, where the joint is fused to help provide stability, improve cosmetic appearance, and correct the deformity. Traditional Lapidus fusion, in comparison, also involves fusion of the first tarsometatarsal joint, but does not take all 3 planes into account. Multiple studies found that patients who underwent the triplanar-first TMT arthrodesis procedure had recurrence rates between 1-3%.10,11,12 While reducing rates of recurrence is beneficial to all patients, it is imperative for older adults to minimize elective surgeries, when possible

In the case of older patients with less severe bunions, particularly those at higher risk of surgical complications, minimally invasive surgeries (MIS) may be considered a more suitable option. The principles of tri-planar correction have been applied to metatarsal osteotomy, where the bone is cut and realigned. Because the incisions made are smaller, there may be a reduced chance of scarring and a faster recovery time, with most patients being able to return to their daily activities within approximately 4 months post-operation.

Geriatric patients suffering from bunions have more options in the case that surgical intervention is needed. Expanded treatment paradigms and improvements to minimally invasive techniques have made surgery more accessible for older adults suffering from adverse changes to their lifestyles. These advancements may help contribute to maintaining mobility and independence in the aging population.

References

1. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010;3:21. Published 2010 Sep 27. doi:10.1186/1757-1146-3-21

2. Bunions. American College of Foot and Ankle Surgeons (ACFAS). https://www.foothealthfacts.org/conditions/bunions. Accessed May 12, 2025.

3. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010;3:21. Published 2010 Sep 27. doi:10.1186/1757-1146-3-21

4. Bunions. WebMD. https://www.webmd.com/skin-problems-and-treatments/understanding-bunions-basics. Accessed May 12, 2025.

5. Sadra S, et al. J Am Podiatr Med Assoc. 2013 Nov-Dec;103(6):489-97.

6. Fleischer A, et al. J Foot Ankle Surg. 2021 Dec 4;61(4):798–801.

7. Bunions. American College of Foot and Ankle Surgeons (ACFAS). https://www.foothealthfacts.org/conditions/bunions. Accessed May 12, 2025.

8. Pentikainen I, et al. Foot Ankle Int. 2014 Dec;35(12):1262-7.

9. Ray JJ, Koay J, Dayton PD, Hatch DJ, Smith B, Santrock RD. Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing. Foot Ankle Int. 2019;40(8):955-960. doi:10.1177/1071100719847700

10. Liu GT, Chhabra A, Dayton MJ, et al. One- and Two-Year Analysis of a Five-Year Prospective Multicenter Study Assessing Radiographic and Patient-Reported Outcomes Following Triplanar First Tarsometatarsal Arthrodesis With Early Weightbearing for Symptomatic Hallux Valgus. J Foot Ankle Surg. 2022;61(6):1308-1316. doi:10.1053/j.jfas.2022.04.008

11. Dayton P, Carvalho S, Egdorf R, Dayton M. Comparison of Radiographic Measurements Before and After Triplane Tarsometatarsal Arthrodesis for Hallux Valgus. J Foot Ankle Surg. 2020;59(2):291-297. doi:10.1053/j.jfas.2019.08.020

12. Shah M, et al. Foot Ankle Spec. 2024 Aug;17(4):352-357.