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Skin-Mediated Traction for Postoperative Bunion Correction Maintenance
Foot deformity correction procedures often encompass a variety of bone and soft tissue work. After undergoing bunion surgery, the surgeon will likely use splinting as part of the postoperative care to aid healing and maintain the corrected hallux alignment. The type of splint used can vary depending on surgical technique and surgeon preference.
In our observation, post–bunion surgery splints can serve several purposes, including:
Immobilization. Splints help keep the foot and hallux in a stable position, preventing excessive movement during the initial healing phase.
Support. Splints provide support to the surgically treated area, reducing stress on the operative site and promoting proper alignment.
Reducing swelling. Splints can help reduce pedal swelling, common after surgery, by maintaining alignment and limiting motion during the immediate post-operative phase.
Protection. Splints can protect the operated toe from accidental bumps or injuries during early recovery.
Maintaining alignment. Splints can help maintain the corrected alignment achieved through the surgery, potentially contributing to reducing bunion recurrence.
There are several discussions in the literature on splinting to maintain alignment after hallux valgus surgery. In a recent article, Lewis and colleagues described using a wooden tongue depressor placed along the medial border of the hallux for support.1 Their rationale was to provide rigidity and for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Certainly, we feel this method could be irritating to the patient and uncomfortable with weight-bearing and pressure to the area.
Donatto and colleagues suggested using a custom-molded thermoplast splint to maintain correction during healing of hallux valgus surgery.2 This could be a significant added cost for the patient. Commonly, surgeons rely on gauze and a rolled dressing to maintain correction, which may not provide enough rigidity as the dressings loosen and swelling subsides.
Maintaining Correction With an Innovative Splint
We suggest an alternative method for maintaining correction utilizing the Hemigard Interlock device (Suturegard Medical). Utilizing the this device for skin-mediated traction after bunion correction is rather intuitive and application is simple. Enclosed in a single package are 2-part adhesive strips, one hook strap and one loop strip. Following surgical correction, the longer hook strap is adhered to the medial hallux oriented from distal to proximal. In a similar fashion, the loop strip is adhered to the long axis of the foot along the medial plantar first metatarsal.
By pulling the hook strap and manually attaching it to the loop strip, the hallux position and medial soft tissue tension becomes offloaded, allowing the Interlock to splint the bunion postop. The differing zones of stiffness in the device allow disbursement of skin stress under tension without sutures, gauze wedges, or significant added cost. This technique usually supports correction for up to 3 weeks postop, is resistant to fluid interference (such as bleeding and showering) and is fully adjustable if desired.
In Conclusion
It’s crucial to provide instructions on how to use and care for the splint properly. This may include guidelines on when to wear the splint, how to keep it clean, and any adjustments during the healing process.
As with any medical procedure, it’s essential to have regular follow-ups with the surgeon to monitor healing and address any concerns or complications that may arise. Each recovery process can vary, so personalized care and guidance are crucial.
Dr. Butto is a Fellow of the American College of Foot and Ankle Surgeons and is in practice at Advanced Foot and Ankle Specialists in Avon, CT.
Dr. Graves is a Fellow of the American College of Foot and Ankle Surgeons and is in practice with Ascension Medical Group in Kokomo, IN.
References
1. Lewis LK, Chen J, Johnson CS, Adams SB Jr. Hallux valgus bunion splint: surgical dressing technique. Foot Ankle Spec. 2023 May 8:19386400231169376. doi: 10.1177/19386400231169376. Epub ahead of print. PMID: 37154096.
2. Donatto KC, Rightor N, D’Ambrosia R. Custom-molded orthotics in postoperative hallux valgus immobilization. Orthopedics. 1992 Apr;15(4):449-51. doi: 10.3928/0147-7447-19920401-08. PMID: 1565578.
