The Center for Podiatric Care and Sports Medicine

Walk a Mini-Tightrope to Bunion Repair

Posted by on Thursday, April 19th, 2012


Bunions! And the bunionettes. Our old friends! Remember them? Well, just to refresh, a bunion is when the big toe is forced inward, creating a bony bump just below the big toe joint; a bunionette is when the little toe is forced inward, creating a bony bump, just below the little toe joint. Complications of bunions (and let’s just talk about bunions for clarity’s sake) include corns, calluses, blisters, hammertoes, and just plain ugliness.

Traditionally, there have been two options for bunion treatment. If the bunion is caught early enough, a person can try to correct them with cushions to protect them from irritation, wear orthotics that take pressure off the area, and choose shoes that give the toes plenty of room and keep them from being forced inward. The other option, for severe bunions that have progressed to an acute stage, has been a surgery known as an osteotomy bunionectomy, where the surgeon shaves down the bony bump, then cuts into the metatarsal and inserts pins to realign the bones so the toe is straight again.

The problem with the osteotomy bunionectomy is that the healing process is very long, with the patient not able to put any weight on the foot for a significant amount of time. In recent years, though, some podiatrists, including those at The Center for Podiatric Care and Sports Medicine (212.996.1900) have been using a less invasive procedure called the “mini-tightrope” that can cut down on the recovery time.

The mini-tightrope procedure involves using a thin fiberwire to connect the first metatarsal bone to the second metatarsal bone (anatomy review: the first metatarsal is the foot bone that runs up to the big toe, the second metatarsal is the foot bone that runs up to the second toe). Ideally, the fiberwire keeps the first metatarsal from bending out of shape by tying it to the second metatarsal, which has been able to remain straight. It’s sort of like the way podiatrists will tape a broken toe to the healthy toe next to it, to help it heal straight. After mini-tightrope surgery, patients should be able to put weight on their feet faster and the recovery period can be shorter than it is with the traditional osteotomy bunionectomy (read one mini-tightrope patient’s story here).

Are you still wondering why it’s called mini-tightrope surgery? Just picture it–the fiberwire forms a tiny, thin wire bridge between the first and second metatarsals. If you were shrunk down to half-half-half nano size and were part of a tiny circus, you could do a tightrope act there. There, a slightly disturbing image that I hope won’t keep you up all night.

In the past, the biggest risk associated with mini-tightrope surgery has been stress fractures in the second metatarsal, but improvements in the procedure have cut down on that. The key to avoiding problems with this type of surgery is to make sure you have it done by someone who has a great deal of experience doing mini-tightrope surgery. The podiatrists at The Center for Podiatric Care and Sports Medicine (212.996.1900) three years, since the inception of the procedure. With this type of experience, they can  cut down on the chances that there will be any complications from the surgery.

If you have bunions or any other foot problems and want to know what to do about them, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. GeldwertDr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet.



If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.