Kim is a 54-year-old female who presented to our clinic with a complaint of pain associated with her first and second toes. She had previous bunion and hammertoe reconstructive surgery which was performed by another physician. The procedure which was chosen by this physician to correct the bunion was a frequently used approach. This included a surgical fracture created in the end of the first metatarsal bone with shifting of the head toward the outside of her foot. This was held in place with cerclage wire. The big toe and the joint associated with it were then repositioned. The hammertoe was addressed by removing a portion of the bone at the middle of the toe and replacing it with a silicone spacer. A complication to the surgery resulted in over correction of the bunion. This is called hallux varus. The hammer toe remained painful and deformed.

After discussing different conservative options with Kim, we determined that surgical correction would be prudent to reduce pain and deformity. The chosen approach was a minimally invasive Akin osteotomy to the great toe as well as removal of the implant in her second toe. The Akin osteotomy is a surgically induced fracture in the base of the great toe. After the fracture is made, the toe is repositioned and splinted while it heals. The decision for this approach came when evaluating the quality of motion at the big toe joint. Kim had no pain with attempted range of motion of this joint. If a classic approach had been taken in reducing her postoperative deformity, not only would she not have been able to be back on her feet as quickly but she would have risked increased scar formation to the joint resulting in stiffness and continued pain.

Kim chose to go ahead with the recommended surgery. She had a fantastic surgical outcome. On the day of her surgery, Kim was able to bear weight and walk on her surgical limb. She had very minimal pain and swelling associated with the surgical site. The pain that has been associated with the deformities to her first and second toes was now resolved. She can fit into a normal shoe without discomfort. In fact, we are pleased to announce that she was able to walk without discomfort while wearing a dress shoe at her son's wedding.