Youth are plagued by bunions too





Yes, I know, bunions are usually found in adults. But kids get them, too.

Devon, a 14-year-old high school freshman, had recognizable bunions as early as 9 years old. Her pediatrician told her to wait until she was an adult to do anything about them, so she and her parents tried to ignore them. The situation lasted for three years until Devon’s bunions began to hurt so much in soccer shoes that she could no longer ignore them. Devon’s mom heard about a procedure that we do in our office for these socalled juvenile bunions and, with the blessing of her pediatrician, came to our office for an appointment.

I had the pleasure of seeing Devon just before school recessed for the summer. I agreed that she had adult-sized bunions and I also agreed that for most bunion procedures we should normally wait until her bones were fully mature. But in our office Devon had one more choice: growth plate stapling. I explained the procedure to Devon and her mom that day (an explanation with photographs can be found on www.conejofeet.com), to her pediatrician a week later and we did the procedure on both feet earlier this morning.

In a bunion, one of the long bones of the foot, the first metatarsal, moves away from the other four. It can move so far that you can see the front head of the metatarsal bulge out the side of the foot behind the big toe. Devon had a large bulge or bunion. In an adult we simply make a surgical fracture in the neck of the metatarsal and move the bulge back toward the foot. For a variety of reasons we usually do not do this in children.

Metatarsals, like all long bones, have a growth plate at one end where the body grows new bone cells so the bone can get longer. The growth plate for the first metatarsal is at the opposite end from the head back by the base of the bone.

We have found that if you place a half-inch wire staple across one side of this growth plate you can slow the growth of that side of the metatarsal. For a bunion, slowing the inside of the bone growth causes the first metatarsal to move back into the correct position.

We try to gauge the time for the surgery so that we can get just the right amount of correction without any overcorrection. If we get complete correction and there is growth remaining we can simply pull out the staple to stop the correction before it overcorrects. In most cases we can just leave the staple in the foot and it causes no harm.

Devon is resting at home tonight and may be taking a pain pill or two but the pain is rarely anything more than mild. In two weeks she will be in tennis shoes and two weeks after that she may well be back on the soccer field.

It always amazes me how well these young adults do after surgery. This is such a great procedure that it has become a staple of our practice.

Zapf is a partner in the AgouraLos Robles Podiatry Centers with offices in Agoura Hills and Thousand Oaks. For information, call (818) 707-3668 or visit www.copnejofeet.com.


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