The syndesmosis bunionectomy


  In January of 2017, Dr. Doug and his daughter Molly (a pre-podiatry student) traveled to Hong Kong to visit Daniel Wu, a Canadian trained orthopedic surgeon.  Dr. Wu has been performing a unique bunionectomy surgery for over 20 years, and while his results are remarkable, the procedure has never really taken off in the United States.  What Dr. Doug witnessed was truly remarkable: postoperative bunionectomy patients, who had both feet operated on, were walking into Dr. Wu's office two weeks after surgery for their first postop visit!   Dr. Doug observed firsthand the surgery and follow up of severe bunions with this technique.

   Dr. Wu's procedure is a 'syndesmosis bunionectomy' that does not require cutting or breaking the bone, unlike almost all other bunionectomy procedures.  The metatarsal deformity is manually realigned and held in place with ultra high strength suture while the formation of a ‘new’ ligament between the metatarsals is facilitated with special 'fishscaling' techniques of the adjacent metatarsals and application of platelet rich fibrin. While walking is permitted from day one, it is necessary to avoid too much walking. There is a maximum # of steps per day that are allowed and a reduced rate of walking which are crucial for healing.  It is 4-6 months before running or brisk walking for fitness can be done.  

   This bunionectomy technique not only corrects the deformity with less surgical trauma, but returns the foot back to its 'anatomically normal' form in ways no other procedure involving bone cuts or fusions can.

   'Minimal incision' techniques are employed and foot swelling is much less than with traditional surgery.  

   Dr. Ichikawa will begin early trials of this surgery on select patients beginning in 2017.  It is his hope that this will quickly replace the traditional 'bone cutting' surgeries that are popular today. 

   Currently there is only one other surgeon worldwide performing this procedure, Dr. Dieter Fellner, of New York City. 

Here is his and Dr. Wu’s websites:




Is the syndesmosis bunion procedure for you? 

   While the syndesmosis bunionectomy procedure allows both feet to be done at one time and allows for immediate walking, certain restrictions will be placed on the patient's walking for 6 months.  If these restrictions are ignored, then complications like stress fractures of the metatarsals or recurrence of the bunion will occur.  This procedure requires strict adherence to postop protocols.  

   You will be required to have a Fitbit or activity tracker to help you limit your walking after surgery. 

   Bilateral procedures will not be performed by Dr. Doug for the first several months of his trials. 

   A forefoot cast will be utilized at two weeks after surgery for a total of 3 months.  This can be seen on Dr. Wu’s postoperative instructions at the bottom of this page.

   A postop shoe or short cam-walker boot will be required for 3 months. 

   Monthly visits and x-rays will be required for the first 6 months. 

   The use of platelet rich fibrin will be needed and may necessitate a surcharge to the patient of $200.  

   If the bunionectomy fails, no significant bridges have been burned and a traditional bunionectomy with osteotomy (bone cut) could be performed later.  

  Step requirements are as follows: 

                     Minimal walking the first month

                     3,000-5,000 steps per day at a slow pace for the 2nd month

                     3,000-5,000 steps per day at an average pace for the 3rd month. 

                     After three months your can increase your steps per day by 1000 each week.  

After four months you can walk unlimited steps in good athletic shoes.  

After six months there are no restrictions with shoegear or activity.