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Foot & Ankle Specialist
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Unilateral Versus Bilateral First Ray Surgery

A Prospective Study of 186 Consecutive Cases–Patient Satisfaction, Cost to Society, and Complications

Robert Fridman, DPM, AACFAS

Foot Associates of New York, New York, RFridmanDPM{at}aol.com, Department of Orthopaedic Surgery, Columbia University Medical Center, New York

Jarrett D. Cain, DPM, AACFAS

Reconstructive Foot and Ankle Surgery and Research, Weil Foot & Ankle Institute, Des Plaines, Illinois

Lowell Weil, Jr, DPM, MBA, FACFAS

Reconstructive Foot and Ankle Surgery and Research, Weil Foot & Ankle Institute, Des Plaines, Illinois

Lowell Scott Weil, Sr, DPM, FACFAS

Reconstructive Foot and Ankle Surgery and Research, Weil Foot & Ankle Institute, Des Plaines, Illinois

Thomas Brent Ray, CPed

St Francis Hospital and Medical Center, Hartford, Connecticut

Many studies have evaluated bilateral versus unilateral surgery in large joints, but limited research is available to compare outcomes of bilateral staged foot surgeries versus synchronous bilateral foot surgery. In total, 186 consecutive cases of first metatarsal-phalangeal (MTP) joint surgery were prospectively included in this study; 252 procedures were performed: 120 were unilateral or staged bilateral operations, and 66 were synchronous bilateral operations. Patients were evaluated at 6 and 12 weeks for specific early complications and surveyed about their return to work, activities of daily living, shoe gear requirements, satisfaction, and reasons for choosing staged or synchronous surgery. In addition, a cost analysis was performed on all surgical scenarios. Student t test showed no statistical significance between groups in all clinical settings to a 95% confidence level. Complication rates were similar and few in all situations. Patients were very satisfied when choosing bilateral synchronous surgery and would elect to repeat it the same way 97% of the time. The economic costs to the health system average 25% greater when patients undergoing first MTP joint surgery have the procedure performed one foot at a time. Combined with the time lost from work, this reveals a significant economic cost to both society and patient.

Key Words: hallux valgus • hallux limitus • bunion • bilateral foot surgery • surgical cost analysis

Foot & Ankle Specialist, Vol. 2, No. 3, 123-129 (2009)
DOI: 10.1177/1938640009335972
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