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Jun 11, 2021

Bunions are fairly common problems in the United States affecting approximately 25% of the country's population. They can cause severe pain and discomfort, making it difficult to walk or perform many daily activities. I'm Hilary Topper. And this is Hilary Topper on Air. Today I have the pleasure of speaking with Jason R. Miller DPM, a foot and ankle surgeon at premier orthopedics in Malvern, Pennsylvania. He's going to discuss Lapiplasty® 3D Bunion Correction™, a relatively new procedure that uses special titanium plates to restabilize and secure the joint. Welcome to the show Dr. Miller.

Dr. Miller - Thank you.

Hilary - So can you tell us a little bit about yourself and your background?

Dr. Miller - So, I'm a doctor of podiatric medicine, meaning that I specifically specialize in below-the-knee surgery, but an ankle surgery, in the state of Pennsylvania. So my four years of training at Temple University Hospital was unique to basically performing foot and ankle surgery on adult and pediatric patients of all walks of life. So, unlike some other physicians that may specialize in foot and ankle, where they do a general residency and then do maybe a year of fellowship or worked with an ankle, my training specifically involved a foot and ankle surgery. So that's where my area of expertise lies.

Hilary - So talk with us about bunions what are they and how do they occur?

Dr. Miller - So most people assume that a bunion is actually just the growth of bone on the side of their foot. In reality a bunion is actually a bone deformity that's caused by an unstable joint. And that is what allows the big toe to begin to drift out of alignment. And then your tendons and ligaments. Sort of add in on the toe by pulling it over even further, once the toe begins to deviate against your second toe on the side. So it is a relatively progressive condition and certainly leads to a lot of discomforts and severe pain. Really, a lot of times patients come in and say, look, I've tried different shoes already. I've tried, you know, these variety of things. I'm having problems now. It was originally when I would run or exercise. Now they even hurt when I'm walking or just going to work on a daily basis. So, you know, the really scary thing about it is that really one in four Americans have bunions.

And that number can be much higher in certain other parts of the world. But here in the US that's the reality, it's about 25%. So it is a problem that we see more frequently in females, but, quite honestly, after doing as many labral classes as I have, I've seen quite a few men as well. And one of the reasons I think men tend to get away with the bunions deformities is men's shoes. You can get wider widths and you don't have the problems that women have where they try to go wide, then there's heels or something in the shoe and the Bunion, then, yeah, it becomes a problem, a friction problem for them. So those are kind of the little statistics and really the real thing that finance is now, why always thought that Bunions were a genetic thing.

Hilary - So you're saying it's not. Well, genetically,

Dr. Miller - You are prone to inherit one of your parent's bedsides so very frequently, and I've seen three generations in my practice, of patients where they all have almost identical types of feet. So mechanically you inherit instructionally or inherit a certain foot site. Whether or not that leads to a bunion or not depends on a variety of factors, how active they are, maybe what type of shoes that they wore early in life. But certainly the foot type itself that is inherent to a lot of Bunions is probably a genetic or inherited condition. But they certainly will develop outside of either one of your parents. Maybe neither parent had a Bunion, but you, the child may get it. So, there is a genetic factor to it. There's certain feet that are more prone to getting bunions and that's something that we'd certainly see and practice.

Hilary - So what are some of the options available for people who are looking to get rid of these Bunions?

Dr. Miller - Well, as I mentioned earlier, it's definitely something that some patients can manage quite well with padding or different types of shoes. And those things do work for some people. When those things fail to work with provide the relief that the patient needs, then we start talking about surgical options. So traditionally, one of the things that we've done in the foot and ankle world is performed what's called a 2d or a two dimensional or two plane type of correction. And that's essentially where we would cut the metatarsal bone somewhere in the middle or towards the head of the bone and then move it over and shave off the remaining portion while cosmetically that would oftentimes give the result that people were looking for. The problem was is that it wasn't a hearty long-lasting resolve because the instability really lies more proximal than that. Further back at the joint behind it. And by not correcting the instability there. That's what leads to a much higher rate of recurrence. What we've seen is that up 70% of patients who’ve had this traditional type of bunionectomy can experience a recurrence of their body. And they become unhappy not only with the cosmetic appearance but functional properties of the body and itself. And in some of these cases, these patients were off their feet for six to eight weeks with these surgeries before they were able to get back on it. So it's a unfortunate investment, the time investment for the patient that didn't lead to, uh, a long lasting result.

Hilary - So now you, you are now performing this Lapiplasty® 3D Bunion Correction™ surgery. Can you tell us what this is and how it works?

Dr. Miller - Yes. So the Lapiplasty® 3D Bunion Correction™procedure is, is based off a tried and true surgical procedure called the Lapidus, on the anatomy. So the concept here is based on a tried and true surgical correction that we've been using for, well, over 50 years. However, what this system does is it allows the surgeon to get a reproducible, consistent result. And correcting all three planes or that 3d dimension of the immune and getting that joint stabilized in a way that allows the patient to get back onto their feet much more quickly. So the system really is designed in a way that's very creative and basically allows the surgeon an almost robotic type of approach to performing it where we can get the same type of results. Every single time we do this. As opposed to some surgical procedures where there's a little factor, so to speak of trying to get things aligned. Three-dimensionally so what we see with this procedure with lapiplasty is that because of the fixation construct being so stable is that 97 to 99% of our patients maintain that 3d correction. A year or two, a year and a half later in the clinical trials that we looked at. So there are just under half a million bunny procedures performed every year in the US. And over 30,000 patients have currently been treated with 11 plasty procedures since it was FDA cleared in 2015.

Hilary - Wow. Well, before we move on, I just have to say I'm so appreciative of our sponsors and must take this time out to thank them. Please support our sponsors and tell them that you heard about them on Hilary Topper on Air special. Thanks to the Russo Law group, The Profit Express, Pop International Galleries, Gold Benes LLP, and the Pegalis law group.

Now back to you, Dr. Miller, we're talking about bunions and a treatment option called Lapiplasty® 3D Bunion Correction™. What are some of the benefits of this treatment option? Is it just, the recovery is quicker.

Dr. Miller - Well, the recovery is, definitely, quicker when we're talking about, on average in my patient population, about 10 days patients for weight-bearing in a boot. So this is a far cry from the six to eight weeks of being in the cast, that we used to do with this type of procedure. But I guess the other advantage of it would be the fact that the procedure really does address all three dimensions of the bone deformity that caused the bunion in the first place. And with, with it also doing that, it also has that lower recurrence rate of one to 3% in these, uh, 12 months to 17 month clinical trials that have been performed.

Hilary - Hmm. Interesting. I'm curious how people feel after the procedure. Can you share any case studies or success stories with our listeners?

Dr. Miller - Sure. I'd say probably, you know, one of the most remarkable quick recoveries is as a patient. I perform this procedure on a triathlete and she's a true warrior. She's in her sixties and finishes in the top of her age group consistently probably would beat a lot of, 30 year olds, triathletes. And she really struggled with it for a few years. And it was beginning to really significantly impact her ability to train about the only area where she could train without pain was swimming. So riding the bike was painful, running was painful. So we examined her. We did radiographs that determined that she was a good candidate for the lateral plasty and that she truly added a tri planar 3d bunion. So we got her corrected with the Lapiplasty® 3D Bunion Correction™ and six weeks post-operative, she began to go into sneakers.

Now, keep in mind, this was something where somebody was in a cast for six weeks, let alone getting into sneakers. And between six and eight weeks, she was running and zero gravity trainer, which you may see professional sports athletes where they have no special shorts and they're able to get into that treadmill situation and begin to run by taking off nearly all the body weight off their feet. And by week 9 to 10, she was actually getting onto pavement and training. And by week 12 she was beginning to train for a marathon. Again, I'm pleased to say that she finished in the top of her age group when she went back to compete, 5 months later. So it's a very rewarding experience not only for her, the patient, but for me, the surgeon, when you receive an email with her with a metal and, you know, pictures of her performing this race down Delaware shore.

Hilary - That is really awesome. I know so many people that suffer from these bunions and Lapiplasty® 3D Bunion Correction™sounds like a really great solution for them. So let me ask you something. How can people get in touch with you and learn more about Lapiplasty® 3D Bunion Correction™and even hire you to help them alleviate this?

Dr. Miller - Yeah, well, there's, there's certainly a bunch of resources. Check out There are fantastic computer-generated videos on there. So there's nothing gory that any patient has to see. Some people choose to find videos on YouTube that show actual procedures, but the website itself has really well-done computer-generated images that really provide the patient with everything they need to know. To make an appointment with me directly we do have our phone number, which would be (610) 644-6900 or you can visit our website to find more information, not only about Lapiplasty® 3D Bunion Correction™ but about myself as a physician and the other physicians in our group at Premier Orthopedics.

Hilary - Awesome. This was so informative. I really appreciate your time coming on. And thank you for sharing this information about Lapiplasty® 3D Bunion Correction™ us.

Dr. Miller - It's been my pleasure Hilary to join you today.

Hilary - Thank you. And I also want to thank our sponsors, The Russo Law Group, The Profit Express, Pop International Galleries, Gold Benes LLP, and the Pegalis Law Group. And last but not least, I want to thank you our listeners for tuning in each week. If you want more information on this show or any other show, visit our website at or you can find us on Spotify, iTunes, apple podcasts, Google Play, Amazon Alexa, you name it. We're out there. Have a great week and we'll see you next time.

Doctor is a paid consultant of Treace Medical Concepts, Inc.