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QUERIES (CLINICAL)

05/07/2012     




Query: Marfan's Syndrome and Bunions

I have a 32 y/o female with Marfan’s syndrome. She had cardiac surgery as a child. Her mom had Marfan’s and also had horrible bunions. Her foot presents with a routine bunion deformity. IM angle 16, HA 28, 1st MTPJ ROM-normal no crepitus, moderately pronated foot with a mild increase in talar declination but a normal calcaneal inclination. Gait shows fairly standard late midstance pronation, no equinus or early heel-off. She does have some hypermobility/ligamentous laxity in her wrists, but her midfoot is fairly stable.

Radiographically, this case is solidly within the parameters for a neck osteotomy. The question is: because of her ligamentous laxity, should one consider a more stable procedure? The procedure that would give her the best chance of never having to have surgery again would be a fusion. With normal joint space and no crepitus, should this be done? Is an STJ arthroeresis an option? How about just a standard Austin? 

Tip Sullivan, DPM, Jackson, MS