1. The Hong Kong Chronicle

2. Non-Bone Breaking Alternative for Hallux Valgus
Surgery
A Biological Bridge to Restoration of Form & Function
A Challenge to the “Gold Standard”

3. Picture 1: In the OR with
Dr. Wu (left), Dr. Fellner (center)

4. In 2014, I travelled to
Hong Kong to meet with
Dr. Wu, Orthopedic
Surgeon, to learn the
unique syndesmosis
technique to correct
bunion deformity.

5. To understand, better, what
makes the syndesmosis unique,
let me recap the standard
surgical approach to bunion
surgery

6. When a patient has a painful bunion that requires surgery
a common approach is the osteotomy.
Bone is cut, shifted and fixated, with screws, plates or
wires, or a joint is fused e.g. the Lapidus procedure.
Figure 1: example of a typical osteotomy

7. The problem with conventional,
‘bone breaking’ bunion surgery:
• Bone is not truly deformed
• The surgery creates a
deformity in the bone, in an
attempt to correct a
displacement of bones
• The displacement is the result
of ligamentous loosening
causing the metatarsal to
lean.

8. Would it not be much better if the normal anatomy of the foot is
restored?
Dr. Wu believes so. He uses a syndesmosis technique. This is also sometimes referred to, in the literature as, as an
osteodesis.
How it works:
• The first metatarsal is re-positioned using sutures. This is a cerclage technique that provides temporary
correction.
• Permanent correction is from the induction of a biological bridge, composed of fibrous tissue.
• After this material has formed the anatomically correct first metatarsal position is permanently maintained

9. Pre-Operative Post-Operative
Courtesy of Dr. Wu

10. The Syndesmosis Procedure: Does it work?
Dr. Wu has performed over 1400 procedures. I was fortunate to follow his
patients in his office, and to learn the technique in the operating room. The
outcome is impressive.
In addition to correcting the bunion I observed the benefit of 1st metatarsal
stabilization:
• 1st metatarsal-phalangeal joint motion consistently 80-90 degrees
• Joint motion has a very natural, flexible feel on examination
• Lesser metatarsalgia is consistently eliminated
• Plantar forefoot callus vanishes, or is significantly ameliorated
• Flexible lesser toe deformity is reduced
Without additional surgery

11. This is a very brief overview
Please see the reference list for additional information
Contact: dieter.fellner@gmail.com

12.  Cape, L. R. I. J., 1999. Intermetatarsal osteodesis: a fresh approach to hallux valgus. The Foot,
Volume 9, pp. 93-98.
 Botteri G, Castellana A., 1961. L'osteodesi distale dei due primi metatarsi nella cura dell' alluce
valgo. La Clinica Ortopedica, XIII(Fasc 1), pp. 39-46.
 Daniel Yiang Wu, 2007. Syndesmosis Procedure: A Non-Osteotomy Approach to Metatarsus Primus
Varus Correction. FOOT &ANKLE INTERNATIONAL, 9.pp. Vol. 28, No. 9, pp 1000-6.
 Wu D, 2006. A Non Osteotomy Technique for Hallux Valgus Correction. Hong Kong J Ortho Surg,
10(1), pp. 34-38.
 Pagella P, Pierleoni. G., 1971. Hallux Valgus and Its Correction. A Technique That Deserves To Be
Better Known Instituto Ortopedico Toscano, 1(55).
 Wong DW, W. D. M. H. L. A., 2014. The use of a syndesmosis procedure for the treatment of hallux
valgus: good clinical and radiological results two years post-operatively. Bone Joint J. , Volume 96-
B(4), pp. 502-7.
 Wu DY, L. K., 2014. Osteodesis for Hallux Valgus Correction: Is it Effective?. Clin Orthop Relat
Research, p. October 28.
 Wu D, Lobo L, 2010 Does Wearing High Heeled Shoes Cause Hallux Valgus? A Survey of 1,056
Chinese Females, Foot & Ankle Online Journal 3: (5) : 3

13. The 20th century economist John
Maynard Keynes once described the
"gold standard" as "a barbarous relic"
and noted "the difficulty lies not so
much in developing new ideas as in
escaping from old ones”
http://en.wikiquote.org/wiki/John_Maynard, n.d.