Modified Coughlin Procedure for Surgical Treatment of Symptomatic Tailor's Bunion: A Prospective Followup Study of 33 Consecutive Operations

Abstract

Background: Symptomatic tailor's bunion is a painful osseous and soft-tissue prominence at the lateral aspect of the fifth metatarsal head. If conservative treatment fails, surgery is necessary to correct the deformity and to relieve the symptoms. The “Coughlin” procedure is an established corrective diaphyseal realignment osteotomy. The purpose of this study was to analyze the results of a modification of the Coughlin procedure in a series of 24 consecutive patients. Methods: Between October, 1999, and August, 2002, we performed a modified Coughlin procedure for painful tailor bunions in 24 patients (33 feet). An additional bunionectomy was done only if the fifth metatarsal head remained prominent after the osteotomy (20 feet). The average age of the patients was 45 years. All patients were evaluated preoperatively and postoperatively using the AOFAS forefoot score, and the correction of the fourth-fifth intermetatarsal angle was assessed on full weightbearing dorsoplantar radiographs. The average followup was 24 months for objective and 39 months for the subjective results. Results: There were no intraoperative and postoperative complications. The mean AOFAS score increased from 55 points preoperatively to 95 points at followup. At longest followup the subjective results were rated as good or excellent in 22 patients (97%). No difference in subjective patient satisfaction was seen whether bunionectomy was done or not. The mean fourth-fifth intermetatarsal angle improved from 10.4 degrees preoperatively to 1 degree at followup. Six patients (18%) required screw removal which was carried out on an outpatient basis under local anesthesia. Conclusion: The modified Coughlin procedure is a technically safe and reliable procedure for treatment of painful tailor's bunion. In our experience, it yields good or excellent results with high patient satisfaction and a low complication rate. Internal screw fixation leads to stable bony fusion with full weightbearing immediately postoperatively and is associated with a relatively low rate of implant removal.