Minimally Invasive Bunion Surgery

Surgery of the bunion can be complex. While it may seem that a quick shave of bone would do the trick, it is much more complicated than that. Surgery has evolved a lot, especially in the past 5-10 years regarding bunion surgery. The shave has never really worked as it doesn’t address the underlying deformity, thus, after time the bunion returns. There are numerous ways to fix a bunion and not all are successful. Probably the most widely used is the Chevron or Austin bunionectomy. This simply involves shaving the bump, cutting the bone near the neck and shifting it over to improve alignment. This was the gold standard for quite some time. However, we have since found that this did not line up the biomechanics of the foot properly it has led to a high incidence of recurrence.

Today we are seeing a lot of fusions, while great, they are also fusions and require a lot of healing time. Fusion of the great toe joint is a powerful bunion procedure but is typically reserved for bunions with severe arthritis in the joint. By addressing this joint we eliminate the bunion and the pain associated with the arthritis. There is also the Lapidus, or Lapiplasty technique which involves fusing the joint in the midfoot. This surgery anatomically realigns the foot, leaving to a more anatomic function and correction of the bunion. However, these are typically more invasive and can cause more pain and longer recovery. The risks of this surgery are non-union (the fusion site fails to fuse together) and ongoing pain and swelling of the foot. When done correctly these are very good procedures and can almost eliminate any chance of the bunion coming back.

Then there is MIS or minimally invasive surgery. Minimally invasive means small incisions, true minimally invasive means no hardware. MIS is slowly becoming more and more popular as patients are opting out of plates and screws for faster recovery. While MIS doesn’t guarantee the bunion never comes back (really none of the procedures can) it does reduce the bunion and makes the foot more anatomically correct. Today, MIS is being touted as big cuts and shifts done through small holes and then a 2nd or 3rd small hole is made to place long screws across the bone cut to stabilize the cut. It’s almost like placing rods down the bone to hold it together. While effective, it is often very intimidating on x-ray.

At Elite we use minimally invasive without hardware. For bunions this is sometimes referred to as a keyhole bunionectomy. This involves a small stab incision <3mm near the bunion deformity. Using a bur that has low speed but high torque, the bur cuts bone but will not entangle the soft tissue. This is all done under x-ray without large incisions. The bone is shaved and a small cut is made in the bone to shift it and reduce the malalignment at the great toe joint. Next, if needed, a 2nd small incision is made in the big toe and a similar cut is made in the bone of the great toe. By doing these two small cuts, most bunions can be fixed and without screws or plates. The bandaging of these surgeries is pretty intense and needs to be changed frequently as it is the bandages that are what holds the foot in the position we want it to heal in. Typically, no pain meds are required and you can walk almost instantly in a boot following surgery. Here is the real catch, MIS surgery without screws or plates can be done in office. No hospital bill, no facility fees, no radiologist or anesthesiologist bills. We perform these surgeries in our Portland location and we have x-ray and all the equipment needed. If you feel uneasy about no anesthesia, we can arrange for a mobile anesthesiologist to come in to help you feel calm and relaxed. If you would like to learn more about MIS call our office and schedule an appointment. Other surgeries that can be done via MIS are hammertoes, plantar fasciotomy, Tailor’s bunions and other forefoot stabilization procedures. Dr. Haynes has trained from the founders of MIS (they have been around since the ‘80’s) and has attended numerous seminars and courses on MIS.

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