If you have a great toe that has deviated toward the second toe and you have a resultant bump on the inside of the foot, you probably have a bunion. This condition is called hallux valgus.
Hallux valgus is a deformity of the forefoot that is associated with foot pain and biomechanical problems with stance, walking and running. Hallux valgus can increase falls in the elderly and is a source of balance problems for others. It also makes wearing shoes difficult. Hallux valgus causes a decreased quality of life overall.
Options for Bunion Treatment
There are almost 400 different described ways to surgically treat this condition. The optimal choice is controversial and at this time, there is no consensus in the medical community on a universal.
One main way to categorize the different surgical approaches is to group them into minimally invasive or invasive procedure types. Minimally invasive surgeries were traditionally performed until the advent of the medical device industry. After that, more invasive methods were devised that required hardware to be implanted into the foot to hold a correction. Today, there is a resurgence of interest in the tried-and-true and very effective techniques of minimally invasive bunion corrections.
Minimally invasive surgery for bunions promises faster recovery, less infection risk and usually little to no scarring. Deformity correction is possible while damage to the surrounding tissues is limited. A recent meta-analysis looked at the current literature existing that compares invasive surgery against minimally invasive.
Invasive Surgery vs Minimally Invasive Surgery
In this study the radiographic outcomes, recovery times, complication rates, satisfaction rates and other factors were compared. For radiographic outcomes (X-Ray results), MIS surgery performed significantly better. The complication rates were found to be similar.
Recovery times were found to be similar as well unless one outlier study was removed; with the removal of this study the MIS group had faster recoveries. Satisfaction rates of the patients were also found to be closely matched between the two types of surgeries. However, when an outlier study was removed from the analysis the MIS group had higher satisfaction as well. Basically, the pooled results showed faster recovery and better satisfaction along with better radiographic outcomes for the MIS group.
J Lu et al. Comparison of minimally invasive and traditionally open surgeries in correction of hallux valgus: A Meta-analysis. The J of Foot and Ankle Surgery 2020; 59: 801-806
Why We Prefer Minimally Invasive Bunion Surgery – In Most Cases
Minimally invasive surgical techniques (MIS) for the correction of bunions are preferred, if possible, over invasive methods. MIS surgery for bunions are less damaging to the surrounding tissues. This preserves the blood supply to the bones, muscles and connective tissues. By preserving blood supply, healing is enhanced. Also, there is much less operative trauma to the tissues and the amount of healing required is reduced while the same effect is achieved.
MIS techniques can also reduce the amount of soft-tissue balancing required during such surgery. By limiting the amount of a lateral release of contracted tissues, there may be better post-operative motion as well. Scarring is almost absent after an MIS bunion correction. Not only is this better cosmetically, but also there is no tethering of the skin or adhesions to the scar that would limit motion or function after the surgery.
One thing to remember with MIS surgeries is that it is not always the best choice. Many patient factors and deformity parameters must be considered when deciding between an invasive surgery or a minimally invasive one. Larger and more severe deformities often require an open approach to the bone and the placement of stronger plates and screws. However, good surgical technique with MIS is still able to correct almost all deformities.
MIS bunion corrections allow for tiny incision to be made and a cutting device is used under the skin. Intra-operative live radiographs are taken during the procedure to guide the surgeon’s cuts. Once the bone cuts are made, the bones are then manipulated into the corrected positions and the case is completed. Some surgeons will utilize pins that are later pulled out in the clinic. Others will use percutaneous implants such as headless screws that are inserted over a guidewire. Still others will use no metal for position stability at all and will rely on post-operative dressings alone.
Our team here at Warner Orthopedics & Wellness are experts in MIS techniques for bunion correction. Our entire team is well-trained to handle this surgery and the post-operative rehabilitation to include specialized dressings and taping along with a proprietary physical therapy protocol.
If you are interested in this type of scar-less bunion surgery with fast recovery times, please come see us for a consultation.
