What is it?
Minimally invasive or key hole bunion surgery involves correcting the alignment of the first metatarsal and hallux through small 2-3mm stab incisions, rather than a single open incision. The main advantage being, that there is less soft tissue dissection, with the potential benefits to the patient of, less pain, quicker healing of soft tissue and faster overall recovery.
Unlike other bunion operations where you need crutches and can only heel weight bear, with key hole surgery, weight can be placed on the foot from day 1. In some cases, no stitches are needed. This along with less swelling means a more rapid recovery and less down time.
Is key hole appropriate for every bunion ?
No. Each patient needs careful evaluation, both clinically and with X-rays. Some bunions are associated with hypermobility or flat feet, which may also need correcting. A significant proportion of patients with the condition will be suitable. Even more severe bunions can be treated, due to the amount of correction that can be achieved.
Will screws be placed in the foot ?
Yes. The bone is broken using special burrs and repositioned. Screws are placed in the metatarsal and where required in the big toe. The screws and specially designed for key hole surgery and shaped to fit the bone. This means less chance of needing to remove them.
Is there less scaring ?
Yes. As smaller incisions are used, scarring is much less. Some people react by forming hypertrophic scars, but the risk of this is much less with key hole.What are the risks?
What are the risks ?
Short term risks include; infection, swelling, numbness and DVT (which is rare). Although less general swelling can be expected, Initial elevation of the limb in the first 2 weeks reduces swelling further. Long term risks: poor bone healing, chronic swelling, Mal position, stiffness and recurrence.
How effective is the surgery?
In a critical review of the literature, key hole surgery has similar outcomes to traditional open surgery. Trnka et al: Minimally invasive hallux valgus surgery: A critical review of the evidence, International Orthopaedics 2013 Sep; 37(9)
What tests should I request?
X-rays are the best imaging modality to request.
Standard views
Dorso-plantar (DP) weight bearing. This view provides the best evaluation of the deformity.
Lateral view weightbearing. This view provides information about the alignment of the hindfoot which may be affected by the condition
Medial oblique (MO). This view provides information about the joint spaces, the metatarsophalangeal joint, especially when evaluating osteoarthritis.
Do all surgeons perform this procedure?
No. The technique requires special training to perform.
About Consultant:
Antony N Wilkinson MSc, FCPodS, Consultant Podiatric Surgeon, please click here to visit profile.
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