Foot and ankle surgery has lagged behind other disciplines in adopting arthroscopic approaches, but that is changing quickly with the advent of several “game-changing” techniques that offer much faster recovery times with no sacrifice of quality, according to Jonathan Kaplan, MD.

Kaplan recently joined Duke’s orthopaedic team, bringing years of unique specialized training in  minimally invasive foot and ankle surgery.

The procedure for treating hallux valgus is likely to spread the fastest with greatest impact because bunions are so common, says Kaplan, who was among the first surgeons in the country to train in and refine the technique when it was FDA-approved. Traditional open surgery requires large 2-to-8 cm incisions. In contrast, the new technique uses six tiny 2-to-3-mm “keyhole” incisions through which surgeons cut and re-align the bones. Specially designed screws fit inside the bones—where patients don’t feel them—to hold the bones in alignment.

“With the larger incisions, you have to lift up all of the soft tissues. That results in more pain and swelling, which translates to a longer recovery time,” Kaplan says. “These new incisions are so small we are not disrupting the soft tissues. Patients are able to walk immediately after surgery in a special post-operative shoe. Post-operative pain levels are lower, especially in the first 6 weeks, and patients require fewer narcotics.”

“Many patients have often avoided bunion surgery because full recovery can take a year, but I tell patients who have the new procedure that most can get back to their normal activities in three to six months,” Kaplan says.

A procedure that rivals bunions in shortened recovery time is Achilles tendon repair. Recovery from traditional Achilles tendon repair can be a year or even two, compared with four to six months for a minimally invasive approach.

In addition, Kaplan offers several other minimally invasive foot and ankle procedures that offer similar benefits compared with traditional approaches, including repairing hammer toes, Tailor’s bunions or bunionettes, and ankle ligaments as well as fusing bones.

Kaplan joins Duke as associate chief of the foot and ankle division as well as director of minimally invasive foot and ankle surgery. He will see patients in clinic at Duke Orthopaedics Arringdon and Duke Orthopaedics of Apex, and will offer surgery at Davis Ambulatory Surgery Center and Duke Regional Hospital.