The bunion on the woman’s left foot was so large that she had to increase her shoe size. It was so painful that she had great difficulty making it through her nursing shifts. She had resisted surgery because of the experiences of others: Her sister had been non-weight bearing for four weeks; a co-worker couldn’t bear weight for six weeks postoperatively and had resorted to using a scooter.
But she clearly needed treatment when she presented for evaluation by Duke foot-and-ankle specialist Selene G. Parekh, MD, MBA. Parekh told her that she would be a good candidate for a new minimally invasive technique for bunion surgery.
Traditional open bunion surgery requires two incisions of 30 to 50 mm and cutting through soft tissues such as the capsule in order to access the bone, shave it, and emplace plates and screws.
But breakthrough equipment that cuts bone without damaging surrounding soft tissue enables a new minimally invasive approach. Using this technique, Parekh makes five small, strategically placed incisions of only 3 to 4 mm in length around the big toe. Guided by fluoroscopy for real-time radiographic imaging to pinpoint the surgical field, these minuscule incisions allow Parekh to shave the bone and insert two or three screws to re-align the toe and hold it in place while the wounds heal.
In contrast, the traditional open technique requires large incisions so the surgeon can see the bone directly. The tiny incisions mean smaller wounds and scars, and therefore faster healing rates with less pain, less swelling, and fewer complications.
In this case, the patient was back at work on her normal schedule 10 days after surgery, limited only by a walking boot to keep her from flexing her toe or putting too much weight on the foot.
Six months post-surgery, she was pain-free and back to all of her normal activities, including walking and going to the gym. “She has done very well,” Parekh says. “Every time I saw her, she had less swelling and pain than we usually see at that point with the traditional techniques.”
“We didn’t have the new tools for minimally invasive surgery until about a year ago. It is only because of the advancement of these tools that we can now offer these options,” Parekh says.
The procedure has been available in Asia and Europe for several years, and as soon as it became available in the U.S., Parekh requested training from the manufacturer. A limited number of surgeons in the country have received the training to offer it.
Severe cases may still require an open procedure, but the minimally invasive technique may encourage patients with moderately sized bunions who have avoided surgery for fear of the associated pain and recovery time to seek treatment.