Minimally Invasive Bunion Surgery

Minimally invasive bunion surgery, also referred to as percutaneous bunionectomy, is a surgical procedure to correct a bunion deformity using small surgical cuts.

A bunion or hallux valgus is an enlargement of bone or soft tissue around the joint at the base of the big toe, resulting in the formation of a bump. The bone that joins the big toe with the first metatarsal bone thickens and enlarges, tightening the tendons. This, in turn, causes the base of the big toe to angle outward, resulting in a painful deformity.

During a minimally invasive bunion surgery, a few small incisions are made through the skin of the foot (percutaneously) to access the bone around the bunion, as opposed to a much larger incision made during an open bunion surgery that cuts across layers of tissue around the bone, causing more postoperative pain, a larger scar, and damage to the surrounding soft tissues.

The main objectives of minimally invasive bunion surgery are to realign the joint, correct the deformity, and relieve pain and discomfort with minimal complications.

Indications

Your surgeon may recommend minimally invasive bunion surgery for the following conditions:

• Significant foot pain that limits your activities of daily living
• Chronic inflammation and swelling of the big toe that does not improve with medication or rest
• Drifting of the big toe towards the second toe or overlapping of toes
• Toe stiffness: the inability to straighten or bend the big toe
• Failure to obtain pain relief with changes in footwear
• Unsuccessful treatment of pain with NSAIDs (nonsteroidal anti-inflammatory drugs)
• You are an active individual who desires a quick return to an active lifestyle
• You are not a candidate for open bunion surgery or wish to avoid open surgery

Preparation

Preoperative preparation for minimally invasive bunion surgery may involve the following steps:

• A review of your medical history and a physical examination are performed as well as routine blood work and imaging.
• Informing your physician about the medicines or supplements you are taking
• Disclosing any medical conditions you have such as heart or lung disease
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Refraining from certain medications such as blood-thinners or anti-inflammatories
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after surgery

Surgical procedure

Minimally invasive bunion surgery is usually performed as a same-day surgery under a local anesthetic ankle block, making the whole foot numb for 6 to 12 hours. You can be awake, sedated or have general anesthetic during surgery, which takes around 45 minutes. In general, the surgery will involve the following steps:

• The skin over the bunion is cleaned with an antiseptic solution.
• A few small incisions are made with the aid of specialized instruments to access the bone around the bunion.
• Through the small incisions, specially designed instruments are inserted to cut the abnormal bone growth and release the soft tissue, enabling realignment of the big toe joint.
• Your surgeon may remove portions of bone, ligament, and tendon in the affected foot, based on the severity of the bunion.
• The incisions are closed with stitches and a sterile dressing is applied.

Postoperative care

General postoperative care and instructions involve the following:

• You will be transferred to the recovery room where your nurse will monitor your vital signs as you recover.
• You can expect some pain and swelling in the foot as the anesthesia wears off. Medications will be prescribed as needed for your comfort.
• Keep your foot elevated as much as possible for the first few days after surgery, and apply ice as advised to relieve pain and swelling.
• For the first couple of weeks, you will require a surgical boot or cast to protect your foot. Orthotic supports or insoles are also advised for additional comfort.
• Physical therapy and an exercise regimen will be gradually implemented to enhance range of motion and help strengthen the foot muscles.
• Instructions on surgical site care, bathing, and driving will be provided.
• You can usually bear weight immediately following the procedure in a surgical shoe.  However, return to normal activities may take 6 to 8 weeks and return to sports activities may take 10 to 12 weeks.
• You should strictly adhere to all scheduled follow-up appointments to monitor your progress.

Risks and Complications

As with any surgery, minimally invasive bunion surgery may involve certain risks and complications. These may include the following:

• Pain
• Swelling
• Discomfort
• Infection
• Anesthetic complications
• Damage to nerves and blood vessels
• Bunion recurrence
• Over or under-correction

Benefits

Some of the benefits of minimally invasive bunion surgery include:

• Minimal post-surgical pain
• Less scarring
• Minimal swelling
• Faster recovery
• Small incisions
• Less damage to tissues
• Minimal joint stiffness

Summary

Minimally invasive bunion surgery is a same-day surgery to correct a bunion deformity. It is performed through small percutaneous, keyhole incisions and enables a faster return to work and normal daily activities.