Bunions are a very common and often painful condition. Medically known as hallux valgus, an estimated 33 per cent of women will develop bunions at some stage in their lives. The term bunion refers to a swelling on the outside of the big toe joint which occurs when the big toe leans too much into the second toe.
This article on minimally invasive bunion surgery is written by David Redfern, a consultant orthopaedic surgeon at the London Foot & Ankle Centre.
For a long time, bunion surgery had a reputation for being very painful with a lengthy recovery period. Indeed, many people put up with their bunions for years rather than face surgery. This was because older techniques involved cutting the bone and not using any form of fixation. Newer techniques introduced during the past decade enabled surgeons to fix the bones into the correct position, reducing pain and promoting a better, more controlled recovery.
However, we are constantly exploring ways of moving from open surgery to minimally invasive or arthroscopic techniques, replacing large incisions with small ‘ports’ through which the surgeon works. In doing so, we offer important benefits for the patient, removing or damaging less tissue, reducing scarring and the subsequent risk of infection.
It was during collaboration between French and UK surgeons based in Sussex that a new approach, applying minimally invasive techniques to established bunion surgery was developed.
Dr Vernois was already using minimally invasive techniques in bunion surgery in France. When he started working with us at the Sussex Orthopaedic Treatment Centre, we wanted to combine the strengths of established bunion surgery with minimally invasive methods.
By combining the two in this way, we aimed to develop a safe, predictable approach along with the benefits for patients of less invasive techniques.
Unlike another form of minimally invasive bunion surgery offered in the UK, there is no need for a wire to remain in the foot after surgery.
Traditional open bunion surgery involves making a cut of 5cm on the outside of the foot and a smaller incision on the inside of the toe to release the tissues holding the toe.
The incisions used in our minimally invasive surgery are just 3mm – the diameter of the lead in a pencil.
Surgeons use instruments originally developed for head, face and neck surgery, which are very fine and rotate at high speed to make tiny, precise cuts.
The surgeon makes small incisions in four places around the big toe, dividing the ligaments and cutting the bone with minimal damage to the tissue. These cuts are designed to allow the surgeon to correct the deformity but maintain bone stability in the area.
A wire is then threaded through the incisions and used to lever the big toe back into the correct position. Once the toe is in the correct place, a small screw is implanted to fix it in this position.
The screw is designed to stay within the bone without causing pain or being palpable for the patient in any way. The wire is then removed.
The whole procedure, which takes place under general anaesthetic, is performed in under 30 minutes.
Forefoot mechanics are very sensitive and this technique was developed to respect the precise anatomy of the foot.
Because it is based on established bunion surgery philosophy, we expect a more predictable recovery and we will not encounter the complications of having a wire sticking out of the foot for the first four weeks after surgery as this is not required.
This is a technique which will have a very significant impact on the way we perform bunion surgery.
However, it is very important that this new technique is performed by a specialist foot and ankle surgeon who has extensive experience of all open bunion surgery techniques, which form the basis for this operation.
Having now completed more than 30 of these procedures, I am confident that minimally invasive bunion surgery is effective and safe with many benefits for patients.