Minimally Invasive Bunion Surgery

Keyhole Bunion Surgery or Minimally Invasive Bunion Surgery

Minimally Invasive bunion surgery, also known as keyhole bunion surgery, uses modern techniques and equipment to decrease the number and size of incisions during surgery. Minimally Invasive bunion surgery has several benefits, including faster recovery time, less postoperative pain and less scarring. The surgery involves three to four small incisions measuring approximately 2 to 4mm in diameter that allow access to specialised surgical instruments to cut and reset the bones and fixate with specialised screws designed specifically for this keyhole bunion operation.

A Bunion is a bony deformity that sticks out of the side of the foot below the big toe. When a Bunion develops, the big toe will typically start to point towards the other toes on the same foot, which may then result in the metatarsal bone attached to it sticking outwards.

Bunions are progressive, meaning that over time they will get worse unless they are treated. Although Bunions are typically treated with conservative measures, at this point in time the only way to fully correct the deformity and realign the toe is with surgery. If the Bunion is quite severe and conservative treatments have failed to provide adequate symptom-relief, your surgeon may recommend an operation to correct the deformity.

There are several surgical procedures that can be used to correct a Bunion and your surgeon will be able to advise on the procedure most suited to your case. This article is written to provide more information on Minimally Invasive Bunion Surgery.

Keyhole / Minimally Invasive Bunion Surgery Procedure Takes Place Over the following Steps:

1. A small 2mm incision is made allowing the first metatarsal to be cut
2. The head of the first metatarsal is repositioned, to partially minimise the bony prominence
3. 2 screws are used to fix both sections of the metatarsal in its new position
4. A wedge is removed from the first proximal phalanx to reposition the toe into a straighter natural alignment. This is also fixed in place with a screw.
5. The protruding bone is cut away and flattened to a natural outer arc

Minimally Invasive Bunion Surgery Procedure Information:

Indications for the procedure	Hallux valgus (bunion) deformity Pain from prominent joint Difficulty with shoe fit despite wearing sensible footwear
Aims of surgery	To reduce pain and deformity To improve the big toe joint alignment (straightening).
Advantages of the operation	A localised procedure that does not involve other joints Reduces the misalignment, which is the cause of the deformity
Specific risks of the operation	Joint stiffness (2%) | Over/under correction | Pain in ball of foot (1%) | Recurrence of deformity | Non-union of bone (bone does not knit together) (0.4%) | Fixation problems with the screws/pins 2% | Fracture or displacement of metatarsal bone (0.6%).
Operation time	Approximately 60 minutes
Incision placement	Typically, on one side of the foot
Stitches	We try to use dissolvable stitches (where possible).
Fixation	Internal fixation (bone screws or pins) is usually used. You will not normally notice them, and they do not usually need to be removed.
Plaster	This is not normally necessary. If your particular operation requires a plaster, we will let you know in advance
Length of stay	Typically, you will be admitted for half a day
Time off work	Two weeks for non-manual work Six to eight weeks for manual work
Alternative treatments	Manage your symptoms by altering activity levels, using painkillers or by changing footwear. The use of insoles, orthoses or toe splints has not been shown to correct toe deformity

Minimally Invasive Bunion Surgery Post-Surgery Recovery Timeline Week by Week

One Week after Minimally Invasive Bunion Surgery

• You will have a one-week review with the consultant and a nurse for your dressing change. You may start to do a little more within pain limits. Pain means you are doing too much.
• First 2-4 days are the worst time for pain but you will be given painkillers to help. You must rest completely for 2-4 days. You will be able to stand and take weight carefully (using crutches) after the operation, but you must rest, with your feet up, as much as possible.
• You should restrict your walking to going to the bathroom and when getting about use your crutches in the way you will have been shown. You can get about a little more after 3 days.

Two weeks after Minimally Invasive Bunion Surgery

• We will arrange a second review where sutures will be removed You will not need a bandage, probably will not need the crutches and can get the foot wet.
• Many patients return to trainers after 2 weeks, but this may take longer. Physiotherapy may be suggested.

Between 2-6 weeks after Minimally Invasive Bunion Surgery

• The foot starts to return to normal and you can return to trainers. 88% of patients return to normal shoes by 8 weeks.
• The foot will still be quite swollen, especially at the end of the day. You may require a review appointment at 4-6 weeks. X-rays may also be taken.
• You may return to work but may need longer if you have an active job. You may return to driving if you can perform an emergency stop.
• You must check with your insurance company before driving again.
• Whilst normal activity will be resumed, sport should be avoided.

Between 6-12 weeks after Minimally Invasive Bunion Surgery

• The foot should continue to improve and begin to feel normal again.
• There will be less swelling. Sport can be considered after 3 months depending on your recovery.

6 months after Minimally Invasive Bunion Surgery

• You will have a final review between 3- 6 months following surgery.
• The swelling should now be slight, and you should be getting the full benefit of surgery.

12 months after Minimally Invasive Bunion Surgery

• The foot has stopped improving with all healing complete.

What Types of Bunion Surgeries are There?

When it comes to types of bunion surgeries, there are broadly speaking more than 200 procedures that have been described over the past 100 years.

However, it is accepted that most bunion surgeons should be able to perform three types of procedures that have good evidence base to provide predictable outcomes for the patient in terms:

• Straightening the big toe by correcting the alignment of the bones (1st metatarsal and proximal phalanx of the big toe)
• Cosmetic correction
• Pain-free joint
• Allowing early weightbearing with gradual return to sports, exercise and range of footwear, including high heels.

What is the Difference Between Traditional and Minimally Invasive Bunion Surgery?

Minimally invasive bunion surgery has become increasingly popular in the United Kingdom with a few centres, like London Foot and Ankle Surgery on Harley Street, that specialise in this technique. Minimally invasive surgery involves three to four small incisions measuring approximately 2 to 4mm in diameter that allow access to specialised surgical instruments to cut and reset the bones, and fixate with specialised screws designed specifically for this keyhole bunion operation.

The other common procedures include an osteotomy procedure, that involves a 3 to 4-inch incision on the inside of the big toe joint. The procedure allows good correction of the deformity with internal screw placement and is traditionally used by most surgeons. The most common procedure is known as a Scarf and Akin osteotomy.

For very large deformities with degenerative changes in the middle of the foot, or instability which may be related to genetic factors such as hypermobility or trauma, a procedure called Lapidus midfoot fusion or more recently popularised “Lapiplasty” procedure is utilised. Only about 5% of bunions in my practice require this type of procedure.

I often have patients who come to my practice requesting a non-invasive bunion surgery. I believe that there is a confusion between minimally invasive keyhole surgery and non-invasive surgery. It is merely not possible to correct the bunion deformity without surgical intervention involving resetting the bones.

Why is Minimally Invasive Bunion Surgery Better?

The main advantage of minimally invasive or keyhole bunion surgery is that there is minimal disruption to the tissues around the big toe joint allowing quicker healing and recovery for patients. Patients also have much less pain postoperatively with most patients reporting that they have only taken painkillers for two to three days following surgery. Patients also are able to return back to trainers with mobilisation after two weeks, as there is less swelling than the open surgical techniques.

Postoperatively, we can monitor bone healing with postoperative X-rays and you will see your specialist two weeks following surgery as well as six weeks, and possibly three months, after surgery for postoperative X-rays to ensure that full healing has taken place.

Typically, you can return to full weight bearing after four weeks following surgery and a range of footwear at approximately eight weeks postoperatively. High impact activities such as exercise and jumping and lunging are allowed after eight weeks.

The swelling and final outcome may well be 10 to 12 weeks after surgery.

FAQs

How long does it take to recover from minimally invasive bunion surgery?

The first five to seven days involve high elevation of your foot and no more than 5 to 10 minutes of walking in a postoperative shoe. You are allowed to walk short distances around the house and ambulate with full weightbearing on the foot. You can make yourself a cup of tea or go to the toilet yourself unaided. You are able to take stairs carefully.

After one week you can increase the activity levels by another 5 minutes an hour. You will still remain in the postoperative specialised shoe. You may be able to take short walks outside within the region.

After two weeks the small stitches may dissolve or need removing at your review. The wounds have healed and at that stage you can start to use your trainers to increase your walking as tolerated. You can also bathe the foot and fully immerse in water at 2 weeks.

At four weeks postoperatively there is enough strength and stability for you to start to do some gentle exercises and increase your activity.

At six to eight weeks postoperatively you can start to carry out high impact exercises, depending on your postoperative healing and X-ray findings. The swelling will continue to subside and there may be a small amount of swelling that still persists.

10 to 12 weeks postoperatively most of bone healing is adequate for you to return to most of your activities and shoes including high heels.

The bone may continue to remodel and heal over time.

Can we straighten a big toe without surgery?

There is no evidence to support that any non-surgical techniques or braces work to correct the deformity. You may find short-term relief with appropriate footwear which are wide at the front at the toe box and use of insoles to reduce the loading of the bunion.

Can we walk after minimally invasive bunion surgery?

Yes. You can walk from day one, although you are limited for the first two weeks and then gradually increase the activities.

More information and how to get in touch

To find out more information about the minimally invasive bunion correction please click here to download our leaflet. You can view all the procedures that I, Mr Kaser Nazir, have carried out at our clinic on the before and after page.

Alternatively, please do get in touch with our admin team who will be happy to assist with questions and arrange appointments. I look forward to meeting you at our 17 Harley Street clinic.