MIS Bunion, Minimally-Invasive Surgery

A minimally-invasive procedure can help you to get back on your feet faster, with less pain. The minimal-incision surgery is performed with small 3-5mm incisions, compared to 3-5 inch incisions used in traditional surgeries. The innovative technique utilizes percutaneous, micro-incisions to correct bunions (hallux valgus), as well as hallux rigidus and other foot conditions, which cause far less damage to your foot.

Minimal-incision bunionectomy, normal healing

Similar, minimal incision bunionectomy, sutures removed

Minimal-incision posterior calcaneal (heel bone) osteotomy with percutaneous (minimal-incision), cannulated screw fixation 

Advantages of the minimal incision surgery include:

• Less pain
• Earlier return to function compared to an open procedure
• Smaller incision
• Minimal disruption of the tissues about joints minimizing stiffness.
• Smaller scars
• Able to avoid general anesthesia
• Ability to obtain the same results as traditional surgery with all the benefits listed above.

What to Expect

Most minimally-invasive surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

• Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be reviewed by your doctor at Dominion Foot and Ankle
• Arranging your schedule to make sure you don’t need to take any long trips for at least two to three weeks following the surgery.
• Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
• Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure with Hibiclens to help reduce surrounding bacteria and prevent infection.

Bunion and cheilectomy surgery is usually performed with a local anesthetic and is administered by us as foot and ankle surgeons. This may be combined with sedation medication to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Recovery times are shorter, earlier return to function and decreased time to weightbearing is expected with the minimal incision surgery. The foot will be covered in a dressing, which you will need to keep dry for one to two weeks or until the surgeon allows.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Based on what was performed by the third or fourth-week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe or a cam walker. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lubricants to soften the skin in the surgical area.

By week five to six after the surgery, you will be able to walk short distances and do mild fitness activities. By 3 months most patients may begin running. Swelling will reduce at individual rates. However, resolution of the swelling may take many months and even up to a year. Continue following your surgeon’s instructions for increasing exercise and activities until you are back to normal.

Below is an example of acute Achilles tendon rupture, MR image and minimally-invasive repair through several small incisions. This creates less scarring and minimal disruption to blood flow to tendon, resulting in quicker healing and return to function than conventional, open approaches.