Foot surgery has been no exception; over the past couple of years there have been articles in the press regarding the use of minimally invasive surgery (MIS) to correct bunions.
Bunions occur when a bony mass forms on the joint at the base of the big toe. This can change the shape of your foot and lead to swelling, pain and tenderness around the big toe. If left untreated the condition usually worsens so it is best to visit your GP or podiatrists who can examine your foot and recommend treatments. Previously, for bunion removal to take place, the toe joint had to be detached through open surgery. This caused significant postoperative pain, swelling and a recovery period of around three months. Scarring was inevitable and often normal shoes couldn’t be worn for up to a year.
In this procedure the operation (osteotomy) to straighten the big toe is performed through a tiny keyhole. It is fixed in the same way as the traditional open procedure with screws. As there is less tissue damage during surgery so there is less swelling and minimal scarring after surgery. The risk of scarring and infection is less. A recent study has shown that the clinical outcome scores –looking at post-operative foot function, pain, ability to wear normal footwear and carry out a range of activities were better than the traditional open approach.
There are many more operations that can be performed using MIS techniques.
Toe Straightening – previously this has involved the fusion of joints using a wire which is left protruding from the toe for six weeks. Using MIS techniques a wire is rarely needed and the operation does not require fusion of the joints – just taking small wedges of bone through a key hole to allow the toe to come straight. This has the advantage of getting back into normal shoes earlier and avoiding stiffness.
Great toe arthritis, which is known as hallux rigidus, can in many cases be improved by removing the bone spurs that have developed. This can be performed through a small keyhole rather than an open incision. Generally with this technique patients are able to get into normal shoes within a few days.
Metatarsalgia. This means pain in the metatarsals - patients complain of pain in the ball of their feet or a feeling of walking on pebbles. This can either be because the joints are taking too much pressure or because of irritation of a nerve – called a Morton’s neuroma. These often co-exist. Previously an operation called a weil osteotomy was performed to take the pressure off the prominent bone – this can now be done using a minimally invasive technique which allows earlier weight bearing.
At Spire Murrayfield Hospital, minimally invasive surgery is carried out by consultant orthopaedic surgeons Mr John McKinley and Mr Robert Clayton. In the last two years, Mr McKinley has carried out 150 minimally invasive procedures - 63 bunions, 22 cheilectomies and the rest lesser toes. Minimally invasive bunion surgery cost for one foot is £4,400.