Every day I have patients present in clinic with painful bunions, looking for long term solutions to their pain. To be able to wear the shoes they want to wear with fearing what their feet look like. And ironically, the first thing all of them say is “Chris anything to avoid that surgery – no way I am going through that. I hear its horrible!”
I know the horror stories do exist (often a story of poor rehab and not poor surgery mind you). The many months off your feet. Poor outcomes 12 months post-op due to stiff and swollen joints. Some patients even end up regretting their decisions. But I tell you now – Keyhole surgery has changed the game!
Although I am not a foot and ankle surgeon, I am fortunate to work almost exclusively in the area of orthopaedics by providing inpatient and outpatient services to patients who have had bunion surgery. I also refer a number of patients for these procedures when conservative treatment has or is likely to fail. And I wouldn’t do that if I wasn’t a believer and big fan of the results we get.
What is keyhole surgery?
Keyhole surgery is a relatively new surgical technique that instead of opening up the entire joint, is performed through small portals in the skin and with-x-ray imaging guidance.
In keyhole bunion surgery, small 2-3 mm portals in the skin are used to correct any deformity present (knock off the bump) and realign the toe. The corrected toe is then held together with screws.
Keyhole surgical techniques for foot & ankle surgery
Speak to any foot and ankle surgeon, and most are adopting these procedures for bunion surgery where possible given the smaller wounds and faster recovery times. Medical reasons aside, from my point of view as a podiatrist, I see three key benefits to the use of keyhole techniques for foot surgery:
3 Benefits of Keyhole Surgery for Bunions
The first-time I saw a patient post-operative in recovery, I was surprised about how comfortable the were. The fact they could walk straight away with relatively no discomfort. And they have just had major foot reconstructive surgery! And then I thought it must just be the super-power of the anaesthetic, yet when I review patients at two weeks, many don’t require intensive pain medications, they don’t suffer significant joint swelling (when compared to open procedures) and then can ambulate pretty well in the sandal.
Post-op rehab can start straight away
The ability to start rehab almost straight away reduces the risk of joints stiffening up and muscles becoming weak. When I see patients in recovery in hospital who have had keyhole procedures performed, I get them up walking straight away in a post-operative sandal. Even in patients who have had bunion surgery where small cuts to the bones of the foot are performed! And I consider this so important to optimising function long-term.
The patients are also provided a discharge summary and plan for the first two weeks which includes active range of motion of the joint from day 4 post-operatively. This is in contrast to my patients I see who are told not to do anything for six weeks and we are still trying to regain range of joint motion 6-12 months later.
Smaller excisions in the skin
Keyhole procedures typically use a number of small portals approx. 2-3 mm in length to perform the surgery. Smaller excisions means smaller scars, less trauma to surrounding tissues, less issues with wound healing and less joint swelling.
Although all surgical procedures contain risks, keyhole surgery has offered many of my patients a permanent solution to the issues they have with their bunions. Life is too short to walk in pain, be limited by the shoes we wear and to be conscious of how our feet look. Now that it is able to be performed keyhole, it is definitely a procedure worth considering.