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Minimally Invasive operation – Percutaneous Hallux Valgus (Bunion)

30 de March de 2020

[vc_row][vc_column][vc_column_text]Minimally invasive or percutaneous hallux valgus techniques allow the surgeon to correct a bunion deformity through a minimal incision that provides faster recovery for patients with fewer complications.

The terms “minimally invasive” or “percutaneous surgery” are general terms that include a variety of surgical techniques and incisions for hallux valgus correction. Most surgeons often use both terms “minimally invasive” and “percutaneous” surgery.

Bunion deformity

Minimally invasive or percutaneous technique offers several advantages over traditional open surgery

Advances in equipment and instrumentation have allowed refinement of bunion correction techniques through millimetric incisions possible, and with it, an array of benefits. The advantages include a reduced postoperative period with minimal postoperative pain as well as an overall faster and comfortable recovery, which allows the patient to continue with their daily routine. A percutaneous technique offers all these advantages because the surgery is performed with minimal damage and disruption to the overlying soft-tissue. Patients seeking the benefits of this modern approach should be adequately examined before undergoing bunion surgery.

 

Minimally Invasive Bunion deformity. Feet deformity. Close up

 

The percutaneous technique for hallux valgus correction

The percutaneous technique for hallux valgus correction uses very small incisions, instead of the commonly-used large incisions in open bunion surgery. Minimally invasive incisions are usually around 4-5 mm long compared to the traditional open foot surgery incisions that range from 7-15 cm long.
Experienced foot surgeons can apply most of the open techniques on hallux valgus correction with the percutaneous or minimally invasive approach. Depending on the severity of the bunion deformity and patient comorbidities, hallux valgus correction; can be performed via several techniques to remove the excess bone and improve the alignment of the toe.

The most common bunion correction technique requires an osteotomy but now, thanks to the percutaneous or minimally invasive approach, experienced foot surgeons can successfully correct the bunion deformity through a minimal incision.

An experienced surgeon should only perform minimally invasive foot surgery with specialised instruments that allow correction through small portals. The surgeon is guided by tactile senses and fluoroscopy to view in real-time the realignment and stabilization of bony parts. Along with percutaneous or minimally invasive techniques, the surgeon requires a mechanical aid in the form of low torque, high-speed burrs to safely cut the bone without causing thermal damage. This approach is very different from the traditional open surgery that requires large flat longitudinal bone saws to correct the bunion deformity.

 

Bunion Pre-op Minimally Invasive

 

 

40 days post-op Minimally Invasive

 

Minimally invasive or percutaneous hallux valgus techniques allow the surgeon to correct a bunion deformity through a minimal incision that provides faster recovery for patients with fewer complications.

The terms “minimally invasive” or “percutaneous surgery” are general terms that include a variety of surgical techniques and incisions for hallux valgus correction. Most surgeons often use both terms “minimally invasive” and “percutaneous” surgery.

Minimally invasive or percutaneous technique offers several advantages over traditional open surgery.

Advances in equipment and instrumentation have allowed refinement of bunion correction techniques through millimetric incisions possible, and with it, an array of benefits. The advantages include a reduced postoperative period with minimal postoperative pain as well as an overall faster and comfortable recovery, which allows the patient to continue with their daily routine. A percutaneous technique offers all these advantages because the surgery is performed with minimal damage and disruption to the overlying soft-tissue. Patients seeking the benefits of this modern approach should be adequately examined before undergoing bunion surgery.

The percutaneous technique for hallux valgus correction

The percutaneous technique for hallux valgus correction uses very small incisions, instead of the commonly-used large incisions in open bunion surgery. Minimally invasive incisions are usually around 4-5 mm long compared to the traditional open foot surgery incisions that range from 7-15 cm long.

Experienced foot surgeons can apply most of the open techniques on hallux valgus correction with the percutaneous or minimally invasive approach. Depending on the severity of the bunion deformity and patient comorbidities, hallux valgus correction can be performed via several techniques to remove the excess bone and improve the alignment of the toe. The most common bunion correction technique requires an osteotomy but now, thanks to the percutaneous or minimally invasive approach, experienced foot surgeons can successfully correct the bunion deformity through a minimal incision.

An experienced surgeon should only perform minimally invasive foot surgery with specialised instruments that allow correction through small portals. The surgeon is guided by tactile senses and fluoroscopy to view in real-time the realignment and stabilization of bony parts. Along with percutaneous or minimally invasive techniques, the surgeon requires a mechanical aid in the form of low torque, high-speed burrs to safely cut the bone without causing thermal damage. This approach is very different from the traditional open surgery that requires large flat longitudinal bone saws to correct the bunion deformity.

Important aspects to know regarding the Minimally Invasive or Percutaneous Approach

Bunion removal itself is straight-forward and was the first procedure to be carried out percutaneously in the foot. Hallux valgus deformity is caused by an anatomical deformity that leads to bone misalignment and protrusion. Therefore, with severe bunion deformities, simple bunion removal should be performed in conjunction with other realigning procedures.

Bone Realignment With The Minimally Invasive Technique

Bunion deformity correction and bony realignment via the percutaneous approach is without doubt the most significant advancement in foot surgery. The surgical act of making an osteotomy (bone cut) to correct a deviation in the foot is similar with both minimally invasive and open traditional approaches. However, the minimally invasive technique modifies the bone cut and does not usually require fixation such as screws or k-wires.

The percutaneous osteotomy is performed at the neck of the metatarsal head and at the proximal phalanx. These osteotomies allow realignment of any deviation of the great toe and reduce the bunion deformity.

Current Literature on Minimally Invasive Hallux Valgus Surgery

Patients and doctors have shown increasing interest in percutaneous or minimally invasive techniques within the past 20 years. Scientific evidence, thus, is in its infancy, making it difficult to make comparison studies. However, given the demanding interest in minimally invasive techniques by both patients and surgeons, more studies are now being carried out, which will allow for better comparisons.

Percutaneous bunion surgery has been performed since the 1940s. However it was not until the late 1980s that S. Isham modified the Reverdin osteotomy and expanded the techniques to Europe first and then to the rest of the World. It was back in the mid 1980s when Dr San Román (Founder of Clinica San Román) went to the US to learn these evolving techniques from Dr. S. Isham.

The scientific literature supports the fact that minimally invasive or percutaneous approaches to bunion surgery have similar or better clinical and radiographic results than the open traditional techniques. Patients also have a better satisfaction rate, better cosmetic result and experience less postoperative pain. There is a need to make larger randomised controlled trials to better assess these novel techniques.

Which Patients Are Eligible Candidates For Minimally Invasive or Percutaneous Surgery?

Most bunions can be operated with minimally invasive techniques. However, surgeon experience and skill level should be of utmost importance in the overall result achieved with these techniques. Most patients with hallux valgus are good candidates for the minimally invasive approach.

What Complications Are Involved With The Percutaneous Techniques?

No surgery has a 100% success rate and there is no perfect technique.

The foot is a complex structure supporting our weight that works interdependently with other components of our locomotor system. Thus, failure of any single functioning part through surgical manipulation will alter the functions of the remaining parts. Despite having fewer complications minimally invasive surgery is not free from complications. Minimally invasive or percutaneous surgery generally has less complications than traditional open techniques. Given the steep learning curve, it is the inexperienced surgeon unfamiliar with these percutaneous techniques that will experience more complications. Some of the complications described in the literature include: infection 1.6%, recurrence 1.8%, joint stiffness 1.9%, transfer metatarsalgia 1.2%, nonunion 0.4%, complex regional pain syndrome 0.9% and osteonecrosis 0.1%.

In Conclusion

Minimally invasive or percutaneous hallux valgus surgery is an excellent method for bunion correction in the hands of the experienced surgeon. The minimally invasive technique to correct the deviation of the great toe (and metatarsal bone) through an osteotomy seems to be the best approach with the least complications.

The percutaneous or minimally invasive techniques are in constant evolution thanks to the development of specialised surgical instruments, mechanical tools and fluoroscopy equipment improvements. For the time being, minimally invasive hallux valgus surgery allows the patient to walk out of the surgery with a millimetric incision and enjoy a fast and easy recovery.[/vc_column_text][vc_row_inner][vc_column_inner width=”1/4″][/vc_column_inner][vc_column_inner width=”1/2″][vc_btn title=”Contact now with our form” style=”3d” color=”primary” align=”center” i_icon_fontawesome=”fab fa-wpforms” add_icon=”true” link=”url:https%3A%2F%2Fclinicasanroman.typeform.com%2Fto%2Fmu5bdg|||”][/vc_column_inner][vc_column_inner width=”1/4″][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Contact Address

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Tel: (+34) 965 921 156

informacion@clinicasanroman.com

References:

  • COUGHLIN, MJ and JONES, CP, 2007. Hallux Valgus: Demographics, Etiology, and Radiographic Assessment. Foot & Ankle International, 28(7), pp. 759-777.
  • ISIDRO, A. and MALGOSA, A., 2017. Oldest Mummified Case of Hallux Valgus from Ancient Egypt. Journal of the American Podiatric Medical Association, 107(3), pp. 261-263.
  • NGUYEN, U.-.DT, HILLSTROM, HJ, LI, W., DUFOUR, AB, KIEL, DP, PROCTER-GRAY, E., GAGNON, MM and HANNAN, MT, 2010. Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study. Osteoarthritis and Cartilage, 18(1), pp. 41.
  • GAGNON, MM and HANNAN, MT, 2010. Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study. Osteoarthritis and Cartilage, 18(1), pp. 41.
  • THOMAS, S. and BARRINGTON, R., 2003. Hallux valgus. Current Orthopaedics, 17(4), pp. 299.

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