Percutaneous Foot Surgery
Percutaneous foot surgery is a technique that allows outpatient correction of large and painful deformities such as bunions, claw toes and hammertoes, through millimeter incisions without the use of screws or needles.
If you have bunions, claw toes, hammer toes or other foot deformities but are afraid of traditional surgery because of the possible risks, complications and complex post-operative procedure, then this article on percutaneous foot surgery at Clínica San Román may be useful to you.
Surgery in general tends to perform less invasive surgeries through smaller and smaller incisions because they reduce postoperative complications and shorten recovery time. Nowadays, foot surgery allows to perform and correct a problem of bunions or claw toes with optimal results thanks to minimally invasive or percutaneous surgery.
Fluoroscopes, what are they?
To successfully perform these techniques, it is essential to have specific instruments, modern radiological equipment(fluoroscopes) and extensive surgical experience in percutaneous surgery is essential and must always be performed by qualified surgeons.
As with other foot surgery techniques, the objective of percutaneous surgery is to treat foot deformities, eliminating pain and correcting the pathological elements that caused the deformity in order to prevent recurrence while maintaining the foot functional for walking. A foot should not be operated on for purely cosmetic reasons; each patient should be treated individually based on his or her circumstances and history.
Therefore, a careful clinical examination of the foot should be performed in order to evaluate the presence of asymmetries, joint alterations, painful bursitis, type of hindfoot (varus, valgus or neutral), reducibility of the deformity, study of the lesser toes, digital formula, plantar arch (flat or cavus foot), etc.
At the same time, the patient should be evaluated for the presence of other pathologies that may cause or aggravate foot deformities such as gout (high uric acid and joint pain), rheumatoid arthritis and psoriatic arthritis, among others. All this always in conjunction with a study of the neurological and vascular status of the foot, especially in diabetic patients.
Hallux Valgus Treatment
The treatment of hallux valgus may change depending on the degree of deformity. In early deformities, conservative treatment with appropriate footwear and orthopedic insoles can be used to slow the development of the deformity. However, the only definitive solution is foot surgery to remove the bony protrusion and correct the deviation caused by hallux valgus.
There are more than 150 surgical techniques for the treatment of bunions with different osteotomies of the first radius, arthrodesis with plates or screws, but there is no doubt that percutaneous foot surgery is the only surgical technique that respects the foot to the maximum, causing the least trauma and with the fewest post-operative complications.
To perform bunion surgery with the minimally invasive technique through an incision of a few millimeters, it is essential to use a fluoroscope.
which transmits images of the foot in real time to guide the surgeon in the various surgical procedures.
Radiological control instruments
Low intensity X-ray equipment (fluoroscope) is essential to accurately monitor and perform osteotomies (surgical bone fractures) and bone resections. When an incision of a few millimeters is made, the fluoroscope is necessary because the surgeon does not have a direct view of the surgical field.
The surgery is performed on an outpatient basis under local anesthesia, which reduces the possible complications and adverse effects that can be caused by general anesthesia.
Bunions, claw toes or hammer toes
Both bunions and claw or hammertoes affect mostly the female sex. If you suffer from any of these deformities, they are most likely due to an inherited condition and/or the repeated use of narrow-toed shoes with excessive heels.
Regardless of the cause of the deformity, it is important to be aware of these deformities, not only for aesthetic reasons, but also because they can have serious consequences in the future, such as dislocation of joints and major deformities that can lead to ulcers and inability to ambulate.
Why is it done?
The most important pathologies treated are those that produce pain in the distal part of the foot, that is, at the base of the toes, such as bunions, claw and hammer toes that produce metatarsalgia and dorsal toe pain.
It is also used for the treatment of:
- Tailor’s bunion: Similar to the bunion but is the bony protrusion that affects the fifth toe (fifth metatarsal head).
- Hallux Rigidus: Osteoarthritis affecting the big toe that causes joint stiffness without the possibility of flexion.
- Calcaneal Spur: A bony prominence is produced in the lower part of the heel that can generate pain.
- Morton’s neuroma: A thickening of the interdigital nerve mainly in the interdigital space between the third and fourth toes.
Who is the target audience?
Anyone with foot deformities who suffers from pain, or is unable to walk properly or wear normal footwear, can benefit from these techniques.
Preparation for percutaneous foot surgery
Before surgery is performed, the specialist must evaluate the degree of deformity to assess the best percutaneous or minimally invasive technique to be used.
Once the surgical technique has been decided, it is essential to perform a blood test with coagulation tests.
What does the operation consist of?
It is an outpatient procedure with a local anesthesia block that allows anesthetizing the area to be operated on. One or several incisions of a few millimeters are made, through which the surgical acts are performed to solve the problem:
- Complete resection of the bony protrusion.
- Depending on the degree of deformity, an osteotomy, i.e. a cut or partial section of the bone, is performed to restore the original position.
- Release of the extensor apparatus of the joint, i.e. the abductor tendon of the first finger.
- Correction of associated deformities, such as claw or hammertoes through 2 mm incisions.
These surgical procedures are performed under fluoroscopic control with real-time imaging of the inside of the foot.
Advantages of Percutaneous Foot Surgery
There are more than 150 surgical techniques for the correction of these deformities, however, percutaneous foot surgery offers the following advantages:
- The incisions or cuts are few millimeters, with less trauma to the foot and with the consequent better and quicker postoperative period.
- No surgical screws or pins are used, thus reducing possible infection problems.
- The anesthesia is local, thus reducing the risks involved in general or total anesthesia.
- After surgery, you walk out on your own feet in a post-surgical shoe with no need for complete rest.
- In general, percutaneous surgery allows a very rapid recovery with fewer complications compared to other more aggressive techniques.
- Of course, there can always be some inconvenience during foot surgery or in the postoperative period.
It is therefore very important that this technique is performed by very experienced professionals under optimal conditions.
After surgery, the patient will have to wearthe post-surgical shoe for one to five weeks to be able to walk safely.
The first check-up is performed after 7 days to remove the stitches. Subsequently, the surgical dressing will need to be changed approximately every 14 days until the patient is discharged from surgery. Finally, for daily foot care, specially designed foot covers will be provided.
San Roman Podiatric Clinic
If you found this article interesting, please contact the specialists in percutaneous or minimal incision surgery at Clínica San Román.
Both doctors and podiatrists will evaluate your problem with the utmost professionalism and give you the best solution.
Remember that your feet are the fundamental pillar that must support your body throughout your life.
Encourage yourself to end pain and improve your quality of life!
For more information on minimally invasive surgery, please visit the frequently asked questions page.
Article prepared by Clínica San Román
Date of publication: 3-08-2017
Date of Publication: 12-02-2020