Minimally invasive bunion surgery: what has actually changed

Bunion surgery has a reputation, largely earned in decades past, for being painful and slow to recover from. Minimally invasive techniques have changed that picture considerably, but the enthusiasm around them deserves a measured explanation rather than marketing language.

What the technique involves

Rather than opening the forefoot, correction is performed through several incisions of a few millimetres using specialised burrs under live imaging. The bone is cut, realigned and fixed with screws placed percutaneously. The correction achieved is comparable to open surgery in appropriately selected feet.

What patients notice

• Markedly less soft tissue disruption and swelling
• Smaller scars, which matters more to patients than surgeons often assume
• Weight bearing in a post-operative shoe from day one in most cases
• Less reliance on strong analgesia in the first fortnight

Where open surgery still wins

Severe deformity, significant arthritis at the first metatarsophalangeal joint, previous failed surgery and certain rheumatoid feet are all situations where an open approach gives better control. Choosing the technique to suit the foot, rather than the foot to suit the technique, remains the point.

The measure of a good operation is not how small the incision is, but how well the foot works a year later.