Minimally Invasive Bunion Surgery

Traditional bunion surgery involves a long incision of 5cm on the outer aspect of the big toe and foot. There is also a smaller incision in the region of the first webspace between the big and 2nd toes.

In our minimally invasive surgery there are several incisions of approximately 3mm. Very fine burrs (originally developed for head, face and neck surgery) which rotate at high speed are used to make tiny precise bone cuts to allow the surgeon to correct the bunion deformity with minimal damage to the surrounding tissue.

The less invasive surgery results in less soft tissue damage during the operation. There is a very low risk of infection and the recovery is expected to be more predictable.

Once the big toe is in the corrected position, screws are implanted to fix the bone in this position. The screws are designed to stay within the bone without causing pain or being palpable.

Patients are admitted to hospital on the day of surgery and meet the anaesthetist prior to surgery. The anaesthetist will discuss the anaesthetic involved. This may take the form of a general anaesthetic with an ankle block. The ankle block is the application of local anaesthetic around the ankle, which may provide pain relief in the foot and ankle for up to 12 hours after the operation.

In general, if a person has surgery on one foot then they stay in hospital overnight and if they have bunion correction on both feet then they would stay in hospital for one to three nights depending on their comfort.

Following the operation a bulky dressing is applied around the foot. This should remain in place for approximately 2 weeks. It is important to keep the dressing dry to reduce the risk of post-surgical infection.

The local anaesthetic block wears off approximately 6 to12 hours after the surgery. Some patients notice an increase in pain at this time, however when pain occurs, tablets generally provide sufficient pain relief. Rest, elevation of the foot/feet and pain medication are all helpful in relieving the pain for the first few days after the surgery.

The pain tends to be worse in the first 3-4 days after surgery. Minimising the time on one’s feet in the first week after leaving hospital helps recovery. Too high an activity level soon after surgery can prolong the recovery time and cause unnecessary setbacks.

The patient may fully weight bear on their feet with the aid of crutches after the surgery. In general, crutches may need to be used for 10-14 days after the surgery. Some patients find that they are comfortable earlier than this and can discard their crutches at that stage.

A post-op shoe (a stiff soled sandal) is fitted after the operation. This needs to be worn for 2-3 weeks after the operation.

Exercises as described below should commence the day following surgery:

1. Ankle movement exercises - set of 12 every 2 hours when awake. This will help to reduce blood pooling in the calf muscle and thereby decrease the risk of deep venous thrombosis (blood clots in the veins of the legs as may occur in long distance plane flights)
   
2. Straight leg raises to 45 degrees, 1 set of 10 twice a day

Week two to six: you will start gradually increasing weight bearing. You may wear supportive sneakers which is straight over the inner aspect of the foot (an example is shown in the picture below) at the end of week 2 to 3 after surgery.

By six months: you should be able to resume all normal activities without pain or discomfort

Sedentary work: 2-3 weeks depending on transport to work and ability to elevate foot at work

Physical work: 2-3 months depending on the nature of work involved

Return to driving will vary depending on whether you drive an automatic or manual car and whether the surgery is to the right foot. Surgery to the right foot may mean not being able to drive for 3-6 weeks. If the surgery is to the left foot and the person drives an automatic car then they may be able to return to driving within 2 weeks. Following surgery to treat a bunion a person may use an exercise bike after 4 weeks and swim between 4-6 weeks. They may not be able to do running/jumping sports for 3 months.