Bunions: Minimally Invasive Surgery

Bunions: Minimally Invasive Surgery

[Marc Stoll, PA-C] Thank you for tuning in to OrthoPedia Patient for a discussion on a common foot problem, bunions. Here, we have a couple of facts that we thought you might find interesting. Babies are born with more than 300 bones, but as adults, we wind up with only 206. There are 28 bones in each foot, so together, the feet make up more than 25% of our skeleton. The average American walks between 4000 and 6000 steps each day, and most Americans travel about 75,000 miles on their feet before the age of 50. Leonardo da Vinci called the human foot a masterpiece of engineering and a work of art.

Let us discuss some common issues surrounding bunions. When we look at a normal foot, we see that the big toe is straight, and there is no bump on the inside of the foot. The bones are well aligned, and there is no obvious deformity. A bunion is a painful, bony bump that develops on the inside of the foot at the big toe joint. It occurs when some of the bones rotate out of alignment and cause your big toe to lean in and crowd your other toes.

Another type of bunion is called a Tailor's bunion, also called a bunionette. The Tailor's bunion is a bony prominence that typically occurs on the outside of the forefoot at the base of the 5th toe. The Tailor's bunion received its name centuries ago. Tailors used to sit cross-legged all day with the outside of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the fifth toe.

How common are bunions? There are over 3,000,000 cases diagnosed every year. We do not know the exact cause of bunions, but what we do know is that women are much more affected than men, and as we get older, our likelihood of developing a bunion increases dramatically. As we can see, patients over the age of 65 have the highest prevalence of developing bunions. Specific footwear types have been linked to bunions, most commonly those with a high heel or a narrow toe box. Age and gender are also risk factors, but additional risk factors include patients with ligamentous laxity, as you can see here.

When we look at the different types of bunions, we can classify them into mild bunions, moderate bunions, severe bunions, and extreme bunions with the classic crossover second toe. As we have discussed, bunions affect the big toe of the foot. We commonly refer to this group of bones as the first ray. Let us take a closer look at the first ray. The bones that make up the first ray provide all of the deformity of the bunion. The 4 bones that make up this first ray are the medial cuneiform, the first metatarsal, and the great toe, both the proximal and distal phalanges.

Next, we have the medial and lateral sesamoids, also called the tibia and fibular sesamoids. All of these bones together play an important role in the formation of bunions. How do we think a bunion forms? A bunion may seem like a simple bump, but it is actually a very complex deformity of the foot. There are over 100 ligaments in the foot, but interestingly, there are no specific ligaments that stabilize the first metatarsal to the second metatarsal. Because of this, the first metatarsal can migrate away from the 2nd metatarsal, causing the bunion deformity.

It begins when the big toe gradually rotates. The irregular angle of the bones is what you see as the bump on the inside of your foot. How do we treat bunions? Bunions can be managed conservatively to reduce pain. However, the only way to properly correct the bunion deformity is surgically. To help alleviate the pain associated with bunions, you can wear shoes with a wider toe box and avoid high heels. You can use splints or taping the toe straight. You can avoid the activities that cause pain using orthotics that help correct foot position, and formal physical therapy that includes foot exercises and mobilization techniques.

If conservative treatment fails to provide enough relief, then we look at surgical options. The goal of traditional bunion procedure is to correct the toe deformity, but they may include large incisions and come with a painful post-op period. Some of these common procedures involve fusing 2 bones in your foot, which can lead to a decreased range of motion and a long recovery period. Currently, there are hundreds of options for fixing bunions dating back to 1836. The treatment plan is mostly based on the age of the patient, the severity of the deformity, and the presence of arthritis.

The image on the right shows just 9 different options for realigning the big toe. The goal for any type of bunion surgery is the same: correct the alignment and improve pain and function. Traditional open procedures involve large incisions that give a lot of exposure to the surgeon. These large incisions may be accompanied by increased scarring as well as trauma to the surrounding soft tissues. That leads us to where we are today. One of the biggest changes in foot and ankle surgery has been centered around minimally invasive bunion surgery.

The Arthrex Minimally Invasive Bunionectomy is truly a minimally invasive procedure done through tiny incisions. Each bunion is different, and your surgeon can customize the 3-dimensional correction of your bunion using specialized instrumentation. The Arthrex Minimally Invasive Bunionectomy allows you to get back quickly after surgery with a cosmetic result, all while removing the bunion deformity using specialized instruments. The procedure is performed through tiny poke-hole incisions to realign the bones into their natural position.

Because it is minimally invasive, there is limited trauma to the surrounding soft tissues, which promotes a better healing environment. On average, recovery after a Minimally Invasive Bunionectomy is up to 8 weeks faster than a traditional open procedure. Most patients are walking in a post-op shoe after surgery and are back into regular shoes at 6 to 8 weeks. The incision size with a Minimally Invasive Bunionectomy procedure is 76% smaller than traditional open bunion procedures. 90% of patients who underwent MIS bunion surgery were satisfied with their cosmetic result.

Minimally invasive surgery has been clinically proven to achieve the same or better results than traditional open procedures, but with major advantages. While most importantly, your bunion will be gone, there are several other key factors and benefits that come with the Minimally Invasive Bunionectomy. Also, minimally invasive bunion correction helps you to maintain or can even improve the range of motion at your big toe joint. The MIS Bunionectomy leaves all the joints in your foot intact, allowing them the freedom to move more naturally. Thank you.