Minimally invasive bunion surgery differs from “traditional bunion surgery,” and what we do at Northwest Surgery Center is more special than anywhere else!

Patients say they’ve heard that bunion surgery is one of the most painful surgeries. So, many people put off fixing their bunion until they either have pain with every step, or until they only have one pair of shoes that fits comfortably.

Let me ease your fears. As far as postoperative pain, at Northwest Surgery Center, hardly any of our patients take any narcotics (prescription pain pills) after surgery, and we are in the process of publishing research about this.

The patients that come into our surgery center typically fall into the following categories:

  • Had bunions for a long time and want them fixed now.
  • Have a bunion growing and have questions about what to do and when to fix it.
  • Had bunion surgery on one side and it is still bothering them.
  • Had bunion surgery and such a difficult post-operative experience that they would never have their other foot fixed.

Ultimately, patients know when they are ready for a bunion surgery. However, there are typically a few things that I tell every patient asking, “When”

When should I fix my bunion?

1) When it hurts, or ideally, right before it hurts!

2) Before it gets “too bad” or the pain is “terrible.” Or, before you need to make accommodations to your shoes, physical activities, etc. If you are embarrassed to have people see you barefoot, then you should fix your feet.

3) Before it affects your other toes. Does it look like your bunion is squeezing your other toes to the side? Or is the toe neighboring the affected toe popping up or going under the affected toe? You should fix your bunion before other toes start to get affected.

Okay, so you think you want your bunion fixed. Next question: “What is the best bunion procedure?”

What is the best bunion procedure?

Tough question! It typically depends on what kind of bunion you have. You may ask, “Isn’t a bunion a bunion?” Well… not all bunions are treated equally! Some people have baby bunions, Tailor’s bunion, or a bunionette (see upcoming blog post on baby bunions).

There are different severities of bunions and different patient goals. Most bunions fall into the mild/moderate category, or the ones that are best treated with minimally invasive surgery. A bunion is like a car tire off alignment (it wears out more quickly). The joint of an affected toe will wear out more quickly. In other words, it becomes more arthritic the longer you wait to have it fixed – so I suggest fixing it when you start thinking about it, before it hurts!

There are hundreds of bunion procedures. Almost every surgeon has training on how to fix a bunion using a traditional technique.

What is traditional bunion surgery?

First, traditional bunion surgery is usually performed at a hospital under general anesthesia (putting you to sleep with medications through an IV and the patient needing a breathing tube).

Traditional bunion involves a long incision made either on top of or on the side of the first metatarsalphalangeal joint (MPJ/MTPJ). Then, everything between the bone and the skin is reflected. It is freed off the bone, and some bone is removed. The bone is cut, the joint is destroyed, and then it is realigned.

After this, plates, screws, wires, or some other form of internal hardware is installed to keep the new alignment in place. After this, the surgeon sews the different layers back together, and a bandage is applied. Typically, doctors use a combination of different sutures, which can often be removed after about two weeks

Most doctors have their patients stay off of their feet for two weeks, up to three or more months! Normally, a cast or a boot is used for support, which goes up the leg, ending just before the knee, and maintained for about four weeks to three months. Afterwards,, doctors may require physical therapy, possibly orthotics (custom inserts for your shoes) or other methods to get you back up and moving, especially since the patient wasn’t walking for that time.

How is minimally invasive bunion surgery different?

Is it really better?

First, the surgery is performed without general anesthesia. At Northwest Surgery Center, our anesthesia is very similar to sedation used at a dentist’s office. It relaxes you but does not put you to sleep. A local nerve block (injection like Novocain before a dental procedure) is often used. You are awake, listening to music, and never put to sleep.

Next, we typically use three tiny incisions to fix almost all of our bunions. The incisions are so small that they can be closed with one small stitch or a steri-strip. With minimally invasive bunion surgery, we can remove your bunion, make small fractures in your bone to realign it, and shift it over. Because the foot is not opened and exposed, internal hardware (screws, plates, and wires) is not required. Next, the foot is wrapped in a soft cast using gauze and coban. In most cases, patients can walk right out of the operating room, even going back to work immediately. Or, they can go to the mall, dinner, drive their car, or most other activities aside from operating heavy machinery, jumping around or swimming, since the bandage needs to be kept dry!

Dr. McCartan, if you do minimally invasive bunion surgery, how do you know what traditional bunion surgery is?

First, doctors train to perform traditional bunion surgery. Less than 100 doctors in the United States regularly perform minimally invasive bunion surgery.  Even fewer doctors do it without internal fixation. I have performed hundreds of traditional bunion surgeries in the past, and all have been different. I’ve found that minimally invasive bunion surgery leads to the quickest, most painless recovery, with the least effect on a patient’s day-to-day life during the recovery period.

Why doesn’t everyone get minimally invasive bunion surgery?

I wish I knew the answer! The only thing that I can consider is that many doctors fall into a comfort zone. They accept the results without trying to get better.

I am always in shock when a patient tells me that their podiatrist told them that minimally invasive bunion surgery doesn’t work. My guess is that they haven’t performed one or even seen one. As someone who has converted to almost only minimally invasive bunion surgery, I cannot imagine going back to a traditional bunion surgery approach. I tell all my colleagues to come shadow me. To come see the benefits of minimally invasive bunion surgery. Most are just too busy with life, or their practice. They are too busy to open their eyes and try to learn something new and better for their patients.

I am a doctor that will always learn the newest, latest, greatest, and best way to help my patients. That is why I have perfected minimally invasive bunion and hammertoe surgery. That is 90% of what we do at Northwest Surgery Center. If I were to have, let’s say, brain surgery, I would want to go to a doctor that only performs brain surgery.

Would you want the same doctor that does your brain surgery to do your colonoscopy also? Or shoulder replacement, carpal tunnel release? I didn’t think so. At Northwest Surgery Center, our focus is on minimally invasive foot surgery, predominantly bunions, hammertoes, and heel spurs. No doctor in the country focuses that much on one condition, and we pride ourselves on being the experts in minimally invasive bunion surgery. Come in, get some x-rays, and get your free consultation on how we can fix your bunion. I look forward to seeing you soon!

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