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How Minimally Invasive Bunion Surgery is Different and Better

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

Patients say they hear that bunion surgery is one of the most painful surgeries. And so many people put off fixing their bunion until they either have pain every step, or only have one pair of shoes that they can wear that is comfortable.

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 will be publishing research soon demonstrating this soon.

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

  • They have had bunions for a long time, and want them fixed now
  • They think that they have a bunion growing and have questions about what to do and when to fix it
  • They have had bunion surgery on one side and it is either still bothering them, or the post-operative experience was so bad that they would never have the bunion on their other foot fixed the same way

Ultimately, you, as the patient will know when you want to have your bunion fixed, and when you are ready to have it done. However, there are typically a few things that I tell every patient asking: “When should I fix my bunion?

When should I fix my bunion?

Number one: when it hurts, or ideally, right before it starts hurting!

Number two: before it gets “too bad”, or “really bad”, or before you start making accommodations to your shoes, physical activities, etc. If you are embarrassed to have people see you barefoot (and it has nothing to do with yellow toe nails) then you should fix your feet.

Number three: before it starts affecting your other toes. Does it look like your bunion is squeezing your other toes to the side? Or is your second toe (toe next to the big one/bunion) popping up, or going over or under your big toe/bunion? You want to fix your bunion before your other toes start getting affected.

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

What is the best bunion procedure?

Tough question! And it typically depends on what kind of bunion you have – whatever that means, isn’t a bunion a bunion? Well…not all bunions are treated equally! And 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 minimally invasive. A bunion is like a car tire off alignment (it wears out more quickly). The joint will wear out more quickly, become arthritic the longer you wait to have your bunion fixed – so I suggest fixing it when you start thinking about it, before it hurts!

There are hundreds of bunion procedures. Almost every doctor is trained to traditionally fix a bunion.

What is traditional bunion surgery?

First of all, traditional bunion surgery is usually performed at a hospital using general anesthesia (putting you to sleep with medications pushed through an IV and a breathing tube).

Traditional bunion surgery is when a long incision is made either on top, or on the side of the first metatarsal phalangeal joint (MPJ/MTPJ). Then, everything between the bone and the skin is reflected, freed off the bone, and bone is removed, bone is cut, joints are destroyed and the joint is realigned.

After this, plates, screws, wires or some other form of internal hardware is used to keep the new alignment in place. Then, the different layers of skin are sewn back together and a bandage is put on. Typically, there are a combination of different sutures that are used, and some need to be taken out at two weeks.

Most doctors have their patients stay off of their feet for a period of a couple of weeks, up to three plus months! Normally, there is a cast or a cast boot that goes up your leg, but ends before you knee. Normally, this is from anywhere between four weeks and three months. After this, physical therapy can be required, possibly orthotics (custom inserts for your shoes) or other methods to get you back moving again after not walking normally for up to three months.

How is minimally invasive bunion surgery different?

First, the surgery is performed without general anesthesia. At Northwest Surgery Center, our anesthesia is very similar to sedations dentistry – meaning you are relaxed, but not put to sleep. A local block (injection like a flu shot, or like Novocain before a dental cavity is fixed). You are awake, listening to music, and never put to sleep. Next, we use typically three, very small incisions to fix almost all of our bunions. Through these small incisions (that are closed with one small stitch, or a steri-strip) I am able to remove your bunion (excess bone). Also, I can make small fractures in your bone to realign it, and shift it over. Because I am not opening up your foot and exposing the entire bone, I do not need to use internal hardware (screws, plates and wires) to keep everything where we want it. I wrap your foot up in a soft cast, using gauze and coban and use that as my “external fixation”. This way, you can walk right out of the operating room. You can go back to work right away, drive your car, go to the mall, dinner, or really whatever you want (aside from operating heavy machinery, jump around or swimming of course – got to keep the bandage dry!).

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

First, almost all doctors are trained to perform traditional bunion surgery. There are hardly any, maybe less than one hundred in the United States that regularly perform minimally invasive bunion surgery, and even fewer that do it without internal fixation. So, I have performed hundreds of traditional bunion surgeries in the past, and all different kinds – and have found that minimally invasive bunion surgery leads to the quickest, painless recovery that has the least affect on your 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 things that I can consider is that many doctors fall into a comfort zone, and 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. I ask them if their doctor has ever seen, or better yet, performed minimally invasive bunion surgery before – my guess is no way! As someone who has converted to almost exclusively minimally invasive bunion surgery, I can not imagine going back to a traditional bunion surgery approach. I tell all of my colleagues to come shadow me and see the benefits of minimally invasive bunion surgery. Most are just too busy with life, or their practice catching up on notes, and dictations and perfecting their electronic medical records and templates 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, lets say, brain surgery, I would want to go to a doctor that only does brain surgery. Would you want the same doctor that does your brain surgery to also do your colonoscopy, shoulder replacement, or carpal tunnel release? NO! At Northwest Surgery Center, our focus is 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 consult on how we can fix your bunion. I look forward to seeing you soon!