Minimally Invasive or Percutaneous surgery for foot patologies.
The disorders known as Hallux valgus is a deformity of the foot that affects the first Ray; it is characterized by lateral deviation of the great toe (hallux valgus) associated with medial deviation of the first metatarsal bone (metatarsus primus virus) (Fig. 1). This problem occurs when the big toe leans too much into the second toe. The medical term for bunion is Hallux Valgus and primary cause is usually genetic. Small bunions usually do not cause any pain. Surgery is recommended if pain is present and cannot be reduced by conservative treatment or adapting orthopedic footwear.
What is Percutaneous (MIS) Bunion surgery? Traditional or open bunion surgery uses a cut of 5 cm and a smaller second incision to release the tissues holding the toe. The incisions used in MIS are just 3mm! MIS used only a few skin punctures with a diameter of 3-4 mm. During MIS, the surgeon constantly controls the treatment using a Mini C arm x-ray device. This new technology gives less damage during the treatment, reduces the risk of scarring and complications. Recovery after MIS is more predictable, with a low risk of infection. The MIS technique is a new technology to perform the procedure in the most minimally invasive way. There is no need for any metal elements to remain in the foot after surgery. Surgeon uses special instruments, which are very thin and rotate at high speed to make precise cuts. The surgeon makes these small incisions avoiding the ligaments and cutting the bones with minimal damage to the surrounding tissue. These cuts of the bone (osteotomies) are designed to correct the deformities of the bones and retain bone stability in treated area. The special dressing and footwear gives additional needed stability after MIS.
Minimally invasive foot surgery is not new, It was pioneered by Morton Polokoff in USA in 1945, developed in 1980s-2000s by Stephen Isham in USA, he descrived his techniques for the treatment of Hallux valgus, Tailor’s Bunion and deformities of the lesser toes, along other conditions. During the 1990’s in Spain, Dr Mariano De Prado and Pedro Luis Ripoll, began using the techniques proposed by S. Islam, broadind their indications and modifying some of the procedures. Dr Stephen Isham (USA) and Dr Mariano De Prado are my most important teachers of MIS. I was (Dr Michele Risi, Villalba Hospital Bologna) one of the first in Italy to introduce a percutaneous minimally invasive (MIS) bunion surgery.
How long will it take to recover from this surgery? The patient will use a special postoperative shoe to walk for the first four weeks; this shoe has a rigid sole to help to mantain the stability of the osteoshynthesis.