Page 34 - HOI Outcomes 2019
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Minimally Invasive Bunion Surgery
by Jonathan R.M. Kaplan, MD, Andrew P. Gerken, MD, and Steve Kang, MD
Hallux valgus deformities, better known as bunions, are extremely common in the United States.
The American Orthopaedic Foot & Ankle Society estimates that one in three women have bunions. While conservative measures are often the initial line of care, in symptomatic bunions, these treatment options are limited in comparison to other common foot and ankle conditions. While bunions often do not cause severe debilitating disease, bunions can cause significant limitations in activities of daily living, difficulty with shoe wear, and limitations in physical exercise interests. It is estimated that approximately 150,000 bunion surgeries are performed in the United States annually.
There are various methods for correcting a bunion deformity, many of which have specific indications based on surgeon preference, anatomic variations, and severity of bunion. However, all traditional bunion surgeries involve open incisions with a combination of bone osteotomies (or fusions) combined with soft tissue balancing. While these procedures are effective at achieving and maintaining correction, many of these traditional open procedures require extensive soft tissue disruption in order to achieve correction. This in turn translates to a prolonged recovery often including a period of non-weight bearing or limited weight-bearing followed by many months of gradual swelling resolution, return to activities of daily living, and eventual progression to full physical activities. With most traditional open
bunion procedures, patients require toe strapping/ dressing changes every one-to-two weeks for approximately six weeks and their return to ‘normal’ can be anywhere between 6-12 months (if not longer).
Alternatively, minimally invasive bunion surgery offers the best of both worlds by combining excellent bone realignment with minimal soft tissue disruption. This in turn translates to less post-operative stiffness, decreased post-operative pain, reduced wound complications, and a quicker recovery and return to activity. The current technique for the minimally invasive percutaneous bunion surgery involves performing multiple one-to-two-millimeter keyhole incisions to complete a Minimally Invasive Chevron and Akin Osteotomy (MICA). Advanced equipment and technology allow this innovative procedure, including a low speed / high torque burr that cuts the bone while protecting the adjacent soft tissues. Additionally, special headless beveled cannulated screws are used for rigid internal fixation to optimize stability and allow early return to activity. The MICA technique optimizes outcomes while limiting the recovery time frame, thereby translating to an earlier return to activity.
The surgery is an outpatient procedure that takes approximately one hour. Post-operatively the patient is weight bearing as tolerated in a hard-sole shoe for six weeks, with a bandage for only one-to-two weeks. Patients are often transitioned to a regular shoe by six weeks, increased physical activities by eight weeks, and usually have a “return to normal” lifestyle within three-to-six months.

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