Keyhole / minimally invasive bunion surgery (MIS)

MIS (minimally invasive surgery) aka Percutaneous. This type of keyhole surgery is used when acting on the bone as opposed to the joint (in which case the medical term is arthroscopy). By using innovative instruments the foot bones can be addressed through 3-5mm incisions. By being more protective of the foot tissues, the surgical aggression is minimal and the pain is reduced leading to a faster recovery.

Advantages of MIS (keyhole surgery) for bunions 

* Less immediate pain 

* Less big toe stiffness / better motion.

* Smaller scars

Research of the highest level of evidence is time consuming but very valuable in assisting clinicians and patients in decision-making. This week a Level I randomised controlled trial I contributed to comparing open surgery vs keyhole (minimally invasive) was published at the Journal of the American Orthopaedic Foot and Ankle Society. This study showed that keyhole surgery is less painful (almost by half) than open surgery in the first 24h from surgery.

Another advantage of these keyhole techniques is that stiffness is almost non-existent allowing for a faster recovery and earlier return to shoes including heels. 

Smaller scars are not the main reason for indication of this type of surgery over traditional open surgery. The end goal is a perfectly corrected bunion that will last for good, and so not all cases are amenable for keyhole (aka minimally invasive) surgery. But when indicated, in addition to the smaller scar, the main benefits of keyhole bunion surgery are less pain and better motion.

This latest study complements a previous one I authored which compared different keyhole techniques for bunion surgery and concluded that higher level studies were needed to advance in the knowledge of the best available techniques.