Keyhole Surgery For Bunion
There are a number of deformities of the big toe which are often incorrectly bundled together as a "bunion"
. A true bunion is a condition called hallux valgus which is when the great toe deviates away from its normal axis normally pushing up against the adjacent second toe. This produces the painful and often rather red prominence on the inside of the great toe. Osteo-arthritis of the great toe is sometimes confused with bunions and this too can produce painful lumps over the top of the great toe with stiffness.
True
keyhole bunion surgery is caused by a combination of familiar or predisposition to the condition and use of tight compressing inappropriate footwear. The pain from bunions tends to be worst when walking in enclosed shoes, often with little bunion pain in sandals or going bare foot.
Treatment options for bunions range from non-operative to operative. Non operative options are obviously using wider shoes, softer shoes, sandals and sometimes little spacers between the toes. Most patients are able to tolerate these treatments for a little while but the majority of patients normally wish eventually to undergo surgery.
The decision to have surgery is based on a combination of the amount of pain, level of deformity/angulations of the great toe and also rate of progression of that deformity. The surgery is straight forward and commonly performed and involves a combination of removing the bony and soft tissue prominence on the inside of the great toe, this is combined with a z-shaped cut through the bone immediately behind the great toe together with a soft tissue correction to completely realign the great toe, returning its architecture to normal.
The surgery takes approximately half an hour per foot, and can be done under other general or local/regional anesthesia. Post operatively patients are in compressive dressings no longer requiring plaster casts and are requested to normally rest and elevate their feet at home for forty-eight hours. For the first fourteen days after surgery the compressive dressings remain on, after which patients come up to clinic, dressings are removed, and sutures are removed and patients can switch over to lose comfortable footwear such as trainers or
sandals, normally being able to get back into more normal footwear after approximately six weeks.
The reason that bunions are so common and they often become such an issue after the long winter is as already mentioned one of the causative factors is tight footwear and obviously during the winter period, ones feet have often been compressed into inappropriate footwear for some months, obviously aggravating a pre-existing condition.
The keyhole bunion surgery technique was developed by a society of French Surgeons in Bordeaux. Mr Palmer was one of the few English Surgeons to be trained and learn these techniques in 2007. Since then he has continued to develop his skills, with other European foot surgeons. Mr Palmer is currently undertaking many research studies in these minimally invasive techniques in all aspects of foot and ankle surgery.
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