Parner
In Podiatry Today, Volume 27, Issue 9, September 2014, there is an
article describing a “minimal incision” approach to bunion (hallux
valgus) surgery by authors Norman A. Siddiqui, DPM and Guido
LaPorta, DPM. The authors recognize that while this is not new in the
United States, it is not a common form of bunion correction surgery
here but is common in Europe and Asia. In addition to describing the
details of their particular technique, and their success rate, they cite
various statistics supporting their notion that this type of surgery meets
with similar success to traditional open surgery for bunion correction. Many podiatrists will
disagree with this position. The authors also cite studies demonstrating
the downside to this kind of surgery.
When your podiatrist proposes bunion correction surgery you should
ask to be informed as to the name of the procedure she intends to use
and some of the details as to how the procedure is going to be
performed such as where and how long will the incision be, which
bones are going to be cut through-and-through (osteotomy) and
repositioned, what kind of internal fixation will be used (k wires,
screw, or absorbable screw are common), and what are the general
risks of the surgery and what specific risks would you be facing in
addition to the generally accepted risks. A good question to ask is this:
“Doctor, of those risks you just mentioned, are there any for which I
am at an increased risk?” Giving only the generally accepted risks of a
surgery is not enough. The list of risks need to be tailored for the
individual patient because there may be things unique to you or your
foot which may change the benefit risk equation.
If your podiatrist is going to propose a type of “minimal incision” form
of bunion correction surgery you should seek a second opinion. This
is something we say over and over again. We find that many of the
podiatrists in New York who prefer this uncommon form of surgery are
not Board Certified by the American Board of Podiatric Surgery, the
most respected Board for podiatrists who perform foot surgery. While
your podiatrist may enjoy success with a minimal approach to bunion
correction, be wary of those who try to convince you of their success in
the hope you will not get a second opinion and go elsewhere for the
surgery. It is very attractive to hear that there is less pain, less recovery
time, earlier walking in regular shoes and a cosmetically acceptable
scar. Often, that is not the case with this kind of surgery.
In fact, this is exactly what these authors say: ” The benefits of this
approach are: Cosmetic incision, Minimal soft tissue/bone dissection,
Low energy osteotomy, Shorter recovery, and Greater patient
satisfaction.” To the authors’ credit, they do cite the problems with this
approach:
“However, there are concerns about the minimally
invasive osteotomy. Kadakia and coworkers reported
on 13 patients who had minimally invasive distal
osteotomies. The authors abandoned the study due to a
high complication rate with problems including
infection, nonunion, osteonecrosis and malunion. The
authors felt this procedure had an unacceptable rate of
complications and did not recommend it. A critique is
that the authors adopted too many modifications to the
original technique when performing the procedure, thus
resulting in the complications they reported.” (Citations
omitted)
If you are interested in this topic, please go directly to the article at:
http://www.podiatrytoday.com/emerginginsightsminimallyinvasive-halluxvalguscorrection.