Minimally invasive surgery

Minimally invasive surgery is a less intrusive, advanced surgical technique revolutionizing foot and ankle surgery. This enables the surgeon to surgically access parts of the bone and joint through tiny incisions made over the skin. The surgeon is guided by using either a lighted scope with a camera at the tip (arthroscope)or a miniaturized X-ray machine (Mini C-arm) which gives real time x-rays in theatre.

Less invasive bunion surgery also knows as minimally invasive bunion surgery or simply MIS, is performed using a newly designed instrumental cutting tool (bur/burr) rather than using an aggressive saw to surgically cut the bone. As a result, the incisions are made percutaneously instead of using standard extensive cuts which are prone to cause wound break down, infections, scarring, swelling and increased pain

By avoiding making large incisions over the foot, Dr Crane can preserve the health of adjacent soft tissues (the joint capsule, bone, muscle and skin). As a result, the foot is usually far less painful and far less swollen following the MIS procedure. Due to the less invasive nature of the procedure, the bones can heal faster and are more stable allowing for early full weight bearing and less pain.

Procedures

Minimally invasive surgery through tiny “keyhole” incisions has grown increasingly popular over the years in the medical field. Less invasive surgery addresses a diverse range of foot and ankle problems, such as ligament tears and foot abnormalities including bunions, hammer toes, pain under the forefoot fat pad (metatarsalgia), bunionettes (bunions of the 5th toes) and several other ankle and foot pathologies.

Some of the surgeries used to treat bunions include:

The Lapidus procedure
is a surgical technique for a mild or severe foot (bunion) deformity. The procedure entails the fusion of the joint that rests between the first metatarsal bone and the smaller bones in the midfoot (medial cuneiform). Surgery entails the removal of cartilage surfaces from the bones, the meticulous correction of the angular deformity and the insertion of hardware (plates and screws) that enable the bones to fuse eliminating the bunion deformity.
Percutaneous Chevron Akin (PECA)
used to correct bunions is a technique that involves cutting and re-aligning of the first metatarsal bone and the bone of the big toe, to restore function and big toe joint alignment. This will eliminate the bunion deformity, allowing you to wear any chosen footwear and restoring the cosmesis of the foot and ankle.
The chevron Akin osteotomy
technique is a minimally invasive procedure (MIS) used to resolve mild or moderate hallux valgus abnormalities. The method involves percutaneous surgery, making small skin incisions to insert the bur and cut the first metatarsal head at the bunion. The bunion will be removed, and the metatarsal head will be shifted over. Two specially designed screws are inserted percutaneously under Mini C-arm X-ray guidance to stabilise the metatarsal permanently in its new corrected position.
The SCARF and AKIN procedures
were one of the original procedures used to treat bunions and incorporated two large unsightly incisions. These can now be performed by less invasive bunion surgery methods and conducted though one small incision.

Surgery used to treat pain under the ball of your forefoot(metatarsalgia)

Distal metatarsal minimally invasive osteotomy (DMMO).
Previously patients with pain under the front of the foot, needed surgery to elevate and shorten the bones in the forefoot (Weil Osteotomy). This involved large incisions and the need for titanium screws. However, with MIS, only 1mm incisions are made and the bone is cut using a bur/burr performing a DMMO on each metatarsal bone involved. With no screws inserted you will be encouraged to walk immediately after surgery. You will experience far less pain and swelling.

Surgery used to Flat Feet: (pes planus)

The previous surgery involved making a large skin cut and using a saw blade to cut and shift the heel bone (calcaneus) across into a more normal position. It was then fixed in place with a large titanium plate and screws fixed against the bone. While Minimally invasive calcaneal osteotomy involves a 1mm skin incision and using the percutaneous bur/burr, the calcaneus is cut and slid into position, a percutaneous screw is then used to stabilise the bone. MIS eliminates wound problems and allows for early mobilisation resulting in less swelling and less pain.

Recovery

Surgery has been performed without interfering too much with the skin, bone and underlying structures, so that early full weight bearing is allowed, in contrast to the previous traditional open surgical technique. For the initial two weeks following surgery, you will be requested to limit or modify physical activity and elevate the foot for at least fifty to eighty per cent of the time to reduce swelling. Dr Crane will advise on further postoperative instructions to limit recovery time and help you return to work and daily activities.

Certificate

Certificate of Participation

The less invasive surgical correction of bunions offers a faster postoperative recovery period, improved big toe range of motion, enhanced cosmetic results and minimal pain.

Qualification for MIS surgery can only be determined based on a comprehensive physical examination of the foot. Diagnostic tests involving X-rays of the foot will be performed during the consultation. All surgical and conservative options will be discussed with you, including all the pro’s and con’s of each surgical technique.

Depending on the surgery, you will begin full weight bearing in a post operative shoe immediately after the surgery. You can return to wearing normal walking shoes (sneakers) within six weeks after the PECA procedure or eight weeks following the MIS Lapidus procedure. Usually swimming and indoor cycling can begin at two weeks, driving at four weeks and impact exercise (running and trail running) after three months.