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photos by Sydney Foot and Ankle Surgeon Damien Lafferty

There have been marked improvements in bunion surgery over the years to the point where, typically, the procedure is day surgery, the pain is controlled and long-term good results are achieved.

Keyhole surgery, better known as minimally invasive surgery, is very much the “flavour of the month”. It does have a place, but I find many surgeons are piling in, attracted by the supposed quicker surgery time before the long-term results are seen. Keyhole surgery, I feel, is one of these cases. I am a fellow of the Academy of Minimally Invasive Foot and Ankle Surgery and utilise the techniques with various pathologies. However, I do not feel it is appropriate with larger bunions, particularly where the sesamoids are sitting lateral. During any bunion surgery, if you do not get the metatarsal head back on top of the sesamoids, when the FHB fires, it can lead to a return of the bunion.

The case featured in this post is a fine example. The image on the left is of a patient who presented last week with a returned bunion from a previous surgeon’s attempt at keyhole surgery. Apart from all the unnecessary screws in this surgery, you can see the lateral sesamoid remains completely in the IM space. There are a few other factors I can see here, but it is the poor sesamoid position that would have led to the return and pain.

The image on the right is a patient who came in an hour after the keyhole case for a one-week review. You can see how the post-op X-rays show the sesamoids sit perfectly under the metatarsal, and a single 2mm screw is all that was required. This was all done via a very small incision leading to minimal swelling and quick healing. I feel keyhole surgery has a place, yet not for all cases.

If you have any specific questions or would like to discuss similar cases, feel free to contact me.

Also read:
Biomechanics of a pathology (bunions and pes planus)
Improvements in bunion surgery
Bunion surgery: Modern procedures for quick recuperation and long-term results

(This content is intended for healthcare professionals only)