Everything you need to know about keyhole foot surgery
What is keyhole foot surgery?
Minimally invasive foot surgery – often called ‘keyhole surgery’ – has been in existence for decades and has now developed into a tried and proven category of surgical practice.
Rather than the large old-fashioned incisions that traditionally were utilised for bunion surgery and most types of foot surgery tiny multiple incisions or a minimal single incision are employed to allow for quicker recuperation and ultimately fewer complications.
Previously a large incision was made over the whole of the joint and extensive exposure of all the structures involved was carried out. This type of procedure leads to excessive trauma to all the tissues involved. It resulted in severe pain and a lengthy recuperation.
As the trauma was marked, prolonged hospitalisation was necessary and so to the problems that sadly goes with time spent on the wards, such as infection and deep vein thrombosis.
Pioneering surgeons commenced the lengthy research into this specialty decades ago, and this research has now lead us to understand how to execute this surgery to attain the results we desire.
What is keyhole bunion surgery?
Depending on the size and type of bunion, either one very small or three tiny incisions are made over the bunion, and specially designed fine instruments are utilised to free up contracted soft tissue structures.
Once this is done, the bone cuts are carried out using minimally invasive burs and saws. Correction of the deformity is then carried out and fixated with small, specially designed screws. These screws are hollow and titanium and do not need to be removed.
Who can carry out minimally invasive surgery?
Minimally invasive surgery requires specialised training.
There is additional training following on from a preceding surgical fellowship, such as podiatric surgery.
Damien Lafferty has undertaken and completed his training with ‘The Academy of Minimally Invasive Foot and Ankle Surgery’.
This organisation has over 2000 members and has been training specialists for decades. It is this specialised training that allows Damien to carry out the surgery safely and expertly.
Is minimally invasive surgery appropriate for everyone?
Minimally invasive surgery can be used to treat many foot conditions; however, in certain situations, this type of surgery is not appropriate. During the initial assessment, a decision will be made, and a discussion will occur to ensure you are comfortable with what is planned. Even if minimally invasive surgery is not appropriate, all surgery has markedly improved, and incisions are very small.
There are many benefits of minimally invasive surgery over traditional surgery.
Keyhole surgery allows for:
- Less trauma to the surrounding tissues
- Less swelling
- Less pain.
- Decreased pain
- Reduced complications
- Quicker recovery.
The surgery is carried out as a day surgery case, and you can walk on the foot immediately after leaving the day hospital. Avoiding overnight stays in the hospital allows us to decrease the problems that can occur with hospitalisation, plus keep costs down.
Keyhole foot Surgery and Recovery
When do I need surgery?
Foot and in particular bunion surgery is typically carried out:
- Once the bunion becomes painful
- Begins to damage the rest of the foot
- Is painful when wearing shoes or is
- Starts to impact on your daily activities.
Bunion surgery in the past was painful and would often only produce a temporary fix.
With modern bunion surgery, this is now not the case, and hence it is usually best to correct the bunion before it damages the rest of the foot.
Is minimally invasive surgery/keyhole surgery appropriate for every bunion surgery?
In certain situations, minimally invasive surgery can be utilised; however, in well-established bunions with particular changes to two small bones around the joint, an open incision is necessary. These open incisions are now very small, and scarring is also very minimal.
What is involved in the recovery after keyhole foot surgery?
The surgery is carried out as a day surgery case, and there is no need for an overnight stay in the hospital. The operation allows patients to be on their feet immediately following the procedure.
In these instances, patients are expected to wear a post-operative protective shoe over their bandaging to protect the surgical site.
In the first 3-7 days, patients are expected to rest as much as possible even though they can walk to the toilet or to perhaps make a cup of tea or heat a meal.
At your first post-operative review (approximately seven days following the procedure), the dressing is changed, and at two weeks this large dressing is replaced by a very small dressing following a daily saltwater soak.
For most patients, a return to regular footwear occurs at about 3 to 4 weeks following the procedure, although this does vary from patient to patient.
When can I drive after keyhole surgery?
It is typically advised to avoid driving while the large dressing is on and you are in the post-op shoe. This will mean you should avoid driving for about 2-3 weeks. This is often for safety reasons.
Is keyhole surgery painful?
One of the main improvements in all foot surgery is the marked reduction in pain. Pain is now controlled.
The incisions are very small, and a lot less damage is done during the operation.
The advancements in medication also allow pain not be an issue at all now. Some patients may require more intervention, however many patients experience no pain after the surgery.
Will bunions come back after bunion surgery?
Research has allowed us to know what works and what does not work. Modern bunion surgery aims to produce permanent results. The aim is to do the surgery once and never again; however, there is always the very slight chance that the bunion may return.
What complications can occur?
Bunion surgery is very safe, and complications are now rare, although there are certain risks that patients must be made aware of, regardless of the rarity.
The risks of foot surgery are very similar to those risks posed by having other surgery, such as infection, unexpected pain, anaesthetic complications, and deep vein thrombosis.
Some specific to bunion surgery are slippage of the corrected bone, movement of the tiny pins or screws, contractures of the wound and unexpected scarring.
There are also risks associated with having certain medicines during and after your surgery, such as the possibility of nausea and vomiting.
There exist many very rare complications that can occur; these are very rare; however, they can occur.
Risks associated with surgery are explained to the patient during their pre-operative consultation. You will have every opportunity to ask as many questions as you like during the consultation.
Useful resources:
The Australasian College of Podiatric Surgeons
The American College of Foot and Ankle Surgeons
The Academy of Minimally Invasive Foot and Ankle Surgery