Authors: Akash Gupta, M.D., Providence Milwaukie Hospital, Eastside Orthopedics & Sports Medicine
Natalie Mesnier, M.D., Providence Portland Medical Center, Multnomah Orthopedic Clinic
Patients with hallux valgus (bunions) or lesser toe deformities such as hammer toes have a wide range of potential options to correct what can be debilitating and limiting conditions. There are many surgical techniques for bunions alone.
Our experience shows, however, that a new type of minimally invasive surgery for bunions, as well as other conditions such as hammer toes, is extremely effective for many patients who have unsuccessfully tried nonsurgical conservative measures.
We believe minimally invasive foot surgery has several advantages over many of the more traditional surgical options, including minimal incisions that result in much less scarring to the soft tissues, earlier weight-bearing, lower infection rates, less pain and swelling, and better joint preservation.
Patients can resume activities several weeks sooner than in traditional surgical approaches. This includes full weight-bearing within two weeks for the vast majority of patients, transition to regular shoe wear at 4-6 weeks, and resumption of most activities at 10-12 weeks in most patients. In more traditional bunion surgeries, weight-bearing doesn’t begin until 4-6 weeks, and full recovery often can take several months up to a year.
Characteristics and presentation: bunions and hammer toes
Bunions
There are many causes and factors related to a presentation of bunions. They include:
- Abnormal foot mechanics
- Tight Achilles tendon
- Severe flatfoot (e.g., rupture of PTT)
- Inflammatory arthritis (gout, RA)
- Shoes
- Hereditary factors
- Other (e.g., trauma, CP, CVA, stroke)
Common symptoms include: pain over the prominent bunion with shoe wear, nerve irritation and/or neuromas, bursitis, and pain under the second and/or third toe. Conservative treatments – including orthotics, night splints, roomy foot wear, bunion pads and low heels – should be attempted before any discussions of surgery.
Hammer toes
A hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth or fifth toe causing it to be bent, resembling a hammer. It commonly occurs in conjunction with other deformities. Common symptoms include: pain, crossing over of the toe, inability to comfortably wear many types of shoes, and skin breakdown over the contracted joint or at the tip of the toe.
As with bunions, a conservative approach for treating hammer toes should be attempted first. This includes: shoe modifications, toe crests, gel sleeves, metatarsal pads and a Budin splint.
Advantages of minimally invasive vs. traditional surgical approach
Relatively new to the U.S., minimally invasive foot surgery was popularized in Europe about 13 years ago. Specialized tools allow for the bones to be cut and realigned through small keyhole incisions of approximately 2-3 mm. This allows for correction of the bony deformity without having to strip away soft tissues. This preservation of soft tissues not only reduces scar tissue formation and stiffness, but also allows for immediate weight-bearing after surgery.
“I’d worn dress shoes all my professional life, with my feet aching at the end of the day. Unbeknownst to me, I was wearing shoes that were too narrow for my foot,” said Jason Johnson, a Portland-area patient who underwent the minimally invasive surgery in October 2021. “The combination of lifestyle and genetics led to a bunion on my right foot and a significant amount of pain. I knew of bunion surgery but never pursued it due to documented lengthy recovery time.
“I walked out of the surgery wearing a special boot that restricted movement but still allowed me to walk,” he said. After following the recovery regimen faithfully for several weeks, Jason continued to elevate and ice his foot as he folded in more walking and other activities.
“Today, exactly one year later, I completely forget about the pain I was experiencing prior to the surgery and truly don’t even think about my right foot.”
For Jason and other patients, the difference in recovery time is significant when comparing traditional open surgery and minimally invasive surgery:
|
Traditional Open Surgery |
Minimally Invasive Surgery |
|
|
Day of surgery |
Nonweight-bearing in splint |
Weight-bearing as tolerated in forefoot offloading shoe |
|
2 weeks |
Transition to boot; either nonweight-bearing for additional 2-4 weeks depending on procedure |
Full weight-bearing in flat post-operative shoe |
|
4 weeks |
Start partial weight-bearing if Scarf osteotomy |
Transition to regular footwear |
|
6 weeks |
Start weight-bearing if fusion; full weight-bearing in post-op shoe |
Begin exercise and strength training |
|
10-12 weeks |
Transition to regular footwear; begin strength training |
Resume all activities as tolerated |
Before and after photos
In addition to comments we hear from our satisfied patients, it’s gratifying – and striking – to see the significant improvement as illustrated in “before and after” images from two different patients.
Patient #1 (pre-op and 6 weeks post-op)
Patient #2 (pre-op and post-op)
“I’m so happy I pursued the less invasive surgery. It’s been a life-changing event for me,” says Jason, whose sister, based on his recommendation, also received the minimally invasive procedure.
For more information or to make a referral
Akash Gupta, M.D.
Eastside Orthopedics and Sports Medicine
6542 SE Lake Road, Suite 201, Milwaukie, OR 97222
25050 SE Stark St., Suite 301, Gresham, OR 97030
For referrals, call 503-659-1769 or fax 503-659-7522
Email: akashg@eosdocs.com
https://www.eosdocs.com/
Natalie Mesnier, M.D.
Multnomah Orthopedic Clinic
5050 NE Hoyt St., Suite 626, Portland, OR 97213
For referrals, call 503-231-1426
https://www.pdxfootandankle.com
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