Not so killer heels – Bunions and their treatment through keyhole surgery/minimally invasive surgery

My experience as a doctor over the last 15 years or so has taught me many things about cause and effect in medicine – smoking kills, sugar rots teeth, too much sun can burn!

Today I’m writing about one that isn’t true. The myth of high heels causing bunions! For all of you, high heel lovers out there breathe a sigh of relief and repeat after me – “heels don’t cause bunions!” For the vast majority of bunion sufferers, it’s inherited and there is a member of the family who has them too. For the rest, I’m afraid it’s a matter of stretchy tissue and biomechanics.

Bunions also known as hallux valgus are a painful protuberance of bone on the inside of the forefoot. Bunions cause pain due to rubbing on footwear. The skin over bunions gets thick and often red and sore especially at the end of the day. The protuberance is the metatarsal bone moving inwards and the toe moving outwards leaving a bunion where they meet at the big toe joint. This joint becomes crooked and the normal moving surfaces do not move how they used to. With time these surfaces can become arthritic which adds to the pain of the bunion.

The bunion is the beginning of the problem with the front of the foot (the forefoot). Again, with time the big toe (great toe) will push on the second toe as it moves over and causes rubbing of this toe. The rubbing on the second toe can cause painful calloused skin as well as changes to the shape of the toe. The second toe can ‘cock-up’ and over-ride the big toe or go under the big toe. This, in turn, causes pain in the joints of the second toe and it can become a mallet toe or hammer toe.

Worse still the other long bones of the foot known as metatarsals can start to take more weight through them rather than going through the now bunion area. This can cause pain in the ball of the foot called transfer metatarsalgia and can feel like walking on pebbles.

I perform a keyhole surgery for bunions. Also known as minimally invasive surgery (MIS) for bunions or minimally invasive chevron and Akin (MICA) bunion surgery. This approach is less painful bunion surgery than open surgery. It also allows for faster recovery time for bunions.

The technique employs several small keyhole cuts over the bunion to break the bone and move it. This small series of scars amounts to less than twenty percent of the overall scar needed in most open surgery. There is an obvious cosmetic benefit but also with a smaller scar, there is a smaller risk of infection.

Once the bone is moved into its desired place it is held with screws. The screws are accurately placed using live X-ray in surgery. The screws I use have a special bevelled edge leading to less screw irritation under the skin. This can sometimes be felt by patients with quite slim feet hence this takes that risk down.

The bunion bump is shaved through the same keyhole used to cut one of the bones. The small cuts and little soft tissue disruption, as well as optimal utilisation of each small cut, allow for a rapid recovery. This is quicker than open surgery. It is also less painful than open surgery.

You can walk immediately after surgery. Keyhole bunion surgery is done as a day case surgery. This minimally invasive approach often needs very little post-operative pain relief. After two weeks you should go into a stretchy training shoe and start stretching exercises.

You can go home the same day as surgery. This minimally invasive bunion technique allows incredibly rapid rehabilitation for a safe return to home the day of surgery.

After surgery, some good elevation at home will help keep swelling down. You can walk quite comfortably and go about light daily duties as required. I recommend outings to those that can. You take lots of breaks and rest your foot up to keep swelling down. By keeping the swelling down, you create a good healing environment for getting the best out of your bunion operation.

I will then look forward to seeing you personally at two weeks and will remove the dressing to show you your new foot. At this stage, I encourage stretching exercises which will be described to you. I feel the early stretching allows you to get a better range of motion after surgery and allow you to get the most out of your surgery.
I’m incredibly passionate about this type of surgery and the rapid recovery with less pain than open surgery which this technique allows.

About Kumar Kunasingam – Kumar is a medically qualified doctor and completed his medical and surgical training in London and the South East. He travelled to Sydney, Australia for extensive fellowship training in foot and ankle surgery. This included all specialist foot and ankle surgery and specialist lower limb trauma surgery. He is also qualified in sports and exercise medicine and specialises in foot and ankle sports injuries. Kumar did a trauma fellowship at King’s College Hospital which is one of London’s major trauma centres. His practice covers all aspects of foot and ankle surgery and he is passionate about keyhole foot and ankle surgery.