A Less Invasive Approach to Bunion Surgery

Nobody likes bunions. These large bumps near the big toe are ugly and painful and can make it difficult to walk or even exercise. Bunions can be corrected surgically but that can generate a new set of issues.

Image of bunions before minimally invasive procedure.

Until recently, all bunion surgeries were invasive, quite painful and required long recoveries. But now, a less invasive approach is providing an additional option for many South Florida patients.

Bunion biology is pretty simple. The base of the big toe’s first metatarsal bone gets angled in, forcing the rest of the bone to angle out. Muscles and tendons soon follow suit. Bunions can be caused by arthritis or even wearing tight shoes, and conservative treatments can include wider shoes or toe spacers.

Orthopedic surgeons can perform different procedures, depending on a patient’s specific needs. But until recently, they’ve always had to significantly manipulate soft tissue in order to expose the problematic metatarsal bone, which is why recovery times have often been so long.

“The majority of these surgeries require that patients stay off that foot for a significant period of time,” said Amiethab Aiyer, M.D., assistant professor and chief of the Foot & Ankle Service in the Department of Orthopaedics at the University of Miami Health System. “We're talking about anywhere from six to eight weeks on average in my experience.”

This long recovery, and the pain associated with surgery, can deter people from getting their bunions repaired. But the minimally invasive approach makes for a much gentler procedure.

“The incisions are drastically smaller,” said Dr. Aiyer. “I basically use small incisions to get to the bone and use a special tool to cut the bone, while limiting the risks of injuring soft tissues. I can cut the bone and shift the position of the metatarsal head within minutes. With this technique, we are minimizing soft tissue dissection, which means the amount of pain patients experience postoperatively tends to be lower.”

Image of feet after bunion correction procedure.

Dr. Aiyer tries to get patients on their feet right away, mostly walking on their heels. The overall recovery time is reduced to four to six weeks.

Rebeca Silva was Dr. Aiyer’s first minimally invasive bunion surgery patient, and she’s a believer. Silva had been reluctant to go the surgical route, worried it might be too painful, but the new procedure took care of that.

“The operation was really easy,” she said. “Maybe the first two days I felt a little bit of pain, after that it wasn’t bad at all.”

Seeing Silva in her recovery boot, some of her friends expressed their own concerns about getting the surgery.

“I told them this is a new technique, and you’re not going to feel much pain,” said Silva. “It’s an easy recovery.”

Dr. Aiyer cautions that this new approach is not for everyone. In some cases, a patient’s condition may be too severe for minimally invasive surgery. However, he’s happy to offer this new option, which can correct bunions without as much pain, or as long a recovery, as traditional surgery.

“Bunions are a quality of life issue more than anything else,” said Dr. Aiyer. “But, if they are affecting your ability to wear shoes or do the activities you love, then it’s reasonable to think about having them addressed surgically.”