Bunion Surgery: is ‘Keyhole’ or ‘Open’ the better option?

15 years ago, a selection of pioneering surgeons in the UK and France began performing foot and ankle surgery through keyhole procedure. This was yet another breakthrough in our incredible medical advances thanks to a couple of very clever surgical specialists.

Fast forward to today, and keyhole surgery has remained an area of specialisation amongst surgeons performing foot and ankle procedures. Only a relative handful of these surgeons in Australia are trained in performing such fine-tuned procedures.

The Pure Physio team recently attended a lecture evening, held by Melbourne Orthopaedic Group, to update our knowledge around these surgical procedures and the best approaches for post-operative rehabilitation. Here’s a quick snapshot of what we learnt.

A background to bunions.

Keyhole surgery has proven an effective approach to bunion treatment, as long as the initial deformity isn’t too severe.

A bunion is the common name for a foot deformity that occurs at the big toe joint. It can cause significant pain when walking, or wearing high heels for women. The pain caused is because the big toe becomes angled inward towards the second toe, which causes stiffness and abnormal movement through the big toe joint.

The most common underlying cause of a bunion is ‘flat feet’. In simple terms, this means the normal arch of the foot is flattened. A flat foot alters the way in which the big toe is able to flex as we raise up onto our toes. Over time, this causes the big toe to be pushed in an inward direction towards the second toe.

Due to the gradual changes in the position of the relevant bones, bunions can be treated without surgery if they’re caught early.

When bunions are caught in the initial stages, physiotherapists can treat and alleviate the issue through a combination of specially-fitted orthotics and specific foot-strengthening exercises.

However, if left unchecked into later stages, bunions lead to long term changes in the structure of the foot which require corrective surgery.

Key benefits of keyhole surgery.

When compared with traditional, ‘open’ procedures, there are three main benefits of the keyhole approach. They are:

— The surgical wounds are much smaller, therefore decreasing the risk of infection and speeding up healing times.

— There is decreased post-operative stiffness in the foot which enables a patient to start mobilising more quickly. That means you’re ‘back on your feet’ in a shorter time frame.

— Weight bearing can commence earlier with less risk of wound infection, due to the lower-grade stiffness.

While all of these benefits are fantastic for patients, there is a downside. Due to the intricate nature of such surgery, keyhole operations causes more swelling to occur post-operatively than in an open surgical approach. This means lots of post-op management for swelling and inflammation.

The importance of rehabilitation.

As with any surgery, the procedure itself is only the starting point of a much greater journey back to full motion. Each of the surgeons who spoke at the event strongly advocated that a solid, structured rehabilitation program be put in place for the period following the operation.

Where bunions are concerned, rehabilitation programs play an essential role in regaining normal walking patterns. They’re most effective when tailored to specific patients based on their further physical goals

The team at Pure Physio is well versed in the assessment, advice and treatment of bunions. We have close collaborative relationships with CBD-based foot and ankle surgeons. The Melbourne Orthopaedic Group itself only a stone’s throw from our two clinics. We also have our own in-house Podiatrist, Ben Westaway, to provide a complete and well-rounded team approach to your treatment.

If you’re experiencing bunions or any other kind of foot pain, or you’d like to know more about the implications of keyhole and open approaches to foot surgery, get in touch today!

About the Author

Kate Senini — Consultant Physiotherapist

Kate, who was a founding partner at Pure Physio in 2010, is now working exclusively in a clinical role. Helping people recover from injury and prevent future injuries has always been her true passion!

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