Percutaneous bunion surgery: step by step

• Among the surgical options available to treat bunions or hallux valgus is the percutaneous minimal incision operation.
• Percutaneous bunion surgery is performed on an outpatient basis, i.e. hospitalisation of the patient is not necessary.
• Percutaneous surgery, like other techniques for treating bunions, eliminates the possibility of bunions recurring.

Before going on to explain what percutaneous surgery for the treatment of bunions consists of, it is necessary to explain what hallux valgus is and what the consequences of hallux valgus are.

Hallux Valgus is simply the outward deviation of the joint of the big toe which, due to its deviation, rests on the second toe and causes a deformity that is perceived as a kind of lump or ball on the side of the big toe: the bunionette.

We could then say that the bunion is a consequence of hallux valgus. In many cases, the bunion becomes inflamed and reddened, which can cause a lot of pain and discomfort to the patient.

It should be noted that bunions can be treated with surgery and that, if this is not done in time, it could cause other more serious problems for the patient, such as claw toes, hammer toes, etc., which are even more severe deformities and more difficult to treat.

On the other hand, we sometimes encounter patients who, although they have had a bunion for many years, have not shown any symptoms.

Some of the causes of bunions could be the following:

• Use of inappropriate footwear: this is one of the most common causes of bunions in the long term. Unsuitable footwear squeezes the toes at the tip, putting pressure on the toes and preventing them from moving freely. Wearing heels too often also causes pressure on the toes.
• Genes: heredity also plays a major role in the development of bunions, as the mechanical structure of the foot is inherited, as is the way we walk.
• Other factors such as age, foot disease (such as flat feet) or other diseases (such as rheumatoid arthritis) can also cause bunions.

This is one of the newest techniques for the treatment of bunions. It is performed under local anaesthesia, i.e. with anaesthesia only on the foot that is to be operated on and on an outpatient basis, meaning that the patient does not need to be hospitalised. 

This means that the patient can usually walk out on their own on the same day as the operation.

It should be noted that this intervention, like others for the treatment of bunions, is aimed at eliminating the deviation of the bone and realigning it. In addition, of course, to eliminate the pain and discomfort that the bunion causes the patient.

Percutaneous surgery does not remove the joint, but is surgery without osteotomy, i.e. without the need to cut the bone as is done in other types of surgery. This surgery basically consists of correcting the position of the joint so that the foot functions correctly.

As we said before, it is a minimally invasive technique that consists of making three or four small incisions (about 3 - 4 mm), which allow the surgeon to treat Hallux Valgus without the need to cut the bone or damage much tissue.

Percutaneous bunion surgery is performed in the following steps:

• First, the patient is given a local anaesthetic and then the X-ray machine is correctly positioned to guide the surgeon through the process and allow him to see what he is doing to the bone.
• Next, the specialist makes an incision right next to the bump, i.e. right next to the bunion.
• By inserting a surgical instrument through the incision made, the surgeon separates the bone to be operated on from the surrounding tissue, i.e. the joint envelope. Through this incision, the specialist inserts a surgical instrument.
• The surgeon then files away the excess bone of the hallux valgus, which is the cause of the bunion. The bone is filed down without damaging the surrounding tissue.
• Next, another incision is made between the first two toes, severing the tendon and capsule that maintains the deformity of the thumb, thus correcting the deformity.
• A third and final incision is made at the base of the big toe to reorient the toe to a position that prevents the bunion from developing.
• Finally, the surgeon sutures the incisions made and places a bandage on the patient to keep the toe in its correct position. This bandage will be removed one week after the operation.

The entire operation will last between 30 and 90 minutes, depending on the personal condition of each patient and the seriousness of their situation. This is the definitive intervention to eliminate the bunion completely and forever, as it will not happen again.

Once the surgery has been completed, the patient will be encouraged to walk as soon as possible with their foot on the ground, starting their recovery as soon as possible.

However, for the first few days, the patient will have to walk in shoes with rigid soles (made of wood or other hard, rigid material). What this type of footwear does is to support the foot correctly, preventing the toes from flexing in the last part of the step, which avoids pressure on the toes and, especially, on the big toe that has been operated on. 

This type of footwear must be worn by the patient during the healing process of the surgery, which will take 4 to 6 weeks in total.

In addition, after removing the bandage, the patient will be fitted with an element between the first two toes that will keep them rigid and allow the deformity to be corrected.

Percutaneous bunion surgery has a number of advantages over traditional surgery that are worth noting.

This type of surgery is more comfortable for patients, as the incisions are tiny and, therefore, healing is relatively quick.

Furthermore, as we have already mentioned, this surgery does not require the patient to be hospitalised, but is performed on an outpatient basis.

Another advantage is the postoperative pain that this operation causes the patient, which is practically non-existent and it is not usually necessary to take painkillers or anti-inflammatory drugs to relieve it.

As for the scars left by the incisions, they are barely noticeable due to their small size.

Finally, it should be noted that, as we have already said, the patient will be able to support himself quite soon after the surgery and will even be able to start carrying out his daily activities as normal. As for returning to work, he or she will be able to do so the same week, depending on the type of operation performed.