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Haglunds/Heel Spur/Achilles Tendinitis
Many patients have pain at the insertion of their Achilles tendon, where it attaches to their heel bone (calcaneus). In this case, the patient had long standing pain with a prominent, palpable, bone spur on the back of the heel. Many times patients with this issue will not improve with physical therapy alone. The traditional surgery involves a large incision directly on the back of the heel in order to remove the bone. This unfortunately, is a high risk area of the body for healing and it is possible to have complications after surgery such as infection and wound healing issues. With an MIS approach, the incisions are much smaller and with less risk of infection. Despite not being able to directly visualize the bone, your surgeon can remove the bone with a bur and then perform an arthroscopy of the posterior ankle to evaluate and repair the tendon back to the bone. Due to the lack of major wound problems, many patients, who would otherwise be excluded due to high risk of wound healing issues may be candidates for this MIS procedure. Finally, patients are allowed to fully weight bear as tolerated in a boot the day after surgery.
Do you have a flat foot with pain at the inside of your ankle? Many times, this is due to posterior tibial tendinitis. The posterior tibial tendon allows you to invert your foot and get up onto your tip toes while standing. When this becomes enflamed and degenerative, the foot can start to deform. There are several ways to treat this, but the most common involves performing a lengthening of the calf muscle, an osteotomy of the heel bone (cutting it and shifting it medially) and then reconstructing the medial tendon and ligaments in order to improve the shape of the foot. Many parts of this surgery can now be performed MIS, including the calf lengthening which may be done using two key hole incisions and an endoscopic camera to find the tendon and lengthen it, as well as the calcaneal osteotomy, which is done via a 5mm incision rather than a 2 inch incision on the outside of the foot. The benefits for pain, scarring and accidental injury to nerves and veins are lower with the MIS technique. The yellow line shoes the extent of the open incision as compared to the MIS incision (red).
Arthritis of the great toe is common, and can occur after injury or trauma or with imbalance of the ligaments. It often affects younger patients than hip and knee arthritis and can be very debilitating. There are several options for treating hallux rigidus, but the mainstay options include either a cheilectomy to remove of bone spurs from the top of the joint or a fusion of the painful joint. Both of these treatments can be performed with an MIS approach. For cheilectomy, the surgeon will use a special instrument to remove the spur through a 3mm incision near the painful bone spur. Due to the small size of the incision, our patients report minimal pain following the surgery and they are allowed to walk immediately since there is so little risk of wound complications. The picture to the left shows the before and after appearance of a patient who underwent simultaneous bilateral cheilectomies. She was able to walk immediately and her pain was significantly improved even at 2 weeks. The central image shows the bone spur before and after it is removed with the burr. The image to the right shows a patient who underwent a MIS 1st MTP fusion. You can see the severity of her arthritis on the pre-operative xray and the successful fusion by 6 weeks.
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Frequently Asked Questions
Should I have Bunion Surgery?
Bunion surgery is almost always elective. Surgery is indicated for pain and/or progressive deformity that interferes with shoe wear and activities, and when non-surgical measures have failed. Cosmetic correction, while generally achieved with surgery, is usually a secondary consideration. Other considerations as to the timing of bunion surgery include age, general health, and foot circulation, as well as setting aside dedicated time for recovery. While shoewear options are improved with bunion surgery, predictable decreases in overall shoe size cannot be guaranteed, and studies have shown that up to one-third of patients still cannot wear some types of shoes.
I have bunions on both feet. Can they be done at the same time?
No. Bunion correction with Lapidus fusion must be performed one foot at a time. The other foot may be corrected generally three to six months later.
I have hammertoes and other foot problems. Can they be corrected at the same time?
Yes, that is usually not a problem. However, they must be evaluated carefully. Make sure you schedule another appointment before surgery. Do not wait until the morning of your surgery to mention it.
Where will the surgery take place?
Your surgery generally takes place at an outpatient surgical center.
What does the post-operative course after Lapidus Fusion look like?
Download the Lapidus Fusion Bunion Realignment Post-Operative Guidelines for full details.
