Grandville Foot and Ankle Recommends Minimally Invasive Surgery for Bunions Instead of Lapiplasty

KEY TAKEAWAYS:

• MIS uses much smaller incisions. The approach is designed to reduce disruption to surrounding skin and soft tissue compared with more extensive open procedures.
• MIS can offer an easier early recovery. Less tissue disruption may mean less postoperative pain, smaller scars, and earlier return to weight-bearing for appropriate patients.
• MIS preserves more of the foot. When a bunion can be appropriately corrected without joint fusion, MIS offers the possibility of achieving that correction through tiny incisions while preserving the joint.

A painful bunion can make walking, running, and even moving a challenge. Bunion pain can feel like a dull constant ache, a sharp or burning sensation, and/or stiffness, accompanied by redness and swelling where the protruding bone rubs against your shoe. This persistent pain is caused by the misalignment of the joint at the base of the big toe—and the bunion develops when the big toe and the long bone behind it move out of their normal positions. Lapiplasty straightens the bone behind the big toe and joins two bones together at a joint in the middle of the foot. The surgeon uses plates and screws to hold everything in position while the bones heal together.

Lapiplasty has been a common surgical procedure to address a foot bunion.  While Lapiplasty can correct a bunion, and the procedure remains useful for some patients, minimally invasive surgery (MIS) for bunions is changing the game. MIS can also make powerful structural corrections to the foot, but the MIS procedure is shorter, and healing is easier and faster. Here, Dr. Sarah Stewart explains MIS for bunions, why some podiatrists are shifting away from Lapiplasty, and why she no longer performs the Lapiplasty procedure in favor of MIS.

The Differences Between Lapiplasty and MIS

One primary difference between Lapiplasty and MIS is how much surgery is required to accomplish the correction. Lapiplasty corrects the position of the first metatarsal and then permanently fuses the joint at its base. Fusion can be valuable when that joint itself needs to be stabilized. But if a patient's bunion can be fully corrected without sacrificing that joint, MIS gives the surgeon another option.

MIS allows the surgeon to cut and reposition the bone through tiny incisions and typically leave the first tarsometatarsal joint intact. That makes the procedure appealing to podiatrists who want to correct the deformity while preserving healthy anatomy and limiting tissue disruption.

Why Does Preserving the Joint Matter?

Every surgical procedure involves tradeoffs. A fusion intentionally eliminates movement at a joint to create stability. Sometimes that tradeoff serves an important purpose. But when fusion is not required, preserving natural anatomy has an obvious appeal. MIS allows the surgeon to address the deformity by cutting and repositioning the metatarsal rather than automatically sacrificing motion at the first tarsometatarsal joint. Combined with small incisions and limited soft-tissue disruption, the MIS procedure is particularly attractive to patients who want their bunion corrected without undergoing more surgery than their condition requires.

Other Benefits of MIS for Bunions

If you’re a good candidate for MIS, Dr. Stewart prefers MIS for bunions for the following reasons:

• Modern MIS doesn’t use screws. Some MIS procedures still use small screws to stabilize the bone. Our Grandville practice offers a hardware-free MIS technique that relies on bone position and natural healing with no permanent metal implants.
• Smaller scars. The tiny access points used for MIS generally produce much smaller scars than other procedures.
• Less disruption, less pain. With MIS, there’s less disruption of healthy tissue. When there is less tissue disruption and smaller access points, the patient may have a more comfortable recovery.

Why Dr. Stewart Recommends MIS Instead of Lapiplasty

When both MIS and Lapiplasty can address a patient's bunion, Dr. Stewart no longer performs Lapiplasty and prefers MIS. But she still makes that decision based on the needs of her patients and whether they’re good candidates for MIS. Factors that can influence the surgical plan include:

• The severity of the foot deformity. X-rays may help determine where the deformity originates and how much correction is required.
• Joint condition and stability. Arthritis, instability, previous surgery, and other structural findings can affect whether the patient is a good candidate.
• The patient's lifestyle. Work demands, activity goals, footwear, and expectations for recovery all deserve consideration.

Ask Dr. Stewart About MIS for Bunions

If you’re dealing with a painful bunion and want to learn about MIS, make an appointment with Dr. Stewart at Grandville Foot and Ankle. She will evaluate the structure of your foot, review your X-rays, and explain if MIS is the best procedure for your particular foot deformity. Dr. Stewart will give you personalized attention and build a treatment plan based on your specific needs.