Traditional bilateral Bunion surgery or Minimally Invasive Bilateral Bunion surgery?

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Hi All,

I'm in Sydney Australia and am considering bunion surgery. I've consulted with both Dr. Peter LAM, who specialises in minimally invasive (MI) surgery, and with Dr Sameer Viswanathan (head of orthopaedics at Campbelltown Hospital) who used to do MI surgery but doesn't do it anymore as he believes better results are had from traditional bunion surgery, where he can visually correct the deformities. 

Dr Lam is a lot more expensive and didn't say that bunions could re-occur (which the other doctor advised due to my age, they could - I'm in my late thirties), though it does appear that the MI technique has a lot quicker recovery time, and Dr Lam is an expert in it. However Dr Viswanthan is mostly covered by my health insurance provider, so a lot less out of pocket expenses and he said there was less chance of damaging the soft tissue through traditional bunion surgery, so it was a better option long term.

Does anyone have any experience with either of these doctors or the procedures themselves? Any thoughts or suggestions? I'm rather confused about which procedure to go with. The MI surgery is looking to be about $6000 out of pocket and the traditional surgery is around $1500. So a fair bit of difference, and I do know that you often get what you pay for, however Dr Viswanthan is the head of the department at a large Sydney Hospital (as well as a lecturer at a university), so he obviously knows what he's about... But then so does Dr Lam re the MI technique. Feeling very confused...

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  • Posted

    Hi Madsy,

    I have not had any minimal invasive surgeries, but I am on my 4th surgery.  The first on only included shaving off the bone.  It didn't work because it's all about the angle of the bones.  The second and third surgeries for both the left (2nd attempt) and right foot were successful.  They included cutting a triangle in the 1st metatarsals so the angle would not longer be there.  I am 49.  The last surgery was 30 years ago.  My toes on both feet did shift back over but the bunions never reappeared.  Over the past 7 years I have had pain in the ball of my foot.  It feels like there is a rock in my shoe.  It is predominately on my left foot.  Turns out because of the amount of shortening of the 1st metatsaral, it put pressure on the 2nd and 3rd metatarsals causing the pain.  This 4th surgery corrected that.   My doctor said it was a common problem.  The angles all have to work together.  Read up on the procedures on the internet.  You will be able to understand the mechanics of the issue.  Hope that helps.

    Carrie

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    • Posted

      Carrie!

      I'm 18 weeks post op and have been battling "the rock in the shoe" pain under ball of foot near

      3-4 toes. 

      My Dr has been ghastly. Acting as if this an anomaly. Finally I researched online and found "neuroma".

      My bottom of foot feels like there is pressure about to pop or squish out both sides when the pain flares up. I hardly go around barefoot anymore.  Was this the case with you?

      How did you repair it? Can you give me more info about it?

      I'm so happy to discover you!

      And relieved by your comment that it's common problem. 

      I teach pilates n yoga and know about alignment issues. I had a sneaky suspicion it was about alignment. 

      Please anything you can share smile

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    • Posted

      Hi Debbie,

      Look up metatarsalagia.  That's what mine was called.  I am going into 7 weeks po now.  I am beginning to walk around barefoot but seem to have pressure under toes 3 & 4 like you.  I am seriously hoping it's because I'm favoring my first three toes.  

      As for me, my first metatarsal had an angle cut out of it 30+ years ago.  The bone from the first knuckle on the big toe also had an angle cut out of it at the same time.  Everything was fine for many years and then I experiences the rock in my shoe thing.  I tried foot inserts and ugly shoes, but it kept coming back.  Going to yoga was out of the question because of the pressure that was on the ball of my foot.  Pretty much all exercise outside of the pool was out of the question.  

      I ended up seeing a local doctor for an ingrown toe nail on the other foot.  I said something to him about the issue in the ball of my left foot.  He said yep I can see that you have a problem.  I'm surprised you didn't come in earlier.  This happens sometimes with the procedure you had in the past.  The angle that was cut out significantly shortens your big toe bone causing more pressure on the second and third toe bones.  So he recommended an osteotomy on the 2nd and the 3rd.  I can't tell if it worked.  I'm still very much favoring my foot.  Looking at the X-rays it looks like there is no toe bones that are significantly longer than the others.  So I'm hopeful.

      Hope that helps.

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  • Posted

    Hi!  I can't help much more but I am wondering if perhaps it is worth asking Dr Viswanthan  how many bunion corrections he does a year?  Is it his specialty?  Does he only do feet/ankles as opposed to all orthopaedic surgery (knees etc).  The other surgeon I saw for a second opinion was on the Northern Beaches and he didn't do as many bunion corrections as Dr Lam per year so that was something that I took into consideration.  Good luck!  Emma

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    • Posted

      First , thank God for the NHS. I've had radical,old fashioned bunion surgery. It is all a question of angles. My bone on the big toe looked like a jig saw puzzle 6 weeks after surgery on the x Ray. After twelve it's all one bone. I've also had the instep fused. However, I think the four months I will have had off work would have applied anyway, even without the instep.

      There have been days when I wished I'd never had it done. Now when I look at my straight, almost pain free foot I know it's been worth it.

      With the NHS you get what you are given and you take it or leave it, that's really the choice. I trusted my doctor with my breast cancer and I'm an 11 year survivor. I've done the same with my feet.

      I think my question would have to be why does the less invasive one cost so much more, what is the difference in the operation and which one will correct the angle.

      Good luck

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  • Posted

    Hi Madsy

    I took ten years to finally get the surgery, and followed so many discussions on this forum to try and decide what surgery was best for me.

    My surgeon (Sunshine Coast Qld Australia) has been trained by Dr Lam and has some great things to say about him and the MI technique. In the end I had the traditional surgery though. 

    It all comes down to individual feet and economics. I originally wanted MI but after scans discovered several fractures in my instep that had to be pinned anyway, the old slice and dice was the better option. My surgeon also did say that he KNEW he could get very good results with my degree of deformity.....I was a dancer and pointe work had broken a lot of my toes too....he wasn't as confident that he could achieve the same with MI. So bunions gone, ligaments shortened (to correct the toes pointing the wrong way) six screws,  and three pins....and very little pain.

    I am THRILLED with the results. Four weeks down and I'm walking (albeit in orthopaedic shoes) very comfortably. My feet are straight, and while they'll never be pretty (too many years of ballet torture for that!) I'm so excited to be able to wear sandals and thongs this summer without people running away in horror!

    There are scars from this surgery, I don't know if that will be an issue for you? The recovery time is longer too I hear, but I'm pretty sure that there would be a whole lot of feet up going on with the MI recovery as well? As far as which surgeon to go with, just make sure they are listening to your concerns. My surgeon is a friend of ours (which helps) but I wouldn't have gone to him if he'd been a general orthopaedic surgeon.... he ONLY does feet and ankles. He knows his stuff and talked me through both options thoroughly. I think try and track down someone who's had the MI with Dr Lam and the same with the traditional with the other surgeon and get their opinion. Hopefully someone who knows them will contact you here. 

    Just going by my experience though (and that of several friends who've also had the traditional surgery.....dancers!) if you're seriously fed up with your feet don't be afraid of the old style surgery. It works. Just know that you'll have some recovery rehabilitation time. And just think of all the new shoes you could buy with the money you save?!

    Hope that helps, and good luck!

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