WA's Premiere Provider of Keyhole Bunion Surgery
Dr Andrew Knox is a podiatric surgeon based in Cottesloe and is recognised as an international expert on minimally invasive surgery (MIS), having published the second largest study worldwide on outcomes from keyhole bunion surgery. He has been practicing since 2011 and was the first surgeon to introduce keyhole bunion surgery to Western Australia in 2018, and remains the premiere provider of this treatment in Perth.
Minimally invasive surgery including keyhole bunion surgery (MICA) procedure) is our core service offering, however Dr Knox is also very experienced in bunion surgery and is able to offer patients other surgical approaches also including traditional methods such as Chevron/akin, Scarf/akin, Lapidus Arthrodesis aka 'Lapiplasty 3D bunion correction' and 1st MTP Arthrodesis.
Rather than adopt a 'cookie-cutter approach' to bunion surgery, we prefer to individually tailor surgical planning for each patient based on their presenting condition, their needs, and expectations. In many instances however, we may suggest the keyhole bunion procedure as being the preferred method of treatment given that our published data demonstrated "95% of participants (161/169) obtained an excellent outcome from our minimally invasive surgery technique, with normal radiographic findings being observed."
The degree of deformity correction obtained from our technique was found to be similar to what is routinely achieved through traditional open surgery approaches. Full recovery from surgery still takes several months, however in our experience the immediate downtime from surgery is considerably less with the minimally invasive approach.
We are committed to providing patients with a high level of service, and open transparency in regards to expected results from treatment. To this end, Andrew remains the only foot and ankle surgeon in WA to have published data on the outcomes of his bunion surgeries to date.
The article titled "Radiographic outcomes from minimally invasive bunion surgery in Australia; a retrospective cohort analysis of 169 procedures using the minimally invasive chevron akin (MICA) procedure" can be found online via the Journal of the American Podiatric Medical Association (JAPMA): https://japmaonline.org/view/journals/apms/aop/21-224/21-224.xml
Keyhole Bunion Surgery provides patients with a faster recovery over traditional open procedures
Bunions are a common foot problem associated with a bump over the side of the big toe joint and progressive deviation of the toe. The condition is strongly associated with a positive family history and typically affects adult females, but can also occur in adolescents. The condition may be associated with pain when wearing shoes, and often leads to other secondary problems developing such as corns calluses, hammertoes, metatarsalgia and morton's neuroma. Research shows that bunions generally progress and worsen with time, and that there is a high risk of developing permanent damage and arthritis of the toe joint if the deformity is not corrected.
Treatment of bunions
Early diagnosis and referral to a specialist for surgical treatment has been shown to lead to a better prognosis for people with bunions. Non-surgical treatment can be attempted initially to try and remove pressure from the bunion area, through a combination of pressure-relief devices, orthotics, and footwear changes but these treatments are often unsuccessful and do not halter progression of the condition. Undergoing surgery for bunions is the mainstay of treatment and usually involves shaving the prominent bony bump and/or realigning the bone back into a normal position. Bunion surgery can be performed safely and effectively through a variety of different methods and is best done as early as possible, before degenerative changes develop in the joint.
Keyhole bunion surgery
Keyhole bunion surgery is the most modern and minimally-invasive method available to correct bunions, in comparison with traditional 'open' orthopaedic approaches. It is most akin to laparoscopic surgery, in that the procedure is carried out with only several small incisions being required. Very fine micro burrs (which are used in head and neck surgery) are inserted into the target bone via small 'portals' and the procedure is performed by the surgeon under live x-ray guidance. The primary benefit of this is that there is minimal disruption to the soft-tissue structures in keyhole surgery, allowing for immediate weightbearing and a faster return to normal activities and footwear than in open surgery.
Our specialist Dr Andrew Knox is recognised as an industry leader in performing keyhole bunion surgery, and was the first podiatric surgeon to introduce these techniques to Western Australia through his practice in January 2018. He has since performed over 500 minimally invasive procedures with good success and high patient satisfaction and now offers these services to residents of Queensland.
Recovery after Keyhole Bunion Surgery
A typical patient journey after keyhole bunion surgery at our practice is documented below for reference. Please note that these milestones are taken as an average and some individuals may take longer to recovery from surgery.
1st post-op day to 1 week - Dressing and post-op sandal in place. Rest and elevate foot. Restrict activities to home only.
1 week to 2 weeks - Dressing changed at 1 week. OK to stand up to 20mins/hour. Continue to minimise time on feet.
2 weeks - Stitches removed. Transition back into sneakers. Apply compressive bandage and commence range of motion exercises. Upper body exercise only.
2-3 weeks - Return to work OK if office based. Driving short distances OK. Low-impact exercises OK.
1 month - Progress review with surgeon. Patients permitted to tolerate weight through toe area and commence rehabilitation exercises as guided by surgeon.
2 months - Progress review with surgeon. X-rays may be taken at this stage to determine healing of bone. Swelling will begin to resolve from the area at this point. Most shoes will be ok to wear. Must abstain from high impact exercise.
3-4 months - Further progress review arranged with surgeon to evaluate the surgical site. Bone healing generally takes 12-16 weeks on average to be fully united. A small amount of swelling may persist at this time, but having significant pain would be rare. Most activities will be permitted from this time including impact exercise.
The keyhole bunion surgery technique currently being performed at our clinics is known as the MICA (Minimally Invasive Chevron Akin) Technique illustrated above. A prospective, randomized controlled trial comparing this technique versus a traditional open 'Scarf/Akin osteotomy' deemed that the corrective potential of both procedures was similar but patients who had the keyhole procedure performed had shorter operative times, improved cosmesis, and a higher level of patient satisfaction. Another recent study comparing these two techniques reported that there were significantly lower pain levels in the early postoperative phase (post-operative day 1 and post-operative week 6), significantly shorter scar length, and a greater proportion reporting high satisfaction.
For additional supporting information and research on this innovative procedure please see: http://www.prostepmis.com/healthcare-professionals/clinical-evidence/
Case Patient 1: Keyhole Bunion Surgery
This patient was a very active 75 year old male with a severe bunion deformity present for most of his adult life. He had avoided having surgery for his condition for many years as he was concerned with the significant downtime required after traditional open surgery. Fortunately he was able to undergo keyhole bunion surgery with good anatomical correction and managed to cut his recovery time in half! The photo on the right was taken 2 months after his surgery.
Case Patient 2: Keyhole Bunion Surgery
This patient was a 28 year old female with a moderate bunion deformity she had since adolescence. Although it was not painful, she was concerned that the problem would worsen over time. She underwent keyhole bunion surgery and achieved anatomical correction and was able to commence normal exercise again just three weeks after her surgery. The photo demonstrates the 3 small portals which are used during the procedure. Note the minimal amount of swelling present even at 1 week post-surgery.
Case Patient 3: Keyhole Bunion Surgery
This patient was a 55 year old female with a severe bunion deformity associated with high pain from the prominent bony bump. She had been waiting many years to seek out surgery for her condition as had been put off by the long down time associated with traditional open methods. After an assessment at our clinic and discussion of her options, she elected to have keyhole bunion surgery performed and achieved good cosmetic results and relief of her symptoms within just a few weeks after her surgery. At 6 weeks post-surgery she has been able to return to weightbearing exercise without pain or restriction.
Case Patient 4 (below): Keyhole Bunion Surgery with MIS Hammertoe Repair
This patient was a 73 year old female with severe longstanding bunion deformity and associated 2nd hammertoe. For years she had worn protective silicone sleeves on her toe to lessen pressure when in footwear, and was concerned that surgery was very major at her age. She underwent a keyhole bunion surgery to her right foot in conjunction with minimally invasive hammertoe repair under twilight sedation. At 4 weeks post-surgery she reports no pain ambulating and for the first time in over a decade was able to return to wearing an enclosed shoe. The result of her surgery has been lasting and she has recently undergone bunion correction for her left side also.
Case Patient 5: Keyhole Bunion Surgery with MIS Hammertoe Repair
This patient was a 68 year old female patient who had significant difficult wearing enclosed shoes from her bunion deformity, and was concerned about rubbing on the top surface of her 2nd toe which had been overlapping for some years. She attempted non-operative treatment for some time including pressure relief devices, footwear changes, and strapping of her to but this did not produce lasting benefit. In 2019 she opted to undertake surgical treatment for her foot problem which involved keyhole bunion surgery and MIS hammertoe repair. This procedure was performed in hospital on a day surgery basis and the patient was permitted to put full weight on her foot from day one. The result of her procedure has been longlasting, and as you will note from the photos, even at 4 weeks post-surgery there is minimal swelling and scarring present from her operation.
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This website is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.