Minimally Invasive Surgery versus Traditional Bunion Surgery: Which is Better?

11th Mar 2025

Understanding Bunion Treatments

Bunions are caused mainly due to genetics, with evidence suggesting an evolutionary aspect. The function of the big toe has changed over time, leading to an inherent weakness causing it to deviate towards the second toe. This adaptation allowed primates to pick up objects with their feet. It is now well documented that a quarter of the world’s population can develop bunions. Women are more affected than men due to traditional footwear types.

Most people present with a deformed toe and a prominence of the big toe towards the inside of their foot. This causes pain and footwear difficulty, potentially restricting activities such as running and sports. Footwear fitting becomes problematic due to swelling over the big toe joint. The size of the bunion doesn’t necessarily correlate with symptom severity; even small bunions can cause significant discomfort.

There is also a cosmetic element, as the toe appears abnormal and can lead to other conditions like hammertoes, corns, and general forefoot disfigurement over time.

Traditional Bunion Surgery

Traditional bunion surgery encompasses various operations from different eras, ranging from removing the bump to cutting and resetting the big toe joint bones, or fusing either the big toe joint or the midfoot joint. This open operation uses a moderate to large incision on the inside of the foot and the arch. The bones are reset after soft tissue stripping, with screws and plates used to realign and correct deformities.

Common traditional bunion surgeries include:

Exostectomy: Removing the bony prominence of the first metatarsal
Osteotomy (e.g., Scarf and Akin): Cutting and resecting the bone
Lapidus procedure: Fusing the arch bone to correct bunion deformities

These procedures have a large evidence base and have been used for many years. The Scarf-Akin procedure is considered standard in most parts of the world for correcting moderate to large bunion deformities.

For unstable bunion types with hypermobility, the Lapidus fusion is used, involving plates and screws.

Minimally Invasive Bunion Surgery

This type of operation has undergone four generations of modifications. It is essentially a keyhole operation using small incisions to correct the bone by cutting it with specialised dental-type instruments called burs. Screws are inserted through small incisions, reducing the amount of incision and soft tissue exposure. The procedure is performed using a specialised technique and skill set under X-rays and is gaining increased popularity due to its added benefits.

The main difference is less trauma to the tissues, potentially leading to easier and quicker recovery.

Laser Bunion Surgery

Many patients enquire about laser bunion surgery, likely due to misinformation. Lasers can reduce inflammation around the bunion bump but cannot remove bony deformities. There is often confusion between minimally invasive or keyhole operations and laser bunion surgery. Most patients are actually referring to keyhole bunion surgery when mentioning laser bunion surgery.

There is no proven laser method for bunion removal, although it may reduce inflammation around the bunion bump.

Comparing Open versus Minimally Invasive Keyhole Bunion Surgery

Keyhole bunion surgery offers several benefits:

Less postoperative pain
Less swelling
Lower chance of joint stiffness
Reduced risk of deformity recurrence
Quicker and more predictable recovery

It is suitable for most patients with good bone quality. However, open surgery techniques may be more appropriate for patients with significant pre-existing arthritis or soft bone.

Choosing the Right Option

The correct procedure depends on the patient, type of bunion, and size of bunion. A consultation, including X-rays and foot examination, is necessary to discuss the best options. Most patients are suitable for keyhole bunion surgery, but not everyone.

FAQs

Can laser surgery fix bunions?

No, lasers cannot fix bunion deformities. However, keyhole bunion surgery can correct the deformity with fewer risks and quicker postoperative recovery.

What is the difference between traditional bunion surgery and minimally invasive surgery?

Traditional bunion surgery involves an open incision and soft tissue dissection, whereas keyhole surgery is done through small incisions. Both usually involve screw fixation to reset the bones. The key difference is the level of incision and soft tissue trauma, which is much less in minimally invasive surgery.

Which treatment has a faster recovery time?

Keyhole bunion surgery has been shown to have quicker initial postoperative healing and less swelling. However, bone healing in both cases still takes 6-8 weeks, with a return to full activity potentially taking 10-12 weeks. Keyhole surgery allows for a quicker return to work and activity.

Is bunion surgery painful?

Bunion surgery is typically painful in the immediate postoperative period. Keyhole bunion surgery generally results in less postoperative pain, with pain usually subsiding within 2-3 days. Open surgery may require pain relief for at least a week.