05/10/2013    Don Peacock, DPM

Chronic 1st MPJ Pain (Scott Hughes, DPM)

I am a believer in MIS foot surgery and have
found it rewarding for my patients. For me, MIS
surgery is very exciting and extremely artistic.
It also provides enormous benefit in many ways,
including better cosmesis. Like you, my
background is in traditional surgery, and I still
find these well-documented noble traditional
procedures to be a big part of my practice today.
I was also originally very skeptical of minimally
invasive surgery.

The x-ray posted is a modified Austin and has a
plantar shelf which I directed back proximally to
give stability to the osteotomy. This should be a
very stable osteotomy. I do place these patients
in a CAM walker for three weeks.

This osteotomy is not a Watermann osteotomy. When
performing a Watermann osteotomy, I modify it and
keep the plantar articular cartilage intact and I
do this open. I use this in cases where I do not
need to plantarflex the first metatarsal .

We have Dale Austin’s work to reference. In
Austin’s original research, he described 1,200
cases-all performed without fixation. His
findings and conclusions resulted in no non-
unions and no AVN. He also stated that fixation
was not necessary.

I will not argue the validity of minimal incision
surgery as opposed to traditional surgery. They
are simply two separate disciplines each having
some inherit advantages and obvious
disadvantages. Also complications will not
discriminate on the size of the incision. I fully
understand your skeptical view, however we need
skilled surgeons to perform minimally invasive
surgery and give us level 1 research conclusions.

Minimally invasive surgery can be rewarding both
to you and your patients. You will never know
until you try.

Don Peacock, DPM, Whiteville, NC,
peacockdpm@gmail.com

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