09/29/2015    Don Peacock, DPM

Standard of Care for Bunion Hardware (Burton Katzen, DPM)

I am a proponent of MIS surgery and I feel the
debate on fixation is off topic when discussing
the advantages of MIS foot surgery. I have
performed the Katzen modified MIS Wilson and was
personally taught this surgery by Dr Burton
Katzen. His technique is incredible and the
results are great in the appropriate patient.

That being said, some patients require fixation
and some do not. The decision to use fixation
lies mostly in what your goals for the foot
correction are. For example, some foot types
require plantarflexion of the 1st ray and this is
better achieved by utilizing fixation.

The real power of MIS is incorporating the
philosophy into your traditional arsenal. An
example of this would be a diabetic patient with
a chronic ulceration under the 1st met.
Typically, I would treat this by tendon
rebalancing ( gastro recession and Per. Long.
lengthening). Soft tissue rebalancing is usually
less invasive than bone work despite needing
larger incisions. Remember there is a difference
between minimally invasive and percutaneous
procedures. I have a philosophy that uses MIS
despite incision length.

I call this the MEP philosophy (minimalistic
effective procedure (s)) and its a hybrid
approach. If this same patent had a foot type
displaying a high pronatory end range motion
(PERM or plantar flexed 1st met) I would do the
GR and a percutaneous non fixated DFWO of the 1st
with the desire for the 1st ray to dorsiflex.

if I needed to address a 2nd met ulcer with a
high SERM (hype-rmobile 1st) I may do a GR and a
plantarflexory MIS 1st met osteotomy with
fixation.

Fixation depends on your goal at hand and the
foot type you are working with. At the risk of
sounding flip, we do not need a fixation debate
with bunion correction. We have too many options
for bunions already and the difference between a
well executed traditional procedure with fixation
and a properly performed MIS technique is not
really important and the head to head comparison
is mute.

As a proud professor in the AAFAS I can honestly
tell you that great power lies in MIS techniques
when addressing a multitude of deformities other
than hammertoes and bunions etc. As a point of
reference, the power of MIS in transverse
dominant plane deformities and DM forefoot
salvage is hard to imagine unless you have done
it. It can be life-saving.

I want the best trained traditional foot surgeons
to come and be a part of the MIS discovery and to
join us at our seminars. I hope that by teaching
well trained surgeons these techniques they can
add some of these procedures to their already
accomplished skill set. In doing so we can
improve lives and make advancements by learning
from these talented traditionally oriented folks
as well. You know who you are. I could easily
list you.

Don Peacock, DPM, Whiteville, NC

There are no more messages in this thread.