09/10/2019    Edward Cohen, DPM

Less Pain and Infections with MIS Bunion Surgery: TX Podiatrist (Don Peacock, DPM, MS)

Surgery has definitely improved over the years
with both traditional and MIS surgery. A lot of
the foot surgeries that were done forty years ago
no longer require a cast or a hospital stay for
several days. This trend to getting the patient
out of the hospital and walking around as soon as
possible can be seen in almost all surgery from
gall bladder, heart, vascular, orthopedic and
most general surgery.

The trend in surgery seems toward smaller
incisions using noninvasive techniques and
equipment that allows less surgical dissection.
As a result patients have less complications
faster healing and can resume their normal
activities sooner. These advances in surgery have
also saved billions of dollars in hospital and in
some cases outpatient surgery costs.

Most of the podiatrists I have spoken to have
gravitated to less invasive foot surgery and the
reason for this transition is for faster healing,
less complications and better patient
satisfaction,

Mariano de Prada, an orthopedist who wrote
Minimally Invasive Foot Surgery, said in a
lecture that he used to do one or two foot
surgeries a week and after he introduced MIS foot
surgery to his practice his foot surgeries
increased to 20 surgeries a week.

I did an MIS foot surgery on a 78 year old male
who had had a rather severe foot deformity and
after a fifteen minute foot surgery had a pretty
good cosmetic and functional result, but the
amazing thing was two days after his surgery he
was able to walk two miles a day every day which
was his workout program. This surgery could have
been done in a more invasive manner and there are
podiatrists and orthopedists that could get this
type of a result, but I think it is a good idea
to learn about these MIS foot surgeries at the
medical school cadaver lab seminar programs.

Edward Cohen, DPM, Gulfport, MS

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09/09/2019    Allen Jacobs, DPM

Less Pain and Infections with MIS Bunion Surgery: TX Podiatrist (Don Peacock, DPM, MS)

Thank you, Dr. Peacock for your interesting
references to MIS surgery for the correction of
bunion deformity. However, the published
statement by the author clearly fails to support
the claim that MIS surgery is associated with
less swelling, less pain, and a lower infection
rate. The references you site do not substantiate
that claim.

The preferred practice guidelines published by
the Academy of ambulatory foot and ankle surgeons
contains references in the chapter on “MIS
correction of Hallux Valgus”. Of the 54
references, over 50% are taken from literature on
open surgical correction or papers having nothing
to do with surgery. Some of the references go
back to the early and mid-1960s. None of the
references cited contain any rigorous study,
controlled studies, or comparative evaluation of
MIS vs. traditional open surgical techniques.

I would like to quote Burton Katzen DPM, the
president of the Academy of minimally invasive
foot and ankle surgery, as published in profiles
in excellence, PM magazine 2019. With reference
to the reluctance of some to embrace MIS
techniques, Dr. Katzen states, “I believe the
number 2 reason is that the lack of publications
or evidence-based medicine scares off many
surgeons.“

That is the point. No one is suggesting that MIS
techniques do not offer potential advantages,
particularly when performed by experienced and
capable surgeons such as Dr. Katzen or Peacock.
However, medical care must be grounded in
science. Autonomy of patient consent requires
presentation of fact. Those enthusiastically
embracing the potential of MIS techniques may do
so based on their personal experience. Marketing
such techniques claiming lower infection rates,
less edema, less pain, or superior outcomes,
without confirmatory data is inappropriate,
misleading, and not supported.

Allen Jacobs, DPM, St. Louis, MO