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09/10/2019 Don Peacock, DPM, MS
Less Pain and Infections with MIS Bunion Surgery: TX Podiatrist (Elliot Udell, DPM)
Dr. Udell, I appreciate your response and I agree with you 100%. I also totally agree with Dr. Jacobs’ take. MIS surgeons cannot scientifically state that there is less swelling and lower infection rates with MIS HAV correction compared to traditional surgery. We can only state that MIS HAV correction with screw fixation yields better early VAS scores than open Scarf/Akin. For MIS HAV correction, we have scientific backing for the Reverdin-Isham, SERI, Bosch, Magnan, and the MICA/PECA. None of these procedures have established dominance over any other HAV surgery.
Some MIS procedures actually have significant pain and swelling after surgery. The non-fixated PMOs that MIS surgeons do for IPK and ulcers have significant swelling and dorsal pain for up to three months post-op compared to the fixated traditional Weil. However, we get better results and less shortening with the non-fixated MIS PMO in mid and long-term follow-up. Take a look at Thomas Bauer's work and another recent 2019 article in a peer-reviewed journal.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505 219/
From my experience only, MIS procedures can achieve comparable results to traditional procedures in the correction of some deformities. MIS is extraordinary with tibial sesamoid shave, Akin osteotomy, tailors, neuroma decompression, Haglunds, crossover 2nd toe, plantar plate tear, heel spur, 5th metatarsal base exostosis, distal toe ulcers, Stage 1-3 hallux rigidus, metatarsalgia, and spoon toe. We can back up some of these procedures, but we need more publications with valid research scrutiny.
The HAV debate is mostly opinion based and as Dr. Jacobs reminds us, we cannot claim what is not proven. I wish MIS HAV was better, but it is not, or at least has not been proven. We can claim equality, but not superiority with MIS HAV.
Don Peacock, DPM, MS, Whiteville, NC
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