Sheldon H. Nadal D.P.M.
Toronto, Ontario M4P1P2
Toll free: (877) 456-3338
Minimally Invasive Foot Surgery
What is minimally invasive foot surgery?
Minimally invasive surgery is a philosophy and set of techniques that allow podiatrists to treat common foot problems using specially designed instruments which allow us to work through smaller openings in the skin compared to conventional hospital surgery. This results in less soft tissue trauma, which usually means less pain, less disability and a quicker return to normal activities for you, the patient.
It has also been referred to as minimal incision foot surgery, minimum incision foot surgery, and ambulatory foot surgery.
What kind of foot problems can be treated with minimally invasive foot surgery?
I have been using minimally invasive foot surgery to treat bunions, hammertoes, corns on the outside of toes (hard corns) and between toes (soft corns), calluses, bone spurs, metatarsal pain and ingrown toenails in my Toronto podiatry office, using local anaesthetic, for more than thirty years.
What are the advantages of minimally invasive foot surgery?
In addition to less pain, swelling and disability due to less soft tissue work, the procedures can be performed in an office with local anaesthetic. This means that the procedures are more cost effective because expensive hospital beds are not needed. Also, local anesthetic is considered to be safer than general anesthetic. Casts and crutches are rarely necessary. You can walk out of my office with an adhesive tape dressing and a special sandal. Instead of narcotic analgesics which can have side effects, most people will just need Aspirin, Tylenol or Ibuprofen for discomfort,. Because you can walk immediately, you are less likely to have complications such as phlebitis or blood clots.
Where can I have these procedures performed?
The number of podiatrists who offer these techniques in North America is small but, thanks to the Academy of Ambulatory Foot and Ankle Surgery based in Philadelphia PA, the number is growing world-wide. I am a trustee of the Academy and am a clinical instructor. We run instructional courses once or twice a year where we train podiatrists and orthopedic surgeons from the United States, Canada, Latin America, Europe, Asia and Australia. Orthopedic surgeons from Latin America and Europe have eagerly embraced our techniques. As European orthopedists enthusiastically write about our procedures, more North American podiatrists and orthopedists are taking notice.
I have been performing these procedures for more than thirty years.
How long have podiatrists been performing minimally invasive foot surgery?
Podiatrists may have been the first group of surgeons to develop minimally invasive techniques .
According to Dr. Leonard Hymes (Forefoot Minimum Incision Surgery in Podiatric Medicine – Futura Publishing 1977), in 1945-46 Morton Polokoff of Patterson N.J. performed subdermal foot surgery using very fine chisels , rasps and spears connected to a galvanic current. In 1960, Edwin probber, D.P.M. of Floral Park N.Y. (whom I had the pleasure of visiting in 1980) began using larger hand rasps. The Earliest power equipment was developed by Bernard Weinstock D.P.M. of Ohio who attached bone rasps to an electric knife! (We have come a long way since then, in the development of both technique and instrumentation.)
Again, according to Hymes, Albert Brown D.P.M., then of Detroit, MI, began reducing heel spurs using a bone curette around 1960-1965. In 1965, Joseph B. Addante D.P.M. of Fitchburg, MA introduced to podiatric medicine, the osteoclasis technique for treating painful calluses and porokeratoses under plantarflexed (long, downward pointing) metatarsals.
In my chapter on bunion surgery, in the textbook Minimally Invasive Surgery of the Foot and Ankle, edited by Maffulli and Easley, published by Springer in 2010, I refer to a conversation I had with another pioneer of minimally invasive foot surgery, Marvin Arnold D.P.M. of Florida. Dr. Arnold informed me that the idea for a minimally invasive version of the Wilson bunionectomy (bunion removal) was first suggested by Lowell Weil Sr. D.P.M. of Chicago IL to Seymour Kesler, D.P.M. also of Chicago, Abram Plon D.P.M. of Philadelphia PA and Arnold in the early 1970’s. They began by performing an oblique osteotomy (sectioning of the bone) at the neck of the first metatarsal through a very small opening in the skin. Plon and Arnold gave the osteotomy a V-shape to make it more stable. Thus, the Modified Wilson Osteotomy was born. This is basically the same procedure that I have been performing in my Toronto foot clinic for over thirty years. The significance of performing an osteotomy of the first metatarsal is that it realigns the metatarsal in a straighter manner. This greatly reduces the chance of recurrence (if you just remove the bump without realigning the first metatarsal, the chance of recurrence is high, regardless of whether minimally invasive or conventional surgery is being performed). Another minimally invasive bunionectomy procedure I perform in my Toronto podiatry clinic is the Reverdin-Isham bunionectomy which was developed by my friend Stephen Isham D.P.M., M.D. of Idaho.
To find out which bunion surgery would be best for you, please call my Toronto podiatry office for a private consultation at 416-486-9917.