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Lesser toe surgery

Discussion in 'Foot Surgery' started by Simon Spooner, Aug 30, 2011.

  1. Griff

    Griff Moderator

    This surgeon works privately in London. I first became aware of him when a Physio I work with saw him (as a patient). Physio had a significant reduction in 1st MTPJ range, with associated dorsal osteophytes and daily pain. Had a minimally invasive procedure with this chap and can't speak highly enough about it. Pain = zero. Range = significantly improved. Healing time = significantly reduced (compared to an 'open' cheilectomy I presume)

    Said surgeon has had a few patients off of me since then.

    Not seen any lesser toe surgery post op however.
     
  2. W J Liggins

    W J Liggins Well-Known Member

    Horses for courses and one swallow doth not a summer make, to outrageously mix metaphors. See previous posts on MIS.

    I'd be dubious with a Rheumatoid personally, but it depends on the patient.

    Bill Liggins

    PS Did he reply in writing to your referral Ian?
     
  3. Griff

    Griff Moderator

    Hey Bill,

    I'm with you on the metaphor. I think there are a sub set of patients who the shorter recovery time appeals to greatly. I'm no surgeon, so if I am having a surgical discussion with my patients it is usually as the window of opportunity for conservative care has closed (in my opinion). I simply explain the options as I understand them, and let the patient decide which they would like to potentially persue.

    I've had no written reply or report back as yet. Out of the two patients I have sent in the last 6 weeks or so I know that one was waiting until he got back from holiday before booking the consultation.
     
  4. I was trained in minimal incision surgery (MIS) back in 1983-84 during my surgical residency. MIS fell out of favor in the US over 20 years ago. Glad to see it is "new" to this UK orthopedic surgeon. The orthopedic surgeons in Italy were also quite interested in this "new technique" when I lectured at a podiatric-orthopedic seminar in Rome a few years ago. Apparently, MIS is making a comeback, but certainly it isn't anything "new".

    Here is what happened to one of the biggest MIS'ers here in California.

    http://www.quackwatch.org/04ConsumerEducation/News/weber.html
     
  5. falconegian

    falconegian Active Member

    I'm an Orthopaedic Surgeon in Rome Italy. Here as Kevin Kirby said there is a "new" interest in MIS. Surgeons are doing a lot of cases using Internet and Televisions to sponsor this "new " technique calling it Laser Surgery. I have seen many bad results after MIS. The problem here in Italy is that our Foot and Ankle Society is non Capable of controlling this phenomena with a validation of results....
    The other problem is that here in Italy there are a lot of Surgeons that do "traditional" osteotomies or lesser toe surgery without a specific training with a lot of bad results and so many people say the better is the less invasive ?
     
  6. Frederick George

    Frederick George Active Member

    Minimally invasive surgery, which used to be called minimal incision surgery (MIS), is a descriptor of all surgery.

    One would certainly not be more invasive than necessary in any surgery. The level of invasiveness is only limited by technology and the surgeon's skill.

    Years ago, some podiatrists who had little skill did MIS with mixed results.

    Some "important" podiatrists made it their crusade to crucify anyone who did this work, whatever the results. Especially if they were incredibly successful. Tall poppy syndrome.

    When the politics of the California Podiatry Board changed, Garey Weber regained his license.

    Pioneers always have arrows in their backs.

    Cheers

    Frederick
     
  7. W J Liggins

    W J Liggins Well-Known Member

    As I said, horses for courses. Since incisions heal from side to side and not lengthways, it makes no difference whether the incision is 3mm or 30mm. Bone takes circa 6 weeks to heal (in a healthy person) whether it is cut by a bone saw or a Shannon 44 cutting burr.

    The two primary issues are that you cannot carry out bone surgery without a full knowledge of the relevant anatomy - and since individuals are different, this means a wide experience of open surgery before embarking on MIS; the second is that you have the knowledge to treat adverse reactions. Effectively, this means the knowledge and ability to carry out open surgery when things go wrong - as they eventually will even in the hands of the most skilled surgeon.

    All the best

    Bill Liggins
     
  8. Tom Galloway

    Tom Galloway Member

    Well said Bill
    it is interesting however that bone takes considerably longer to heal if nicely cut with the bone saw and not fixated in some way.
    I was surprised by this difference many years ago when I switched to undertaking metatarsal osteoclasis using a bone saw instead of a Shannon 44 side cutting burr or Stamm’s bone cutter.
    It was quite shocking to see the two bits of cut bone sitting adjacent to each other and happily ignoring each other for months on end instead of the doing the usual trick of healing quite quickly over 6 to 8 weeks as they had previously.
    So while I would quite agree that bone will heal at approximately the same rate regardless of what it's cut by (unless of course the instrument is allowed to get hot and burn the bone) the only proviso being that if some trauma is induced by a Shannon 44 or bone cutter you'll see profuse callous form and it's likely to heal even if not well fixated, if the bonus cut with a bone saw - that really does need to be well fixated otherwise greatly delayed union or non-union is going to be the likely outcome.
    I have always undertaken MIS for a small range of pathologies that it is well suited for and as techniques and equipment is developed I am sure it will increase – as long as the outcomes are shown to be better than the more open alternatives - the trick being to be able to judge this objectively and not on blind enthusiasm (if you’ll pardon the pun)

    Tom
     
  9. Frederick George

    Frederick George Active Member

    Tom, how right you are. Many procedures are done using a variety of instruments, and for those fixated (pun intended) on the oscillating bone saw, perhaps they can research MidasRex technology, studies, etc. re. "burning bone" or the width of the osteotomy.

    The reason minimally invasive surgery or minimally traumatic surgery is now used is because it is descriptive of the technique over a number of surgical specialities. Whether it is knees, bunions, gall bladders, or breast implants, it is the way to go. It doesn't just mean the size of the incision, but also the procedure chosen and the venue (outpatient vs inpatient) as well as the postop course.

    Boy, does this make me laugh. It could only be written by a "theoretical surgeon."

    Cheers

    Frederick
     
  10. W J Liggins

    W J Liggins Well-Known Member

    Well Frederick, I'm delighted to amuse you. Unfortunately the humour seems not to have survived the trip across the pond.

    Please define 'theoretical surgeon' and explain what is funny about the statement and then we can all roll about in the aisles.

    Kind regards

    Bill Liggins
     
  11. Frederick George

    Frederick George Active Member

    Dear Bill

    the·o·ret·i·calAdjective/THēəˈretikəl/1. Concerned with or involving the theory of a subject or area of study rather than its practical application: "a theoretical physicist".
    2. Based on or calculated through theory rather than experience or practice: "a theoretical reformer of opinions". More »
    Dictionary.com - Answers.com - Merriam-Webster - The Free Dictionary

    Come on, Bill, get real. Imagine we're sitting in a pub, I pull out my Swiss Army knife and give you the choice of a 3mm cut or a 30mm cut on you somewhere. Which would you prefer? Why?
    What do you think patients prefer? Why are so many different surgical specialities developing minimally invasive procedures? Just because it's more difficult/techical?

    So, if we ever have a beer together, I promise I won't offer you the choice.

    Cheers

    Frederick :drinks
     
  12. drsarbes

    drsarbes Well-Known Member

    There are many surgical procedures that can be performed through a smaller incision with good results and have survived the test of time and pier review.
    Those that are not reproducible or have high rates of complications have not become the standard. Whether these are cardiac stents, ACL repairs or hammer toes it does not matter.

    When you have the MIS in foot surgery running its natural progression here in the USA for the past 3 decades one has to wonder why Europe feels the needs to re-invent the wheel?

    When marketing replaces scientific studies in the field of healthcare then we're all doomed. The shannon#44 burr belongs in the surgical museum not in the operating room.

    As far as the length of an incision is concerned; We make the proper length required to perform a successful surgery. If that is 3 cm, then the incision will be 3 cm.......

    Steve
     
  13. Would that be the pier at the Pacific Ocean Park (P.O.P.) AKA dogtown? I heard it took no prisoners.
    http://www.youtube.com/watch?v=QmU1jSmJF_c
     
  14. drsarbes

    drsarbes Well-Known Member

    haha
    I stand corrected!
    Just goes to prove I really AM not perfict!
     
  15. Just yankin' on your toe, Steve. Your points are well made.
     
  16. Frederick George

    Frederick George Active Member

    Well said, Steve.

    But of course surgery advances over time, and I'm not sure the orthopaedic surgeons in Germany, UK, and Italy are being imitative. They may just be advancing the art of foot surgery.

    In America I don't think healthcare is moved primarily by science or marketing, unless it's the marketing of HMO's with their lists of discounted doctors/discounted care.

    Presumably, any surgeon would perform surgery with the minimum trauma possible, limited only by his personal skill.

    Cheers

    Frederick
     
  17. W J Liggins

    W J Liggins Well-Known Member

    Thanks for your explanation Frederick. I note your opinion based on ignorance and your analysis devoid of facts.

    I now understand your sense of humour. You are a clown! :empathy:

    All the best

    Bill
     
  18. Frederick George

    Frederick George Active Member

    Thank you Bill. I think we almost have a relationship now. You're the straight man, and I'm the clown. "The fool on the ridge, who sees the sun going down."

    And of course narrow pedantry is always such a tempting target, don't you agree?

    What fun!

    Cheers

    Frederick
     
  19. drsarbes

    drsarbes Well-Known Member

    Question: On the inital link to the marketing page, it is stated that the NHS will pay 2-4 THOUSAND POUNDS for this hammer toe procedure.
    Is that true?
    I can perform an MIS hammer toe in 30 seconds.
    I may be moving to the UK.

    Here in the US we are lucky to get $400 for a hammer toe.

    Steve
     
  20. W J Liggins

    W J Liggins Well-Known Member

    I wish!

    Bill
     
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