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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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