Expert Insights on Minimally Invasive Bunion Surgery

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Hi, I'm Larry DiDomenico. I'm in Youngstown, Ohio. I am a Program Director for East Liverpool City Hospital Residency Program. I'm also a Fellowship Director for NOMS Ankle Foot Care Centers and also relative to Minimally Invasive Surgery. I am the Director of Medical Education for Voom Medical Devices. That's a minimally invasive bunion-focused company with a Bunionplasty 360 repair procedure.

Can you share your experience in practice with MIS bunion surgery?

Yeah, so in most of my career, I would say almost all of it, I've been a Lapidus advocate and a believer and I still do love Lapidus. Until recent years, and not that I don't, but I think there is a newer market that is more physician-friendly and patient-friendly, in particular patients. This may come to a shock to a lot of who followed my career that know I've loved Lapidus, and I think it's a great procedure.

But I believe now that MIS or minimally invasive bunion surgery has been redefined and it is really something special. When I was getting out of school that was sort of voodoo and the science wasn't there, the technology wasn't there, the knowledge and experience wasn't there.

Now today it is definitely getting better and better and a lot of the science, knowledge, experience is there, and Voom, Bunionplasty procedure by Voom Medical Devices is fantastic, which again, I am the director of medical education for full disclosure.

So you asked how I got introduced to MIBS, we call it minimally invasive bunion surgery. I, for 30 plus years I've been doing my calcaneal osteotomy is minimally invasive and I can't tell you the last time I opened up a calcaneal osteotomy. And it's such great advantages for the patients, for the physicians too. And I always say physician and patient friendly. And I'm moving this direction towards my bunions also.

And how I got introduced was at Neal Blitz. Neal was also a big advocate over Lapidus, and that's how he and I got to know each other through the AO about 25 years ago. And subsequently, he started performing at MIS, went over to Europe, studied with the Europeans, and got very proficient at it.

So we went from Lapidus, and now he's introduced me to the MIS part of it. And it took some convincing, but once I saw the results and saw the new technology and all associated with it, it really doesn't take long 'cause again, it's a very, very patient friendly. In the early 2000s, Neil and I published early weight-bearing Lapidus before people were weight-bearing them.

And I've published many since. since. It's just a great procedure, but this is actually even better for patients in terms of recovery and cosmoses and probably a little bit easier, Brian, for the patients to recover from with the minimally invasive. So this is changing the way I think bunion surgery is going to be done in the future because of the way we can do this now. Neal didn't indicate it to me about bunion surgery, what he was doing, the outcomes. I went to New York, worked with him a little bit, salt myself, and like I said, much different from 30, 40 years ago because the structure of the science, the knowledge, the background, the experience, the newer procedures being done today are really, really a game changer compared to what it was many, many years ago.

And really, that's how I got involved with minimally invasive bunion surgery. And I believe it's here to stay. I believe it's here. And I think it'll continue to be really, really good. Matter of fact, I just got done with the case of a very large inter metatarsal, probably 20, 22 degrees, similar nature, where I just completed that just a few minutes ago before coming on this call.

What is the most challenging aspect of bunion MIS?

I think the surgery is technically challenging, like any other surgery, like first time riding a bike, you got to do it a couple of times before you get to do it. But technically, I think it's going to be challenging. I think it's easier physically on me. So for me, particularly in my later years of my practice, I think this is going to be more advantageous to my back and be helpful in that respect. So I think to the surgeons out there, maybe a little less stressful once you get enough cases underneath your belt, everybody has a different learning curve. So that's going to depend on that individual who's doing these procedures, how skilled or how experienced that individual is going into it.

How do you determine how far to move the metatarsal after making your osteotomy cut?

That's the hard part to wrap your brain around it at first because like the lady I just did today, a gigantic bunion, you want to move as far as you can and sometimes some people are not even have any bone to bone contact and some people want just a very and most of the time it's very little bone-to-bone contact, but it really is very similar to limb deformity correction. So if those who out there who studied tibial varum deformities have previous traumas, it's really the same concept except they use external fixator where you're getting regenerative bone.

We're just using internal fixation and getting regenerative bone. So we're moving as far as you possibly can and or as far as you possibly need to get it clinically to the toes sit straight and no stress on that area. And the nice thing about this, patients are walking the same day as you're doing these procedures.

It's really amazing. And so it's much friendlier and the incisions are tiny, relatively speaking. There's no splints, no casts. It depends on the patient, you may need to use a surgical shoe or a CAM boot, but they can weight-bear the same same day. And you can do, and some patients or some doctors have done bilateral, same day. I have not done this point in my career doing this, but this works for all sizes. You can do this for a mild bunion, a moderate bunion, or a severe bunion for that just to be complete on that.

How do you determine an appropriate postop course including weight-bearing and return to activity?

So for MIBS, everybody's full weight bearing. There's no problem. It is just a procedure that allows that. It affords the patients, and this is again that patient-friendly part of it. As a matter of fact, I've had some patients in tennis shoes that three weeks with this, maybe a little bit longer somewhere in that neighborhood. They can go into tennis shoes quite easily because the recovery is so much more friendly or getting back to the patients with us.

And one more thing to note, me being a big Lapidus user over the years, hypermobility in sagittal plane always been my first, my guess biggest factor when I was in a Lapidus, the nice thing is you can control the hypermobility to some degree with this procedure without fusing the TMT-1 and it's all about the technique and the drive in that area of the technique that Voom offers to provide that. And it's really quite amazing, again, this is where the friendlier part of this procedure comes in place.

So I still love Lapidus, I’m still big fan of it, but this is a little bit nicer and more friendlier for the patient and the doctor again.

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