Frequently Asked Questions

This was a major breakthrough in the field of foot surgery that was first

developed in the 1960’s. “Percutaneous” simply means through a hole or

puncture. It is a virtually painless way to correct the bony enlargements that

cause most foot deformities using specially designed state-of-the-art

instrumentation. Doctors at this location have been performing and

perfecting these procedures since 1977.

Small punctures usually less than 1/8 inch in diameter, or about the size of

this “o” are made into the skin at the site of the deformity. The surgeon then

proceeds to fragmentize any disfigurement or enlargement of bone like a

bunion into bone dust using specially designed surgical burs and instruments.

The pulverized bone is mixed with your blood and turns into a bony paste

which is then squeezed out through the initial opening.

Special training, experience, knowledge, digital perception and

fluoroscopic examination enable the surgeon to explore the “nooks and

crannies” of a foot disfigurement and perform its correction without the

need for long ugly scars, stitches, pins, wires, screws or casts. The patient is

allowed to be weight bearing throughout their recovery so there is no need

for the use of crutches or a scooter.

Bunions, bunionettes, hammertoes, displaced metatarsals, corns, calluses,

bone spurs, heel spurs, neuromas, ingrown nails and other foot deformities.

A small puncture is made through the skin using a specialized side cutting

bur that is attached to a surgical drill similar to that used in dentistry. The low

speed rotating bur fragmentizes the bony deformity into a powdery material

that when combined with a patient’s own blood turns into a paste-like

substance that the surgeon then physically squeezes out through the original

opening. The small punctures in the skin shrink in size over time as swelling

decreases.

Stitches, pins, wires, screws, stapes or other hardware are not necessary with percutaneous or “puncture” surgery as they have been shown to be unnecessary. Hard casts are also not necessary when these techniques are performed. Most patients following their surgery can wear conventional sandals, cut open sneakers or a small surgical shoe.

When the surgical sites heal, the scabs fall off and the swelling recedes, your feet can start to gradually accept some stylish shoes providing they fit properly, are comfortable and do not irritate the surgical sites.

The initial dressings are removed about 1 week later. Special

wet medicated (soft casts) bandages are then applied to control the normal swelling for approximately the following 3 -4 weeks. The swelling that follows the next couple of months is controlled using special stretchable elastic bandages.

The puncture sites will usually begin to close within the first week. Swelling which is a normal part of the healing process is greatest the first two to four months and then gradually decreases over time as the foot progressively improves. Bleeding through the bandages is quite normal for the first day or two following your surgery. Don’t panic, just apply pressure with paper towels to dry up any blood and elevate the foot.

As with all surgery there are often risks. These risks include slow healing, infection, dislocation, rigid joints, decreased range of motion, formation of scar tissue or adhesions and prolonged swelling. Serious adversities are virtually nonexistent. Infections are very rare as the main cause is foreign bodies such as stitches or internal screws, plates or wires.

This technique allows your deformities to be comfortably “erased” via pin-head sized punctures instead of long incisions. Since the skin is punctured and not cut, trauma is greatly decreased to the foot and the patient experiences less post-op pain, less complications and a quicker healing time. If the skin and the structures below are not cut open then they obviously don’t have to heal. Hospital stays, general anesthesia, stitches, casts, pins, crutches, and scooters are not required. There are no long ugly scars and you can often drive within two days of your surgery, if you feel capable.

These procedures are performed in the office under local anesthesia, while the patient watches TV. You avoid both the risks of general anesthesia and the anxiety associated with a hospital-type environment. It is also easier since patients are not required to go through the time consuming process of obtaining medical clearance, chest x-rays, EKG’s and unnecessary blood tests. Post-operatively there is no need for extensive physical therapy treatments unless advised.

Patients are usually able to return within the first week or two to most normal activities but will be slower depending on the amount of surgery performed. Driving is permitted as soon as you feel capable and you can do some minimal walking if comfortable. The doctor will advise you on what activities to limit or refrain from depending on the extent of your surgery. If you like to exercise you can perform most upper body exercises and ride a stationary or recumbent bicycle. Many individuals with desk type jobs can return to work within a few days. Remember, even though you will have no long scars or hardware in your foot and are not bedridden it is still surgery. Don’t over exert yourself, don’t pick on your scabs and try to give your wounds the necessary time required to heal.

After the surgery our office will dispense a prophylactic antibiotic, an OTC pain killer and an anti-inflammatory to help reduce any initial discomfort and swelling. Our office dispenses these medications directly to you to save you time from going to your pharmacy. Apply the ice packs that will be provided to you when you leave directly to your foot, 20 minutes on and then 20 minutes off for at least the next week. If you prefer you can also use frozen peas put into a couple of sandwich baggies and apply them directly to your foot. You will also be instructed to elevate your foot when possible. You will also be able to shower or bathe using the cast protector that will also be provided to you upon leaving the office.

Since minimally invasive, percutaneous puncture techniques are used, problems that are more difficult to resolve with conventional surgery can be solved. Scar tissue is much less, trauma is less, and there is usually a shorter healing time with less pain. Multiple corrective procedures can also be performed in a single surgical session as these less traumatic punctures allow for the performance of multiple procedures that lengthy incisions and a patient’s circulation may not allow for.

While many doctors across the country claim they perform minimally invasive foot surgery, in reality they are still performing the old traditional procedures. If your doctor will be putting stitches or some screws or pins in your foot then they are not performing percutaneous surgery. Upon a consultation, the patient is usually informed by the surgeon that they are simply not a candidate for puncture surgery and therefore will have to undergo traditional open hospital surgery with the long incisions. This surgery is not easy to learn and it is harder to perform than traditional hospital surgery. The schools and hospitals which are run by large hospital corporations want patients in the hospitals. Traditional hospital doctors might often tell their patients they perform minimal incision surgery if they now make a 5” incision instead of their usual 6” incision. This might be minimal to the surgeon, but will not be minimal to you.

While they might often look easy to perform, these are very sophisticated procedures and most surgeons have difficulty learning how to perform these office-based procedures. Doctors trained in traditional hospital techniques often do not to want to be retrained as it takes significant time and effort. This is a long conversion process and not easy. Presently, only the doctors competent by education and experience are performing these procedures.

The biggest problems with traditional surgery is the disruption of your lifestyle, the long recovery period, post-op pain and debility, and the increased risk of complications. Lengthy incisions limit the traditional surgeon’s ability to perform multiple procedures during a surgical session. Experience has also shown there is no longer any need to subject patients to general anesthesia, long scars, internal pins, wires, screws, sutures, casts or unnecessary hospitalization. Pre-operative medical clearance, chest x-rays, EKG’s, and blood tests are not necessary. Not being able to put weight on your foot or drive is also a tremendous inconvenience.

For years, these procedures have been written up in numerous magazine articles and texts discussing the state-of-the-art techniques. Patients are often not informed by other doctors about these procedures due to what is what is often known as “competitive protection measures”. Other doctors are simply not going to refer a patient to their competitor, while patients will refer their friends and relatives to a doctor that might help them. While doctors are “ethically” required to inform patients of all the surgical options available, many are afraid they’ll lose their patient to another doctor and are not willing to admit that they lack the training, expertise or knowledge to perform percutaneous surgery. Even though these are decade old procedures, doctors will often state that these techniques are either “not yet proven/experimental” or “they just do not work/have disastrous results.”

Always ask your doctor whether they actually perform percutaneous “puncture” surgery. If he/she says he does minimal incision surgery/percutaneous surgery, simply ask if they make incisions with stitches. If so, their surgery falls into the category of minimal conventional open surgery since these surgeries still usually require 2-3 inch long incisions with stitches and some type of internal hardware. Percutaneous techniques are performed through tiny holes just the size of an “o” and stitches and surgical “hardware” are never employed.

Yes, many patients from around the country seek out percutaneous procedures, and this is a frequent concern. It is recommended you have a phone consult first and then possibly e-mail or text over photos of your feet along with any available x-rays. A tentative surgical date, assuming your health is optimized and insurance approved can then be scheduled.

You should prepare to have someone drive you home the day of surgery. You should take all your usual medications and have a normal breakfast or lunch the day of surgery. There is no need to remove your nail polish so have a fresh pedicure prior to your surgical date. If you live more than 3 hours away, it is recommended a stay in a local hotel for at least 3 days after surgery.