Innovative Bunion Surgery: Tiny Incision, No Broken Bones
Manhattan-based podiatrist Andrew Glass didn’t set out to create a new way to do bunion surgery, but when a constellation of factors aligned, he grabbed the opportunities for innovation.
He now treats even severe bunions without breaking a single bone, something that is virtually unheard of in bunion surgery.
Dr. Glass was fully trained to perform standard bunion surgeries in podiatry school. Although post-surgery complications are rare, personal experience gave him a reason to be cautious of broken bones.
In his early 20s, Dr. Glass’s jaw needed to be broken during surgery, which required a screw. He subsequently got an infection, had the screw removed, and was left with a gaping wound that took six weeks to heal and months of antibiotics. Years later, he broke his leg and got another infection. It took him a year to fully recover.
The experience got him thinking: What if there was a better way to perform bunion surgery without the risk of breaking bones?
An Innovative Procedure
Dr. Glass’s procedure to treat bunions is very similar to other minimally invasive bunion surgeries, which are done by making a small, 5-millimeter incision. The procedures are performed with long, thin instruments inserted through this opening.
The surgeon knows where to work by looking at X-rays in real time.
Minimally invasive procedures have big advantages over open procedures, which require a 2- or 3-inch incision. These incisions can take two months longer to heal, cause significantly more pain and swelling, and leave the patient with a very visible scar.
If a patient has moderate to severe bunions, most minimally invasive procedures still include cutting through a bone in addition to shaving off the bunion bump and repositioning tendons and ligaments.
Dr. Glass has found that he can treat the majority of these bunions only by shaving and working with the ligaments and tendons. He sometimes makes up to three 5-millimeter incisions to access the right parts of the tendons and ligaments.
He now sometimes performs up to 16 bunion surgeries per week on many different types of bunions. In the past few years, he has rarely seen a bunion whose treatment required breaking a bone.
Discovering a Better Method
During the first few years of podiatry school and his residency, Dr. Glass learned how to perform open bunion surgeries. Later, he had the chance to witness some minimally invasive procedures and knew it was his calling.
“If you’re going to have a tiny incision, there’s not a big scar and your chance of infection is way less,” he said.
As luck would have it, he graduated just when the X-ray machines necessary to perform the surgery became commercially available.
Podiatrists had actually come up with the idea for minimally invasive bunion surgery in the 1950s, but back then it took 30 minutes to process an X-ray in a dark room, Dr. Glass said. That meant surgeons were pretty much working blind.
In the ’60s and ’70s, some botched surgeries gave the minimally invasive technique a bad rap, and podiatrists stopped doing it. Even today, minimally invasive bunion surgery is not offered in many hospitals.
In 2014, Dr. Glass had an elderly patient whose bone he really did not want to break, so he experimented with other, more conservative options.
“I started loosening a lot of things, and next thing I know, her toe straightened out. I was blown away because no one ever taught me that,” Dr. Glass said, recalling the surgery.
Eventually, the Academy of Ambulatory Foot and Ankle Surgery asked him to teach his procedure to other podiatrists. So far, he’s been too busy treating his many patients to find the time.
Recovery and Insurance
Recovery time for conventional surgery is around six months if there are no complications.
“If you break the bone, it takes the average person about three months to heal the broken bone. It takes at least six months before you are stable,” Dr. Glass said.
With minimally invasive procedures, patients can be back in their regular shoes after two to four weeks. Some of Dr. Glass’s patients have gone on to do activities like skiing only six weeks after surgery, without any trouble.
Any insurance plan that covers bunion surgery will cover Dr. Glass’s procedure. However, Dr. Glass said that some insurance companies don’t really understand what he’s doing and have called him to request that he break bone.
“They didn’t want to pay me to not break it. … That blew my mind,” he said.
Insurance companies also pay him less than what they would for operating on the same bunion if he broke a bone.
But Dr. Glass is optimistic that minimally invasive procedures are the way of the future. He cites the example of gallbladder surgery. Previously an open procedure, it is now done almost exclusively laparoscopically, with several small incisions in the abdomen.
“Now it’s just the norm. No one opens you up to do that anymore,” he said.
“I feel like in the future, bunion surgery will definitely go that way. Maybe not for every case, but for a lot of them.”
Dr. Andrew Glass, DPM
315 Madison Ave.
New York, NY 10017