Keyhole vs Traditional Bunion Surgery: What’s the Difference?

For many people, the biggest barrier to bunion surgery isn’t the bunion itself. It’s the stories they’ve heard.

Long hospital stays, casts, wheelchairs, severe pain and bunions “just coming back anyway” still shape how people think about treatment. But those stories may reflect an older procedure or a different approach from the one being offered today.

Dr Meghan Dares, foot and ankle orthopaedic surgeon at Joint Vision in Wollongong, explains what keyhole bunion surgery involves and what patients should understand when comparing their options.

Watch Dr Meghan Dares discuss bunion surgery

How has bunion surgery changed?

Bunion surgery aims to correct the alignment of the bones, reduce pain and improve function.

Traditional open surgery uses a larger incision to access the bones and surrounding soft tissues. Recovery depends on the particular procedure, the correction required and the surgeon’s approach.

Some older techniques involved more extensive soft tissue dissection, prolonged periods off the foot and considerable swelling and stiffness. In some cases, treatment focused on removing the visible bump without adequately correcting the underlying alignment.

This helps explain why stories about difficult recoveries and bunions returning have persisted.

However, modern open surgery also includes procedures that realign the bones. The distinction is about more than the size of the incision: what matters is how the deformity is corrected and which approach suits the patient.

What is keyhole bunion surgery?

Minimally invasive, or keyhole, bunion surgery allows the surgeon to realign the bones through small incisions.

Specialised instruments called burrs are used to make controlled cuts in the bone, with less disruption to the surrounding soft tissues. The bones are moved into a corrected position and held with small screws while they heal.

The aims include:

• Straightening the big toe and narrowing the forefoot.
• Reducing pain and pressure in footwear.
• Improving foot function.
• Maintaining the correction over time.

The smaller incisions are one part of the procedure. Correcting the underlying alignment is central to its success.

Key differences at a glance

Incisions and soft tissues

Open surgery uses a larger incision, with soft tissue disruption varying according to the procedure. Keyhole surgery uses small incisions and specialised instruments to limit disruption to surrounding tissues.

Bone correction

Modern open techniques and keyhole techniques both realign the bones. Keyhole surgery achieves this through smaller incisions.

Walking after surgery

After open surgery, walking depends on the procedure; some require a period of restricted weight-bearing. After keyhole surgery, patients can often walk immediately in a protective postoperative shoe, following their surgeon’s instructions.

Pain and swelling

Pain and swelling vary with the procedure and individual recovery. Smaller incisions and less soft tissue disruption may reduce these after keyhole surgery, although both can still occur.

Recurrence

A bunion can return after either approach. Lasting correction depends on more than incision size.

Why does correcting the alignment matter?

A bunion involves a change in the alignment of the bones around the big toe joint. Removing the visible bump alone may leave the underlying deformity uncorrected.

When planning surgery, the surgeon considers the shape and alignment of the foot, the severity of the bunion and the forces acting on the joint.

Keyhole techniques allow the bones to be repositioned to narrow the forefoot and straighten the toe. The aim is to achieve a correction that remains stable as the foot heals and the patient returns to activity.

Recurrence can happen after either open or keyhole surgery. Published rates vary with the technique, how recurrence is defined and how long patients are followed. Your surgeon can explain the evidence relevant to the procedure being recommended.

What is recovery like?

Pain is an understandable concern for anyone considering foot surgery.

Some discomfort and swelling are expected after keyhole bunion surgery, but smaller incisions and less soft tissue disruption can make recovery more manageable.

In Dr Dares’ practice, many patients:

• Have their procedure as day surgery, including selected patients having both feet treated.
• Begin walking straight away in a protective postoperative shoe.
• Manage their initial pain with oral medication.

Walking in a protective shoe does not mean the foot has fully healed. Patients still need to follow instructions about rest, elevation, wound care and activity while the bones recover.

Returning to work, normal footwear, driving and exercise will depend on the procedure, progress with healing and individual circumstances.

Does surgeon experience matter?

Keyhole bunion surgery requires specific training and experience. Like other advanced surgical techniques, it has a learning curve.

It is reasonable to ask your surgeon how regularly they perform the procedure, how they monitor outcomes and what their patients typically experience during recovery.

Dr Dares has performed more than 300 minimally invasive bunion procedures, presents her outcomes at national and international medical conferences, and trains other surgeons internationally in the technique.

Which approach is right for you?

Not every bunion needs surgery. The decision depends on your pain, difficulties with footwear, effect on everyday activities and response to non-surgical treatment.

If surgery is being considered, useful questions include:

• Which procedure are you recommending, and why?
• How will it correct the alignment of my foot?
• What are the risks, including recurrence?
• When can I walk, work, drive and return to exercise?
• What support will I need during recovery?

The right discussion should leave you with a realistic understanding of the options and what each would mean for your daily life.

Find out what your options could look like

If bunion pain is affecting your footwear, walking or everyday activities, an assessment can help you understand the available treatments and whether surgery is appropriate.

Speak with your GP about a referral. To arrange an appointment with Dr Meghan Dares at Joint Vision in Wollongong, call (02) 4250 4500 or request an appointment with the Joint Vision patient services team.

For more detail, read What Is Keyhole Bunion Surgery? A Complete Guide for Wollongong Patients or explore our foot and ankle care.

About the author

Dr Meghan Dares is an Illawarra-based orthopaedic surgeon specialising in foot and ankle surgery at Joint Vision. She has performed more than 300 minimally invasive bunion procedures and regularly presents her outcomes at national and international medical conferences. She also trains other surgeons internationally in the procedure. Her practice focuses on evidence-based treatment to reduce pain, improve function and help patients return to everyday activities.