Bunion surgery

Is Bunion surgery normally performed in the doctors office under a local anesthesia. If so, what type or procedure might this be.

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Perhaps forty or so years ago, when many of even the best podiatric surgeons in many, if not most areas of the U.S. were prejudicially blocked from obtaining quality hospital privileges, some reasonably sophisticated podiatric surgeries were indeed performed quite effectively and under local anesthesia in offices which were appropriately equipped for such procedures. But in more recent years, that situation has markedly changed, and most hospitals have podiatrist on their staff who have full podiatric surgical privileges and who can perform surgery under any type of anesthesia. Having said this, in my view, properly and skillfully administer local anesthesia under a skilled surgeon who knows how to handle awake patients during surgery is generally preferable to other forms of anesthesia.

But, now-a-days, as hospital privileges are available to most qualified podiatric surgeons, more often than not, bunion surgeries performed in the office are of the so-called minimal incision type, wherein bone is blindly burred, and in my view, such techniques not only limit the type of procedures which may be performed but are many times the procedures of choice by those who lack the training needed to perform the more sophisticated procedures which often better target the specific problems present. Those who perform only or mainly these types of procedures will normally take offense to this opinion and attempt to improperly present and many times "sell" their blind procedures as being more cutting edge and requiring more skill and training than traditional open procedures. They will often imply that their procedures are on a par with the truly advanced minimally invasive procedures now performed by other specialties such as arthroscopic knee procedures and endoscopic hernia repairs and gall bladder removals. But these procedures differ in that in those procedures the tissues are visualized by close up tiny TV camera fed through the endoscopes or arthroscopes and not attacked blindly.

In my personal view, there is just about no justification for performing bone-burr bunionectomies, and I certainly would caution against undergoing such procedures by a doctor who cannot or does not also perform traditional open procedures. I would highly recommend that one seeks a podiatric surgeon Board Certified by the ABPS and is fully certified in what is known as its American Board Section and not simply its Ambulatory Section.

Finally, the benefits of having surgery performed in a hospital setting include:

1. The hospital credentials its surgeons and generally provides a better assessment of what a surgeon is and is not qualified and skilled to do than do State licensing agencies

2. Hospital facilities for the performance of surgery must be certified and meet established standards, while not all in-office facilities need meet such requirements.

3. A surgeon performing surgery in the hospital puts his skill and talent on display with peers and ancillary medical personnel, while surgery performed in the office has no such potential oversight.