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Dr. Victor S. Cernis, D.P.M.

(419) 381-1815

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Minimal Incision Surgery      |        CO2 Laser Surgery

Minimal Incision Surgery Boon To Bunion Sufferers

Victor S. Cernis, D.P.M.

A painful bunion can many times make a person feel ill all over. By definition, a bunion is an abnormal swelling occurring on the side of the foot at the great toe joint. When standing and looking at your foot, it will have the appearance of a golf ball stuck into the side of the big toe joint. This is very painful when wearing shoes and often limits motion in the big toe joint, thus causing pain.

In general, most authorities agree that bunions are primarily caused from a genetic or hereditary predisposition to this problem. More specifically, they state it is an autosomal, dominant trait with incomplete penetrance. Thus, if a member in your family has the problem, chances are you may have the problem also.

In the past, it was thought that shoes were the primary source of causing bunions and now it is well understood that they do not cause bunions but they do, in fact, aggravate the condition significantly, especially in structurally weak feet.

Females appear to have a greater occurrence for several reasons. They tend to wear stylish shoes that put lateral pressure on the great toe, thus weakening the structures that help hold the great toe in straight alignment. They also have a higher occurrence of pronation, or flatfeet.

Pronation, or the tendency of one's foot to roll inwards, thus causing the arch to flatten out, also puts greater strain on the big toe joint and allows the great toe to deviate more lateralward toward the little toes, thus accentuation the great toe joint and starting the occurrence that will eventually lead to an acquired bunion deformity.

Most often associated with the large growth over the big toe joint, which is referred to as the bunion, would be a condition in general called hallux abductovalgus. This simply means that the great toe of hailux is laterally positioned and not in alignment with the foot. This condition may be even more accentuated in appearance by another condition known as metatarsus primus varus which is the first long gone on the inside of the foot, called the first metatarsal, swinging inward and leaving a large gapping between itself and the other metatarsals.

Thus, a bunion deformity is not a simple bursa that needs to be drained for eradication of the problem. The gone deformities causing this syndrome need to be addressed to properly evaluate and treat this problem.

Throughout the late 1800's and early 1900's, various types of bracing and splints were used to try to correct this condition or at least aid in the relief of pain. In general, these devices do not work in an adult since one cannot straighten or bend abnormal curvatures in bone when the bone is at full maturity. Conservatively for this problem, custom-made shoes with special pocketed areas for the large growth help in reducing the pain that patients have. These are called molded shoes.

Ultimately, those who want this problem corrected most often need surgery. There have been over 100 documented, different types of surgeries for the bunion condition and, because no two people have the same type of bunion caused from the same mechanism forming the problem, it is important for the surgeon to choose well the procedure that most fits the patient's needs.

Conventionally, surgery has been performed in a hospital setting requiring the patient to under general anesthesia, having a six to eight inch incision on the top or side of the foot with much dissection of the tissues, pins to help hold the bones in their corrected positions and prolonged castings.

Many times, this was a very uncomfortable situation for the patient to experience and, often times, the results were not optimal.

Minimal incision surgery for eradication of bunions when performed for the proper set of criteria has been a great step toward eradicating this problem with minimal disability and much less pain. The tem "minimal incision" was coined because a small incision is used to perform the procedures. The incision is approximately 1/8 of an inch and is placed just in front of the large bunion and extended to the bone.

Any piece of bone that must be removed is first pulverized and then flushed through the small incision with a mixture of sterile solutions. Most of the time, stitches are not required. There is virtually no soft tissue dissection or interruption of the structures around the bones. Therefore, the patient has less pain, swelling and disability with this procedure.

Normal function may be resumed after surgery with some limitation on the amount of walking.

A surgical shoe is worn following surgery for three to four weeks after which time the patient is back into his or her own shoes. The simplification of these procedures through minimal incision technique enables surgery to be performed in the podiatrist's office under local anesthesia. This means there is a great savings to the patient as approximately 75 percent of the cost of traditional surgery is for hospitalization.

With this technique, the bunions may be removed, the large toes may be straightened, the foot may be narrowed (should a person have a protruding first metatarsal), and greater mobility may be acquired in the joint of the great toe through this technique.

Minimal incision surgery requires exceptional dexterity on the surgeon's part to perform an accurate procedure. The surgeon must be totally familiar with the intrinsic anatomy and mechanical difficulties that inherently contribute to this problem so they may be addressed as well as for correction at the time of surgery.


Victor S. Cernis, D.P.M.

The laser is one of the twentieth century's most triumphant technological developments. Its applications, since its conception in the early sixties, has revolutionized the way we live today and with its continued new applications, will help make our lives better in the twenty-first century. Laser has been applied successfully to industrial systems, communication systems and military systems to name a few. It has taken what was once only dreams and science fiction and successfully turned into reality. The field of medicine is one of the prime areas where dreams have been taking the form of reality for the last twenty years. The laser beam is projecting a revolutionary new light in many types of surgical procedures by replacing the knife and making it obsolete in such fields as opthomalogy, dermatology, neurosurgery, and gynecology just to name a few.

Uses in medicine: laser has been effective for controlling intestinal hemorrhages, retinal bleeding, birthmarks, tumors, internal and external lesions and a growing list of other bodily impairments previously requiring risky surgery, blood transfusions and hospitalization. There has always been the risk of infection and other side affects such as bleeding and pain. These problems are virtually nonexistent with laser surgery as the laser sterilizes and destroys any bacteria in its path and at the same time it coagulates and seals closed any open blood vessels resulting in bloodless surgery and little or no post-operative swelling. Laser has also allowed surgeons to approach areas that were once very difficult or impossible to reach; such as the inner ear and fallopian tube. In the past, skin surgery has been plagued by the inevitable relationship between cutting and scarring. But since laser has no blade, it can do its healing work and leave few traces behind.

How laser works: the laser beam is a concentrated and amplified beam of light which can be focused down to 1/50 the size of a human hair and has the capacity to vaporize, seal and even stimulate human tissue to heal itself. As opposed to removing diseased or damaged tissue by cutting with a knife or burning or chemical destruction, the beam of light is focused on the tissue and it is instantly vaporized. The light from the laser beam is readily absorbed by most solids and liquids especially water of which human tissue is 70%. The energy from the laser is absorbed by the water in the tissues turning it to steam and literally vaporizing it away. The remaining solid tissue is then simply wiped away.

Advantages in laser surgery: considering some of the advantages the patient also enjoys is the virtual elimination of common recurrences, which often plague the conventional forms of treatment. This is because vaporization is complete and that the precision and exactness of the technique cannot be accomplished with any other instrumentation available today. The laser beam can be controlled and guided to any depth even as little as the skin of a tomato without damaging the underlying pulp. This results in only the diseased tissue being eliminated with virtually no damage to surrounding healthy tissue which is always traumatized with conventional surgery. The attributes of laser treatment in most cases result in swift, virtually painless healing and immediate mobility, resulting in fewer postoperative visits, decreased medical costs to the patient and the insurance company and substantial reduction in time lost from work.

Podiatric applications: the most recent adaptation of the laser technique is in the treatment of various foot problems requiring the removal of diseased or damaged tissue. Some of the conditions now successfully being treated include:

Fungus Nails: previously required painful removal of nail by cutting or chemical destruction. Vaporizing the nail is simpler and quicker while the laser beam sterilizes and destroys the fungus.

Ingrown Nails: laser vaporizes the corners of the nail and the root that causes the condition.

Warts: a virus which grows internally on the hands and feet are vaporized swiftly and immediately as opposed to painful cutting burning or chemotherapy which can take months.

Callouses (porokeratosis): deep-rooted callouses with plugged up pores creating hardening, sensitive, painful area. Removed and cleaned up by laser.

These are only a few of the common conditions routinely treated on the foot. If you are interested in knowing how laser may benefit you and your particular condition, we invite your inquires for personal consultations and advice on laser treatment of your foot problems. Please call 381-1815 for an appointment with Dr. Victor Cernis.


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Dr. Victor S. Cernis * 1614 S. Byrne Rd., Toledo, OH 43614 * 381-1815

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