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Minimally Invasive Bunion Surgery Sussex | Keyhole Bunion Correction Specialist
Mr Adam Ajis BMedSc (Hons) MBChB MRCSEd FRCS (Tr & Orth) GMC Registration: 6048783 Consultant Trauma and Orthopaedic Surgeon, University Hospitals Sussex NHS Foundation Trust Member, British Orthopaedic Foot and Ankle Society (BOFAS) Fellowship trained: Institute for Foot and Ankle Reconstruction, Baltimore USA Honorary Clinical Lecturer, Brighton and Sussex Medical School Consulting at: Nuffield Health Brighton Hospital and Goring Hall Hospital, Worthing
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Why Patients Choose Sussex Foot & Ankle Clinic
Mr Adam Ajis BMedSc (Hons) MBChB MRCSEd FRCS (Tr & Orth) is a Consultant Trauma and Orthopaedic Surgeon at University Hospitals Sussex NHS Foundation Trust, with a private practice devoted exclusively to the foot and ankle at Nuffield Health Brighton Hospital and Goring Hall Hospital, Worthing.
His subspecialty training included a fellowship at the Institute for Foot and Ankle Reconstruction in Baltimore, USA, under Dr Mark Myerson. A second fellowship followed in the UK.
Minimally invasive bunion correction forms a significant and high-volume part of his practice. He has extensive experience in total ankle replacement, including the use of patient-specific planning and instrumentation (e.g. Prophecy/Infinity systems) total ankle replacement, and serves as an Honorary Clinical Lecturer at Brighton and Sussex Medical School, examining and training the next generation of orthopaedic surgeons. Minimally invasive (percutaneous) bunion correction has formed a core, high-volume part of his practice since 2013.
Patients travel to this practice from across Sussex and the South East, frequently having been unable to find a surgeon performing true percutaneous correction with comparable regularity closer to home.
His subspecialty training included a fellowship at the Institute for Foot and Ankle Reconstruction in Baltimore, USA, under Dr Mark Myerson. A second fellowship followed in the UK.
Minimally invasive bunion correction forms a significant and high-volume part of his practice. He has extensive experience in total ankle replacement, including the use of patient-specific planning and instrumentation (e.g. Prophecy/Infinity systems) total ankle replacement, and serves as an Honorary Clinical Lecturer at Brighton and Sussex Medical School, examining and training the next generation of orthopaedic surgeons. Minimally invasive (percutaneous) bunion correction has formed a core, high-volume part of his practice since 2013.
Patients travel to this practice from across Sussex and the South East, frequently having been unable to find a surgeon performing true percutaneous correction with comparable regularity closer to home.
Experience Is Not a Minor Detail in Minimally Invasive Surgery
Percutaneous bunion surgery is technically demanding and closely linked to surgical experience and procedural volume. The surgeon operates through portals of two to five millimetres, guided by fluoroscopic imaging rather than direct visualisation. There is no margin for imprecision.
This technique has formed a core part of Mr Ajis’s practice for over a decade, reflecting sustained experience rather than recent adoption.
A useful question to ask any surgeon you consult: what proportion of their practice is foot and ankle, and how many percutaneous bunion procedures do they perform each year? The answers are more informative than any website.
This technique has formed a core part of Mr Ajis’s practice for over a decade, reflecting sustained experience rather than recent adoption.
A useful question to ask any surgeon you consult: what proportion of their practice is foot and ankle, and how many percutaneous bunion procedures do they perform each year? The answers are more informative than any website.
What Is a Bunion? Understanding Hallux Valgus
A bunion, known clinically as hallux valgus, is a progressive structural deformity of the forefoot. It is not simply a cosmetic prominence on the side of the foot. The condition involves a gradual malalignment of the first metatarsal bone, which shifts outward while the big toe angles inward toward the smaller toes.
Left untreated, the deformity typically worsens over time. Common consequences include persistent pain and inflammation at the base of the big toe, difficulty finding comfortable footwear as the forefoot widens, and altered load distribution across the ball of the foot. This shift in loading frequently leads to secondary conditions including transfer metatarsalgia transfer metatarsalgia and lesser toe deformities such as hammer toe hammer toe, claw toe [claw toe — https://foot-ankle-surgeon.co.uk/claw-toe/], and mallet toe mallet toe.
Where a bony prominence also develops on the outer side of the foot, this is known as a bunionette deformity bunionette deformity, a separate but related condition that can be addressed at the same time in appropriate cases.
Treating hallux valgus effectively means addressing the underlying structural cause, not simply the visible prominence. That principle shapes the entire surgical approach used at this practice.
Left untreated, the deformity typically worsens over time. Common consequences include persistent pain and inflammation at the base of the big toe, difficulty finding comfortable footwear as the forefoot widens, and altered load distribution across the ball of the foot. This shift in loading frequently leads to secondary conditions including transfer metatarsalgia transfer metatarsalgia and lesser toe deformities such as hammer toe hammer toe, claw toe [claw toe — https://foot-ankle-surgeon.co.uk/claw-toe/], and mallet toe mallet toe.
Where a bony prominence also develops on the outer side of the foot, this is known as a bunionette deformity bunionette deformity, a separate but related condition that can be addressed at the same time in appropriate cases.
Treating hallux valgus effectively means addressing the underlying structural cause, not simply the visible prominence. That principle shapes the entire surgical approach used at this practice.
True Minimally Invasive Bunion Surgery: What That Actually Means
The term “minimally invasive” is applied loosely in orthopaedic surgery. In bunion correction, it is frequently used to describe open surgery performed through a slightly shorter incision. That is not what is offered here. At Sussex Foot & Ankle, minimally invasive refers specifically to true percutaneous correction performed entirely through keyhole portals. This approach has been used consistently since 2013, reinforcing that it is a sustained rather than a recently adopted technique.
True percutaneous bunion surgery involves operating entirely through keyhole portals of two to five millimetres. The distinction matters clinically. The degree of soft tissue disruption, post-operative pain, swelling, and the overall recovery trajectory differ substantially between a genuine percutaneous approach and a modified open technique.
True percutaneous bunion surgery involves operating entirely through keyhole portals of two to five millimetres. The distinction matters clinically. The degree of soft tissue disruption, post-operative pain, swelling, and the overall recovery trajectory differ substantially between a genuine percutaneous approach and a modified open technique.
Keyhole Portals and Specialist Instrumentation
The procedure is performed through two to three small portals. Purpose-built percutaneous instruments, which are not part of a standard orthopaedic theatre kit, are introduced through these portals to perform the entire correction.
Precision Bone Cuts Using Surgical Burrs
The osteotomies, the controlled cuts made in the metatarsal to allow repositioning, are performed using high-torque, low-speed surgical burrs rather than a conventional bone saw. This instrument cuts bone cleanly while preserving the surrounding blood supply, soft tissue, and neurovascular structures. Preserving these structures reduces the risk of complications and contributes directly to a smoother recovery.
Continuous Fluoroscopic Guidance
A mini C-arm fluoroscope provides real-time X-ray imaging throughout the procedure. Every stage of the correction is verified against live imaging. This is not an optional adjunct; it is what makes the technique both safe and accurate. The same principle of imaging-guided precision underpins the approach used in ankle arthroscopy ankle arthroscopy and other minimally invasive procedures performed at this practice.
Internal Fixation for Immediate Stability
Once the metatarsal is repositioned, it is held in place with low-profile medical-grade screws. This internal fixation provides immediate mechanical stability and is what allows patients to bear weight in a protective shoe on the day of surgery.
Conditions That Can Be Treated at the Same Time
One advantage of the percutaneous approach is the ability to address associated forefoot pathology through additional keyhole portals within the same operating session, avoiding the need for separate procedures.
Conditions commonly treated alongside bunion correction include:
Conditions commonly treated alongside bunion correction include:
- Transfer metatarsalgia transfer metatarsalgia, where excess load has shifted to the adjacent metatarsal heads
- Hammer toe hammer toe and claw toe claw toe deformities of the lesser toes
- Mallet toe mallet toe affecting the tip joints of the smaller toes
- Plantar plate injury plantar plate injury at the second metatarsophalangeal joint
- Second MTP joint instability 2nd MTP joint instability, which commonly coexists with hallux valgus deformity
- Crossover toe crossover toe, often a direct consequence of altered load distribution from the bunion
Where big toe arthritis is also present, this is assessed separately, as it influences both surgical technique and expected outcomes big toe arthritis surgery.
Is Keyhole Bunion Surgery Right for You?
Minimally invasive correction is not appropriate for every patient or every bunion. Deformity severity, joint condition, bone quality, and anatomical variation all influence which technique will produce the safest and most reliable result.
Assessment at this practice includes weight-bearing X-rays to measure deformity angles precisely, a detailed clinical examination of joint mobility and soft tissue integrity, and a candid discussion about your activity level, footwear expectations, and recovery timeline.
Where the percutaneous approach is not the right fit, this will be explained honestly, with a clear rationale and a recommendation for the most appropriate alternative technique.
A significant number of patients attend having been told elsewhere that minimally invasive surgery is either unavailable or not suitable for them. In a meaningful proportion of these cases, full assessment here confirms that the keyhole approach is entirely appropriate. In many cases, the determining factor is surgical experience with the technique rather than patient anatomy.
Assessment at this practice includes weight-bearing X-rays to measure deformity angles precisely, a detailed clinical examination of joint mobility and soft tissue integrity, and a candid discussion about your activity level, footwear expectations, and recovery timeline.
Where the percutaneous approach is not the right fit, this will be explained honestly, with a clear rationale and a recommendation for the most appropriate alternative technique.
A significant number of patients attend having been told elsewhere that minimally invasive surgery is either unavailable or not suitable for them. In a meaningful proportion of these cases, full assessment here confirms that the keyhole approach is entirely appropriate. In many cases, the determining factor is surgical experience with the technique rather than patient anatomy.
The Benefits of Minimally Invasive Bunion Surgery
When performed by a surgeon with genuine volume and experience in percutaneous techniques, the clinical advantages over traditional open surgery are consistent and well supported. When performed in a high-volume specialist setting, these advantages are consistent and reproducible.
- Reduced post-operative pain. Smaller incisions and limited soft tissue handling typically result in lower pain levels in the days following surgery compared with open methods.
- Minimal scarring. Each keyhole portal heals to a scar that is, in most cases, barely visible once fully resolved.
- Same-day weight bearing. Most patients leave hospital in a protective post-operative shoe and are walking independently on the day of surgery.
- Lower risk of wound complications. The reduced wound surface area is associated with a lower incidence of wound healing difficulties and superficial infection compared with open approaches.
- Concurrent treatment of associated conditions. Lesser toe deformities, plantar plate injuries plantar plate injury, and transfer metatarsalgia transfer metatarsalgia can frequently be corrected within the same procedure, avoiding the need for a second operation.
Your Recovery: An Honest Timeline
This is a bone realignment procedure. The incisions are small, but the biological process of bone healing takes the same time regardless of surgical technique. Recovery should be approached with patience and realism.
Weeks One and Two
Wound care and swelling management are the priorities. You will be in a protective post-operative shoe and advised to elevate your foot regularly when resting. Most patients manage discomfort with standard over-the-counter analgesics after the first few days.
Weeks Two to Six
Walking distance within the protective shoe increases gradually. Swelling begins to reduce, though some residual puffiness in the forefoot during this phase is entirely normal.
Weeks Six to Twelve
A clinical review with follow-up X-rays confirms healing progress. Most patients transition into supportive wide-fitting trainers at this stage, which marks the beginning of a return to everyday footwear.
Three to Six Months
Full recovery is typically achieved within this window. Return to sport, higher-impact activity, and a broader range of footwear is guided by clinical progress at each review, not a fixed date.
Persistent swelling in the foot for several months following bone surgery is a normal feature of healing, not a sign of complication. This is discussed in detail at your preoperative consultation so that recovery expectations are accurate from the outset.
FAQS
Frequently Asked Questions About Bunion Surgery in Sussex
How do I know if I need bunion surgery?
Surgery is considered when conservative measures, including wide footwear, padding, and orthotics, have not adequately controlled symptoms. The decision is based on pain, functional limitation, and structural severity. The right time to operate is a clinical judgement made with you, not for you.
Is minimally invasive bunion surgery painful?
Long-acting local anaesthetic and nerve blocks are used during surgery. The majority of patients find the post-operative period more manageable than they expected. Over-the-counter pain relief is typically sufficient after the first few days.
Will my bunion come back after surgery?
Recurrence is uncommon when the technique is appropriately selected and executed with precision. Both factors depend on surgical experience. Thorough preoperative planning and meticulous intraoperative technique are the most reliable protections against the deformity returning.
When can I drive after bunion surgery?
This depends on which foot is operated on, your vehicle type, and your clinical progress. Most patients return to driving between six and eight weeks post-surgery, once weight bearing in normal footwear is comfortable and emergency braking ability is unimpaired.
Can both feet be treated at the same time?
Bilateral surgery is possible but requires careful consideration. Operating on both feet simultaneously significantly reduces independent mobility during early recovery. This is discussed in detail at consultation and decided on an individual basis.
Are there other foot conditions that may be related to my bunion?
Hallux valgus commonly coexists with or causes secondary conditions in the forefoot. These include transfer metatarsalgia transfer metatarsalgia, second MTP joint instability 2nd MTP joint instability, plantar plate injury plantar plate injury, and lesser toe deformities including hammer toe hammer toe and crossover toe crossover toe. A full assessment will identify any associated pathology.
Do I need a GP referral?
No. You can self-refer directly to book a private consultation. Contact the practice here
What Patients Say
Book Your Bunion Surgery Consultation in Sussex
Your initial appointment is a clinical assessment. You will receive a clear explanation of your diagnosis, a review of your imaging, and an honest account of your surgical options, including the risks and realistic outcomes of each, before any decision is made.
Mr Adam Ajis, Consultant Foot and Ankle Surgeon. Specialist practice in Sussex.
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