Pain zero or, if impossible, minimal—that is now the goal
Durante generaciones, la cirugía de pie fue sinónimo de sufrimiento, un miedo transmitido de familia en familia con la fuerza de una advertencia colectiva. Hoy, gracias a técnicas mínimamente invasivas que operan a través de incisiones de medio centímetro, el noventa por ciento de los pacientes no experimenta dolor alguno en las primeras veinticuatro horas tras la intervención. Este cambio no es solo técnico: refleja una transformación filosófica en la medicina, que ha aprendido a respetar el tiempo, el cuerpo y la vida cotidiana del paciente.
- La cirugía de pie cargaba con una reputación de dolor casi mítico, construida durante décadas de técnicas agresivas y anestesias insuficientes que dejaban a los pacientes indefensos ante el sufrimiento postoperatorio.
- Esa memoria colectiva del dolor disuadía a muchos pacientes de operarse, permitiendo que condiciones como los juanetes avanzaran sin tratamiento por miedo a las consecuencias.
- La presión de la vida moderna —trabajos, familias, obligaciones que no se detienen— obligó a los cirujanos a reinventar sus métodos, reduciendo drásticamente el daño tisular sin sacrificar la eficacia.
- La cirugía percutánea y la artroscopia, con incisiones de apenas medio centímetro, permiten hoy corregir deformidades del pie en régimen ambulatorio, con el paciente en casa el mismo día de la operación.
- El resultado es una inversión radical del paradigma: donde antes el dolor postoperatorio se aceptaba como inevitable, ahora el objetivo declarado es cero dolor, y en nueve de cada diez casos se alcanza.
Durante décadas, la cirugía de pie acumuló una reputación tan temida que muchos pacientes preferían convivir con el dolor antes que someterse a ella. El Dr. Eduard Rabat, cirujano ortopédico especializado en pie y tobillo en el Hospital Quirón Barcelona, sitúa el origen de ese miedo en las técnicas del siglo XX: procedimientos agresivos que dañaban el tejido sin contemplaciones y anestesias que se disipaban rápidamente, dejando a los pacientes expuestos a un dolor que los analgésicos convencionales apenas podían mitigar. Esas experiencias se transmitieron de generación en generación hasta convertirse en un miedo cultural arraigado.
Pero la medicina ha cambiado de rumbo. La vida contemporánea no permite semanas de baja ni hospitalizaciones prolongadas, y esa realidad ha actuado paradójicamente como motor de innovación. Los cirujanos han desarrollado técnicas mínimamente invasivas que logran la misma corrección con una fracción del trauma tisular. El resultado más llamativo: el noventa por ciento de los pacientes de Rabat no siente dolor alguno en las primeras veinticuatro horas tras la operación.
Las dos técnicas principales son la artroscopia y la cirugía percutánea. Ambas trabajan a través de incisiones de apenas medio centímetro. Con ellas es posible acceder al hueso, eliminar deformidades, realizar osteotomías y colocar tornillos cuando es necesario —en aproximadamente el ochenta por ciento de los casos graves—. Rabat recurre a la cirugía percutánea en el noventa por ciento de sus intervenciones: el paciente llega por la mañana, es operado bajo sedación con el pie anestesiado localmente, y regresa a casa ese mismo día tras unas horas de recuperación ambulatoria.
La vuelta a la normalidad es gradual pero rápida. La primera semana exige reposo relativo, aunque el paciente puede caminar con un zapato quirúrgico especial. A partir de ahí, puede salir a la calle y, según su trabajo, reincorporarse a la actividad laboral. Al mes, ya usa calzado normal. El pie permanece insensible durante las primeras veinticuatro horas —el período crítico— y, gracias al enfoque mínimamente invasivo, el dolor no debería reaparecer después. Para la mayoría de las patologías del antepié —juanetes, dedos en martillo, metatarsalgia, fascitis plantar, neuromas de Morton— este es ya el camino estándar. Un cambio que, en el fondo, refleja algo más amplio: la cirugía aprendiendo a adaptarse a la vida, y no al revés.
For decades, foot surgery carried a reputation so grim that patients dreaded it almost as much as the condition it would fix. The pain was legendary—passed down through families like a warning, whispered in waiting rooms, lodged in the collective memory of anyone who had ever heard a relative's story about bunion surgery gone wrong. Dr. Eduard Rabat, an orthopedic surgeon who runs the Foot and Ankle Surgery Unit at Hospital Quirón Barcelona and dedicates 90 percent of his practice to this specialty, traces that reputation to its source: the brutal reality of twentieth-century surgical technique.
For most of the 1900s and well into the 1990s, foot surgery was genuinely as terrible as people said it was. The procedures themselves were aggressive, tearing through tissue with little regard for the body's healing capacity or the patient's comfort afterward. The anesthesia—typically general or epidural—wore off quickly, leaving patients in the grip of pain that conventional painkillers could barely touch. Once the numbness faded, there was nothing between them and the hurt. Those experiences accumulated, generation to generation, until the very idea of foot surgery became synonymous with suffering.
But something fundamental has shifted. Modern orthopedic surgeons, responding to the realities of contemporary life, have reimagined foot surgery from the ground up. Today's patients cannot afford weeks away from work or extended hospital stays. They have jobs, families, obligations that do not pause for recovery. This pressure, paradoxically, has driven innovation. Surgeons evolved their techniques not by abandoning effectiveness but by radically reducing the tissue damage that accompanies every surgical intervention. The result is what Rabat calls minimally invasive surgery—a constellation of methods designed to accomplish the same correction with a fraction of the trauma.
The numbers tell the story. Ninety percent of Rabat's patients report experiencing no pain whatsoever in the first twenty-four hours after surgery. Not mild pain. Not manageable pain. No pain. This is not because the surgery is less effective—it is as effective as or more effective than traditional approaches—but because the philosophy has inverted. Where surgeons once accepted postoperative pain as inevitable and treated it chemically, the goal now is zero pain, or as close to it as possible. A painless procedure, Rabat argues, is the foundation of genuine recovery.
The two main techniques are arthroscopy and percutaneous surgery. Arthroscopy uses a half-centimeter incision to access the interior of joints, particularly useful for ankle injuries, cartilage damage, chronic ligament problems, and tendon repairs. Percutaneous surgery, the workhorse for forefoot deformities like bunions, also works through tiny half-centimeter cuts. Through these openings, surgeons can access bone, shave away growths, perform osteotomies to reposition bone, and even insert screws—necessary in roughly eighty percent of cases, especially severe ones. Rabat uses percutaneous surgery in ninety percent of his cases because the patient benefits are overwhelming: minimal pain, no visible scars, and the ability to go home the same day.
A standard bunion procedure unfolds like this: the patient arrives at the surgical suite in the morning, checks in with the nursing team, and within hours is in the operating room. The anesthesiologist administers sedation first, so the patient feels nothing as the foot is put to sleep with two or three injections around the ankle. Then, under portable X-ray guidance, the surgeon works through those tiny incisions, correcting the bunion and any other forefoot deformities. The patient spends two to five hours in the outpatient recovery unit and then goes home.
What follows is a managed return to normalcy. The first week calls for relative rest, though most patients can walk with support using a specialized surgical shoe. After that week, they can venture outside and, if their job permits, return to work. Pain is controlled with simple medication—and crucially, the foot remains numb for the first twenty-four hours, the window when pain would traditionally strike hardest. After that, thanks to the minimally invasive approach, pain should not return. By one month, patients transition to regular comfortable shoes. By then, the reeducation process has begun, and life has largely resumed.
This is not to say all foot pathology can be treated this way. Some conditions still require traditional open surgery and, in those cases, careful anesthesia management ensures a painless recovery, though it may mean at least one night in the hospital. But for the majority of cases—bunions, hammer toes, metatarsalgia, plantar fasciitis, Morton's neuromas—the minimally invasive path is now the standard. The shift reflects a deeper change in surgical thinking: the recognition that a patient's life does not stop for recovery, and surgery must adapt accordingly.
Citas Notables
The most important change is in the mindset of professionals. Before, postoperative pain was considered normal and treated with drugs. Today, the goal is zero pain or, if that's not possible, minimal pain.— Dr. Eduard Rabat
La Conversación del Hearth Otra perspectiva de la historia
Why did foot surgery get such a terrible reputation in the first place? Was it just the pain, or something else?
It was the pain, but the pain was real and it was everywhere. The old techniques were genuinely brutal—large incisions, aggressive handling of tissue, and then anesthesia that wore off in hours, leaving patients in agony with no effective medication. That experience got passed down. Every generation heard the horror stories.
And now ninety percent of patients feel nothing in the first day. That's a remarkable swing. What changed?
Two things converged. The surgical techniques became much more refined—smaller incisions, better tools, more precision. But equally important was the philosophy shift. Surgeons stopped accepting pain as the price of surgery. They started asking: how do we fix the problem and minimize harm? That question drove everything.
Is the surgery itself less effective, or are you just causing less damage while doing the same thing?
The same thing, or better. The correction is as durable, the outcomes are as good or superior. We're not trading effectiveness for comfort. We're achieving both.
What about the patient who needs traditional open surgery? Are they left behind?
Not entirely. Good anesthesia management can still ensure a painless recovery, though they may need to stay overnight. But honestly, that's becoming the exception. Most foot problems can now be handled minimally invasively.
How quickly can someone actually get back to their life?
Within days for most people. A week in the surgical shoe, then back to regular shoes and work if the job isn't physically demanding. By a month, they're in the reeducation phase. It's designed around the reality that people cannot afford to disappear for weeks.