Minimally Invasive Foot and Ankle Surgery: A Primer for Orthopaedic Surgeons

Abstract

There is rapidly growing interest in minimally invasive surgery (MIS) of the foot and ankle. Technological advances, specifically with the advent of low-speed high-torque burrs, have enabled the expansion of MIS techniques. Accordingly, there is growing literature reporting excellent outcomes of MIS surgery to address many different pathologies of the foot and ankle. MIS techniques are particularly useful for conducting percutaneous osteotomies and bony de ´bridement. These can be used to address bunion deformity, hammertoes, metatarsalgia, bunionette deformity, bone spurs, and hindfoot deformity. A detailed understanding of the technology, equipment, and techniques is crucial to safely conduct MIS of the foot and ankle. When done safely, MIS provides favorable outcomes with an expedited recovery and limited complications. Minimally invasive surgery (MIS) of the foot and ankle refers to percutaneous procedures that use small incisions for deformity correction, osteotomies, and débridement of the foot and ankle. These techniques have gained attention because of reported faster recovery time, early weight bearing, improved cosmesis, and reduced postoperative opioid use. [1][2][3] Although MIS can include many minimal incision techniques, including arthroscopic surgery, for the purposes of this review, we will discuss MIS techniques that use a specialized low-speed high-torque burr.MIS of the foot and ankle initially gained popularity in the United States in the 1980s for treatment of forefoot deformities. However, early procedures were largely abandoned because of poorly reproducible outcomes, soft-tissue complications, and high rates of recurrence and revision surgery. 4 The initial MIS efforts were technically demanding and required challenging postoperative protocols, which were difficult to follow. Subsequent MIS procedures added provisional fixation using Kirschner wires, but these also had issues with stability and osteotomy positioning. 5,6 For these reasons, early MIS efforts failed to take hold in North America. By contrast, MIS interest in Europe remained strong, and with this interest, came additional research into MIS techniques and the development of the first international MIS foot study group: Groupe de Recherche et Etude en Chirurgie Mini-Invasive du Pied in 2002. International surgeons developed new

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study

“…The realm of minimally invasive foot surgery (MIS) is already recognized for its multitude of advantages, including swifter recovery periods [4][5][6] and less scarring [10,17]. The introduction of this innovative technology into MIS procedures holds the promise of further enhancing clinical outcomes for patients undergoing such interventions.…”

“…The surgical approach involves performing osteotomies on the affected metatarsal bones [2,3]. Capital osteotomy, performed by minimally invasive surgery, represents a modern surgical procedure, widely employed to treat a variety of forefoot pathologies [2], offering significant advantages in terms of postoperative recovery [4][5][6] compared to traditional surgical approaches [7].…”

Minimally Invasive vs Open Approach for First Metatarsophalangeal Joint Arthrodesis: Short Report of Early Results

“…The development of a specialized low-speed, high-torque burr has allowed surgeons to convert many procedures to the MIS approach. 7 MIS requires much smaller incisions than open surgery, giving the putative benefit of faster recovery times. 1 Disadvantages of MIS approaches include the need for specialized equipment, adequacy of cartilage removal, potential for collateral damage, and a learning curve for surgeons.…”

Perspectives and trends for minimally invasive surgery for hallux valgus deformity in the Asia Pacific region

“…MIS hallux valgus correction is traditionally popular in Europe and is increasingly gaining acceptance in the United States. 12 It remains unclear whether MIS surgery is popular in the Asia Pacific region. The purpose of this study was to investigate the current trend of the practice of MIS hallux valgus surgery amongst Asia Pacific fellowship-trained foot and ankle surgeons.…”