Minimally Invasive Surgery of the Forefoot

I was wondering about the efficiency of minimally invasive surgery of the forefoot. AAFAS presented it to my school this year and it seemed to be a very successful practice among many of the members. Is there any research/personal experience to advocate or discredit its employment?

aspiringDPM said:

I was wondering about the efficiency of minimally invasive surgery of the forefoot. AAFAS presented it to my school this year and it seemed to be a very successful practice among many of the members. Is there any research/personal experience to advocate or discredit its employment?

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I was also interested in this topic and did a little research not too long ago. Evidently the concept of minimally invasive surgery is not new to podiatry. The concept (from what I read) was introduced and performed by podiatrists before the days of extensive surgical training and faded quickly due to poor outcomes (deep space infections, non-unions, etc.) Today the issue is still somewhat taboo due to continued complications. However the idea is popular on the West coast and most of the published info on the success of forefoot/rearfoot MIS cames from Italy and Japan.

Mark Myerson (ortho) evidently had to stop a trial on percutaneous bunionetomies due to serious AE's, although the Italian surgeon who advocates for the procedure said Myerson's study was flawed (they didn't do enough bunions and didn't use proper fixation).

Long and short of my reading is that there is a steep learning curve to doing bunions with minimal incisions/fixation/arthroscopic equipment. Medial incisions for bunions and transverse/lateral incisions for hammertoe are more common, but most don't do minimally invasive bunions as described in the literature because it's just not how they were taught and/or they have acceptable outcomes with whichever method they currently use. Perhaps these procedures more popular in other areas because people are willing to pay for more cosmetic procedures and/or the docs are trained differently, probably a little of both.

If you're interested in reading more about things such as percutaneous/arthroscopic foot and ankle surgery look at the research by Tun Hing Lui and Sandro Giannini in pub med.

Good luck