Minimally Invasive Surgery (MIS)

Minimally Invasive Surgery in Foot and Ankle

Minimally invasive surgery (MIS) in foot and ankle has emerged as a paradigm shift from traditional open surgical approaches, emphasizing reduced tissue trauma while maintaining surgical efficacy. This philosophy encompasses various techniques including percutaneous procedures, arthroscopy, and small-incision surgery.

Key Principles and Techniques

MIS techniques utilize specialized instrumentation and imaging guidance to perform complex procedures through minimal skin incisions, typically ranging from 2-3mm for percutaneous approaches to small incisions under 3cm. Fluoroscopic guidance enables precise bone work and hardware placement without extensive soft tissue dissection.

Common Applications

• Forefoot Surgery: Percutaneous bunion correction, hammertoe repair, and metatarsal osteotomies can be performed through tiny stab incisions. These procedures often result in reduced postoperative pain and faster return to activities.
• Hindfoot and Ankle: Minimally invasive approaches for ankle arthrodesis, calcaneal osteotomy, and Achilles tendon repair minimize soft tissue complications while achieving comparable clinical outcomes to open procedures.
• Arthroscopy: Remains the gold standard for joint-preserving procedures in ankle, subtalar, and first MTP joints, addressing impingement, loose bodies, and cartilage lesions.

Advantages

Primary benefits include reduced surgical trauma, smaller scars, decreased postoperative pain, faster rehabilitation, lower infection rates, and improved patient satisfaction. The preservation of soft tissue envelope is particularly important in foot and ankle surgery where wound healing can be problematic.

Limitations and Considerations

MIS techniques require extensive training and specialized instrumentation. Limited tactile feedback and visual exposure can increase technical difficulty. Certain complex deformities or revision cases may not be suitable for minimally invasive approaches. Fluoroscopy usage increases radiation exposure, necessitating appropriate safety measures.

Future Directions

Advancing technology including computer navigation, robotics, and improved imaging systems continues to expand MIS applications. Three-dimensional imaging and augmented reality show promise for enhancing precision and safety in minimally invasive foot and ankle procedures.